AQS Homecare - Hampshire East

• AQS Homecare-Hampshire East is a domiciliary care agency that was providing personal care to 112 people at the time of the inspection.

People’s experience of using this service:

• People told us the service had improved since the last inspection. A person’s relative said, “Everything is personalised for my Mum, we have been with AQS for 2 years now and things have definitely improved in the last 6 months to a year.” Another relative said, “I have been with the service for 3 years and things are `turning around’ especially during the last year-we used to get calls saying that no one could come as they had no available staff-but that seems to be getting sorted now.”

• People told us they received a safe and effective service. People’s needs were met by kind and caring staff and care plans described the care people required to meet their needs.

• The provider had acted to make improvements to the service and to meet their regulatory requirements. An effective system was in place to monitor and assess the service, including feedback from people and staff, and this had been used to drive continuous improvement and deliver a good quality of care.

Rating at last inspection:

• At the last inspection the service was rated Requires Improvement (18 July 2018). Following the last inspection, we met with the provider to confirm they had completed their action plan to improve all the key questions to at least good. At this inspection the overall rating has improved to Good.

Why we inspected:

• This was a planned inspection based on the previous rating.

Follow up: we will continue to monitor and inspect this service based on the information we receive.

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

At the time of our inspection a registered manager was not in post. The previous registered manager had left the service on 7 March 2018. The service was being managed by one of the provider’s locality managers who was planning to register with the Commission. 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. We have therefore referred to the locality manager as ‘the manager’ in this report.

At our last inspection of the 7 and 8 March 2017 we found a breach of Regulation 18 (Registration) Regulations 2009 Notification of other incidents. This was because the provider had failed to notify the Commission without delay of any abuse or allegations of abuse in relation to people who use the service. At this inspection we found the provider had failed to make the required improvements and this Regulation had not been met.

This inspection was the third inspection since the service had been registered. The previous two inspections identified failures to meet the fundamental standards of care and both inspections awarded a rating of overall requires improvement with each key question rated as requires improvement. At this inspection we have continued to find that this service is not meeting fundamental standards and has been unable to improve their rating in any key question or overall. This demonstrates a lack of understanding of the principles of good quality assurance, a lack of effective quality assurance, a lack of learning, reflective practice and a lack of drivers for service improvement.

Whilst a system of audits was in place to monitor and assess the quality and safety of the service, these were not effective in identifying and addressing all of the concerns we found.

People told us they felt they were safely cared for by the provider’s staff. However, risks associated with people’s needs had not always been assessed and when they had risk management plans did not always provide sufficient guidance for staff to ensure they minimised these risks. People told us they were supported appropriately with food and drinks were applicable. Risks to people from eating and drinking required more detail to ensure safe guidance was available for all staff to follow.

Incidents were recorded, acted on and monitored to address safety issues and prevent a reoccurrence. Staff were aware of their responsibilities to report concerns and protect people from abuse. Action was taken when safeguarding concerns were identified but people’s care records were not always updated following these to reduce risks for people.

People’s records did not always evidence a mental capacity assessment had been completed to determine if the person had the capacity to agree to their care and treatment. We found inconsistent and incomplete information in people’s care plans about their capacity to consent. Not all staff were aware of the principles of the Mental Capacity Act (2005) and how these should be applied to support people to have maximum choice and control of their lives.

At the time of our inspection there were enough staff to meet people’s needs. However, people told us they did not always receive their care in an informed, consistent or timely manner that met their preferences. The manager told us local authority commissioning arrangements meant care calls were needs led and this meant people could not always have their preferences for call times met.

People and their relatives told us the care they received met their or their relative’s needs. Some care plans we reviewed contained clear information about people’s needs and how these should be met by staff. Some people’s care plans did not fully reflect their choices, preferences, personal history and important information to ensure staff would know how to provide person-centred care when they did not know the person well.

People and their relatives told us they were supported by kind and caring staff who respected their privacy and dignity. Some people said they did not always experience a caring response from office staff and told us they did not always feel listened to. People were not always able to make decisions about the preferred time for their care due to commissioning arrangements. People were not always given information about when to expect their care call and who would be delivering their care. This meant people did not always feel involved, valued and respected by all staff.

The management of people’s medicines required improvement. Medicine administration records (MARs) were not always completed to show people had received their medicines as prescribed. Care plans did not always include accurate and up to date information about people’s medicines. The provider was taking action to improve this for people, however, the provider required more time to embedded improvements into practice to ensure people’s medicines were safely managed.

People told us they were aware of how to raise any concerns or complaints with the provider. We saw records which showed complaints received had been responded to. However, people did not feel their concerns were always sufficiently heard or responded to. Whilst records showed actions had been taken in response to complaints received, the system in place did not evidence trends were monitored to identify learning which would drive improvements in the service people received. We have made a recommendation about improving the management and learning from concerns and complaints.

Not all staff had completed training in line with the provider’s requirements. This meant people could be supported by staff without the knowledge or skills to provide effective care. Following the inspection the provider confirmed all staff had been booked to attend any outstanding training.

People’s needs were assessed when their package of care commenced and this included their needs in relation to the protected characteristics under the Equalities Act 2010. The provider had policies and procedures in place to guide staff in providing a service which took account of people’s diverse needs and respected their beliefs and lifestyle choices. Staff acted promptly to support people with their healthcare needs. The provider had an ‘end of life care’ policy to support staff in providing appropriate care and treatment when supporting people approaching the end of their life.

A new manager was in post and staff spoke positively about their leadership. Staff were confident any concerns raised would be acted on by managers and told us the culture of the organisation was open and transparent. Staff were supported to understand their roles and responsibilities through supervision, spot checks and team meetings.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the (Registration) Regulations 2009, we have made one recommendation. You can see what action we told the provider to take at the back of this report.

AQS Homecare Hampshire East provides personal care to people who live in their own homes. They provide services to older people, people living with dementia and younger adults. At the time of our inspection there were 101 people receiving personal care from the service. There were 43 care staff, two senior care staff, one recruitment officer, one referrals co-ordinator, three co-ordinators who planned people’s care, which included one senior care co-ordinator, a training officer and an operations manager.

There was a registered manager in place. 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.

Although people said they felt safe and were contracted to receive a non time specific service; people were not aware of this arrangement and said they experienced late or rushed visits as a result of insufficient staffing levels. We have made a recommendation for the provider to ensure people understand their contractual obligations. Although people did not always receive their visit on time we did not receive any concerns that this impacted on them receiving their medicines; therefore safe medicines practices were followed.

Safe recruitment processes were followed. Staff demonstrated a good understanding of safeguarding processes and were able to identify potential signs and symptoms of possible abuse and they knew how to report these concerns.

Risk assessments were in place but did not always contain sufficient information on the risks associated with people’s care or how to minimise risks to people. However staff demonstrated a good understanding of the risks related to people living in their own homes.

Staff training and supervision had improved although some staff still had not received updated training in required subjects. However there were action plans in place to ensure staff received this training. Staff had not received an appraisal until the week of the inspection. Staff felt management were open and supportive and felt confident to question practice.

Some people did not always receive support with their meals due to late visits; however risks to people’s nutrition had been identified, assessed and included in their care plan.

Staff demonstrated a good understanding on how to respect people’s privacy and dignity when providing care to them, however in times of insufficient staffing levels people’s privacy and dignity may not be respected as family were requested to provide care.

Care plans were completed and reviewed but did not always contain information that had been identified in people’s initial assessments and risk assessments. Some care plans were task focused and did not include information on how staff were required to support people with certain tasks and what people could do for themselves. Although care plans lacked detail and were not always accurate staff provided people with the care they required.

Audits were in place to monitor the overall quality and safety of the service and systems were in place to learn from incidents, accidents, complaints and concerns. Although people continued to raise concerns about insufficient staffing levels; there had been an improvement with the number of late visits since the last inspection and missed visits had not occurred.

Notifications had not been received by the Commission for four of the five safeguarding concerns raised since the last inspection.

Responses were mixed with regards to communication. People felt this could improve because they did not feel listened to with regards to late visits. Staff, however; found communication had improved.

People felt staff were kind and caring but sometimes felt rushed due to insufficient staffing levels.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and the importance of choice, decision making and consent.

People were supported to access Health care services.

Complaints had been received into the service and dealt with appropriately.

The provider had displayed their rating conspicuously.

We identified one breach of the Care Quality Commission (Registration) Regulations 2009 and made one recommendation. You can see what action we told the provider to take at the back of the full version of this report.

AQS Homecare Hampshire East provides personal care to people who live in their own homes. They provide services to older people, people living with dementia and younger adults. At the time of our inspection there were 165 people receiving personal care from the service. There were 53 care staff, three senior care staff, one recruitment officer, one referrals co-ordinator, one co-ordinator who planned people’s care, a quality and compliance manager and an area manager.

There was a registered manager in place; however they were not present at the time of the inspection. The area manager was applying to the Commission to become the registered manager for the service. 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.

People felt safe but there were insufficient numbers of staff to provide a consistent service. Risk assessments were completed and up to date but did not always contain enough detail about how the person could be kept safe.

People and their relatives felt they received care from staff who had the skills and knowledge to carry out their roles effectively. However staff did not always agree. Staff may not have received the appropriate training. Supervisions and Appraisal were not always provided in line with the provider’s policy.

Staff showed a limited understanding of the Mental Capacity Act 2005; however staff knew what to do if they felt people were making unsafe choices. We have made a recommendation for the provider to review the Mental Capacity Act 2005 and its subsequent codes of practice.

People’s privacy and dignity was not always respected and promoted.

People and their relatives confirmed care planning and needs assessments had not always been a positive experience for them. However people and their relatives felt that there had been an improvement with care plans and assessments since the area manager joined the service in November 2015. New care plans had been introduced but they were not always personalised.

Positive changes had been made by the area manager but there were still concerns about staff shortages, due to high unplanned absence and poor communication. Measures had been implemented to improve communication between office staff, care staff and people.

Some quality assurance systems were in place to monitor the quality of service being delivered and the running of the service, such as quality assurance surveys, complaints and safeguarding logs. Audits of care records and staff records were being completed. Audits were not in place to monitor accidents, incidents or complaints and concerns.

There were clear procedures for supporting people safely with their medicines. Safe recruitment practices were followed. Staff received an induction programme in line with the current recognised standards. People were protected against the risks of potential abuse. Notifications had been sent to the Commission.

People were supported to maintain good health and have access to health care services.

People and their relatives said that the care staff were kind and caring. Office staff spoke with people in a kind and caring manner when using the telephone. Compliment cards and letters had been received into the service thanking the service for their help and support.

People were involved in their care and stated they made decisions about their care. People had signed their care plans to indicate they consented to their care.

Complaints had been received into the service and dealt with in line with the provider’s policy.

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