Aspire Home Carers Limited

Aspire Home Carers Limited is a domiciliary care agency providing support to people in their own homes. At the time of our inspection there were 11 people using the service. Some people were living with dementia. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were not supported by staff who had been recruited safely. There were gaps in new staff's previous employment history which had not been explored and references had not been consistently obtained.

Risks had not been consistently assessed in line with best practice. For example, people and staff had not been individually assessed for the risks of COVID-19. Staff did not consistently record the actions taken when there had been concerns about a person’s health.

The registered manager did not have clear oversight of the day to day running of the service. There had been several changes in branch management in the previous 12 months. People told us the communication was not good. Checks and audits were not robust, and the registered manager had not reviewed the audits to check they were effective.

The service was actively recruiting for staff. Office staff covered care calls to make sure people received the support they needed. People told us that generally staff were on time and they stayed the length of time they should. People and relatives said they were contacted by the service if staff were running late.

People were supported by staff who understood how to keep them safe. Staff understood their responsibilities around the risks of discrimination, abuse and harm. People told us they felt safe having staff coming into their homes to support them. One person said, “I trust them with all my heart.” A relative said, “[Staff are helpful and caring. I feel safe knowing they are there for [my loved one]. They use a stick and a walking frame and staff support them when they are moving round the house.”

People received their medicines as prescribed. The service used an electronic system which alerted office staff if a medicine was not signed as administered. This enabled them to double check, and if necessary, take action quickly. People and relatives told us staff wore gloves, face masks and aprons when they visited.

A new branch manager had been recruited and had already identified shortfalls. They prioritised obtaining feedback from people, relatives and staff to begin to drive improvements. Staff felt the service had improved since the new branch manager had started working at the service and felt confident this would continue. Staff felt valued and believed their opinions and ideas were listened to.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 5 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about the day to day management of the service. As a result, we undertook a focused inspection to review Safe and Well-Led only.

We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aspire Home Carers Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to recruitment practice and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service has a registered manager in post who is also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered provider/manager also operates a residential care home from the same location.

We last inspected Aspire Homes carers Limited in January 2017 when two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We rated the service as requires improvements and issued requirement notices in respect of person centred care and good governance.

We asked the registered provider/manager to send us an action plan of the improvements they intended to make to become compliant with the legal requirements in regard to the breaches. This inspection was to assess the actions they had taken and confirm they had now addressed the breaches. No breaches of regulation were found at this inspection although we identified an area for further improvement.

At our previous inspection there had been concerns that some staff were carrying out personal care activities related to health monitoring that the person had not been assessed for, this need was not reflected in the persons care plan and staff had not been trained by the organisation to undertake this. At this inspection there was greater understanding by staff of the tasks they were able to undertake and provide support with. People told us that staff understood their needs and provided the level of support they needed and wanted. Both people and relatives spoke positively about the attitudes and ethos of the staff and the quality of the personalised support provided. Whilst some care plans would benefit from an improved level of detail.. Any impact was currently mitigated by the size of the client base and current staff team, and their ability to provide continuity of staff support to people; this could change so is an area of further improvement.

We were previously concerned that quality assurance processes had not picked up that staff were providing support outside of their remit. Since then the deputy manager has visited every person supported, and had undertaken personal care calls to all of them and understood the tasks staff need to provide. Care plans and risk information have been updated to ensure these reflect the current levels of support needed and risk reduction measures in place; these are reviewed every few months or earlier if changes occur. The deputy manager undertakes competency assessment of staff during visits to people’s homes and undertakes spot checks and observations. An electronic recording system enables care plans, medicine administration record sheets and daily logs to be viewed through a secure application online by people and their relatives; they can also comment on what the records contain. All records are in real time and the deputy manager can review each person’s record to ensure medicines have been taken by the person through prompting and supervision of staff or whether any changes have occurred.

People and relatives were universally complimentary of the service and staff. The registered provider/manager and staff share the same values of offering high quality personalised care and in order to select the right staff for the team, had adopted a values based recruitment process that scores staff on whether they also display the attributes of for example kindness, compassion, empathy, innovation, respect. A comprehensive process of interviews and checks were in place to ensure applicants are suitable for the role before commencing employment. New staff were inducted and offered training to provide them with the necessary skills and knowledge; they said that they were always introduced to people before they provide them with support. People could request a change of staff working with them if they wished. Staff said they felt supported and valued and the registered provider/ manager provided incentives to help retain staff once recruited. Staff felt able to challenge and offer solutions to problems when they arose. People, their relatives and staff thought that communication was good and staff were able to discuss issues that arose with the deputy manager through supervision or staff meetings. Staff showed innovation in finding solutions to help for example improved communication strategies for people who needed it. People gave us examples of staff providing ‘little extras’ that added to the personalisation and quality of support they received. For example staff visiting people they had supported who had moved into a care home or were in hospital in their own time, staff changing light bulbs and bringing in a pint of milk when needed.

Staff supported people to retain their independence and do as much for themselves as they could. Staff demonstrated an understanding of how to protect people from harm or abuse and who to tell if they had concerns. Accidents and incidents were rare but any that occurred were analysed by the deputy manager to ensure all appropriate measures were in place to avoid recurrence.

Staff supported people to health appointments if asked to; they worked in partnership with health professionals when needed to provide joined up practical support for rehabilitation exercises or helping community nurses with turning people who needed their skin monitored or treated by the nurse.

People and their relatives understood how to complain if they were not happy with the service, they found all the staff easy to talk with and approachable, two people’s relatives had expressed concerns at least once since their relative had begun using the service; they thought their concerns had been dealt with quickly and to their satisfaction. People had confidence in being listened to and that action would be taken. They were asked for their views about the service during quality visits by the deputy manager and also surveyed. Analysis of survey responses informed service quality and development. The registered provider/manager used independent consultants at various times to review the service and implement recommendations from these for service improvements. Regular audit checks of medicine records, care plans, daily logs, quality visits and reviews of peoples care needs, competency assessment of staff, and arrangements for their supervision and appraisal all helped inform the registered provider/manager that service quality was being maintained.

Aspire Home Carers Limited provide care and support to people in their own homes. The service is provided to mainly older people. At the time of the inspection there were approximately six people using the service, of which five people received support with their personal care. The service undertakes visits to provide care and support to people in Lympne, Folkestone, Dover and immediate surrounding area. It also offers staff to provide a sitting in service for people who do not need support with their personal care.

The service is run by a registered manager who was registered with the Commission in January 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager of this service is also the registered provider of the service. In addition, they operate a residential care home, of which, they are also the registered manager and provider.

Risks associated with people’s care had been identified and there was sufficient guidance in place for staff. However, care plans were not in place for all aspects of people’s care and support needs.

There were audits and systems in place to monitor the quality of the service people received. These had not always been effective in identifying and addressing shortfalls.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. Care plans contained a good level of detail and ensured people received care and support consistently and according to their wishes.

People told us their independence was encouraged wherever possible, this was supported by the care plan.

People told us they received their medicines when they should and felt their medicines were handled safely.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place. Staff demonstrated clear understanding of what abuse was and how to report any concerns to keep people safe.

People had their needs met by sufficient numbers of staff. Visits were allocated permanently to named staff and were only changed when staff were on leave. People received a consistent service at the right time, for the full planned visit from a team of regular staff.

New staff underwent an induction programme, which included relevant training and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role.

People told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection although some people had made Lasting Power of Attorney arrangements. Some people chose to be supported by family members when making decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People felt staff were very caring; they told us they were relaxed in their company, staff listened to what people wanted and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs well.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.

People told us communication with the office was good and if there were any queries they telephoned and action was taken. People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided. People felt the service was well-led and well organised. There was an open and positive atmosphere in the office and staff were committed to improving the service people received.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.