Austen Allen Healthcare Ltd T/A Austen Allen Homecare Also known as Austen Allen Homecare

Austen Allen Homecare, Dartford, is a domiciliary care agency registered to provide personal care for people who require support in their own home. The Dartford office is one of two locations the provider has registered with CQC.

CQC only inspects the service being received by people provided with ‘personal care’ and help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, the service was supporting 55 people, all of whom received some element of personal care. Austen Allen Homecare provide care services mainly to people living in the Dartford and surrounding areas.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe and Well-led, to at least Good. We found that the provider had undertaken actions in their action plan.

People’s experience of using this service:

• People told us they felt safe with staff. People when asked if they felt safe said, “Yes, I do feel safe”, “Yes I do, they are doing it right”, and “I do when regular carers come.”

• People had good relationships with staff, who were knowledgeable of their physical and emotional needs, as well as likes, dislikes and interests. Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

• People felt included in planning their care. Care plans were person centred, achieved good outcomes and showed people were offered choice and involved wherever possible.

• People’s rights and their dignity and privacy were respected. One relative said, “Staff respect their relative” and another relative said, “Staff are caring and compassionate.”

• Staff supported people to maintain a balanced diet and monitor their nutritional health.

• Medicines were stored and managed safely in people’s homes. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

• People received care from staff who were well supported with induction, training and ongoing supervision.

• People knew how to complain and that any concerns would be listened and responded to by the provider. Actions were taken as a response to complaints.

• Feedback from people and relatives was sought and used to make improvements.

• The provider had made changes to improve the service for people. An electronic care planning and monitoring system had been implemented to make sure that people’s needs were being met and people told us that they had been involved with this.

• Quality monitoring systems included audits, checks on staff practice and checks on people's satisfaction with the service they received, using questionnaires.

• The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

• Lessons were learnt and used to make improvements.

• The service was led by an experienced, competent manager who understood their role and responsibilities, as did staff. The service had a clear management structure and people had confidence in the manager and provider.

Rating at last inspection: This service was rated, ‘Requires Improvement’ at the last inspection on 19 February 2018. This was because processes were not fully in place in relation to robust medicine recording, recruitment process and auditing systems

At this inspection, we found that improvements had been made and the service met the characteristics of Good in all domains.

Why we inspected: This was a planned comprehensive inspection to follow up on the issues raised at the last inspection.

Follow up: We will continue to monitor the service through the information we receive.

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

Austen Allen Homecare Ltd is a domiciliary care agency registered to provide personal care for people who require support in their own home. The organisation is registered to provide care to people living with dementia, learning disability or autistic spectrum disorder, mental health needs, older people, physical disabilities and sensory impairment.

Not everyone using Austen Allen Homecare receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, they were supporting 73 people who received support with personal care tasks.

At the last Care Quality Commission (CQC) inspection on 19 and 20 December 2016, the service was rated Good in Caring and rated Requires Improvement in Safe, Effective, Responsive and Well Led with overall Requires Improvement rating.

We found a breach of Regulation 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider did not ensure that care was consistently delivered in a person centred way. The provider did not ensure that consent was sought in line with the Mental Capacity Act 2005. The provider did not ensure that people were kept safe from risks or avoidable harm and did not ensure that medicines were managed safely or in line with best practice. The provider had not ensured that quality monitoring systems were effective in highlighting shortfalls in the service and did not ensure that staff had sufficient time to deliver care. People had access to healthcare professionals but they were at risk of not having their health needs met as information was not consistently updated. For example one person was at risk of skin breakdown and had information for staff on how to support them, but this information had not been updated in over two years. We made a recommendation about this. Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. However, the training programme did not contain any provision for safeguarding children. We made a recommendation about this. Care plans were not always up to date. People's preferences and views about their care were not always recorded. We made a recommendation about this.

We asked the provider to take action to meet the regulations. We received an action plan on 15 March 2017 which stated that the provider will be meeting the regulations by 30 September 2017.

At this inspection, we found the service Requires Improvement. The provider delivered care in a consistent manner and Mental Capacity Act 2005 processes were followed. We found that training programme had been improved upon and staff had the right skills and knowledge to deliver care. Although medicine management had improved, we found that more work needed to be done to ensure medicine administration was safe. Further, staff recruitment needed to be more robust.

There was a registered manager at the service. The registered manager was responsible for overseeing the day to day running of this and another of the provider’s services. 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 and associated Regulations about how the service is run.

There had been improvements in the way that medicines were managed so that information about medicines management was included in people’s care plans. Although changes had been made to how staff recorded the medicines they gave people, there continued to be errors highlighted through the auditing process and at this inspection. Medicines had not always been recorded adequately and action required had not always been taken. We have made a recommendation about this.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. The provider had not ensured that all staff had two suitable references before working alone in the community. This was contrary to the service’s recruitment policy to make sure staff were safe to work with vulnerable adults.

The provider provided sufficient numbers of staff to meet people’s needs and provide a flexible service. However, we still saw and heard about some instances where staff were running late. We found that visits were not always scheduled to allow staff time to complete the required care and support, and also to travel from one person to the next. We have made a recommendation about this.

The provider had developed a planned programme of monitoring and audits to assess the effectiveness of the service and the outcomes for people. However, the audit and records had not been robust enough. We have made a recommendation about this.

Although communication in the service had been improved, people and care staff told us they were not satisfied with communication with office staff. We have made a recommendation about this.

The provider had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the service’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

The provider carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the service and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

All staff received induction training at start of their employment. Refresher training was provided at regular intervals.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Deprivation of Liberty Safeguards.

People were supported with meal planning, preparation, eating and drinking. Staff supported people, by contacting the office to alert the provider to any identified health needs so that their doctor or nurse could be informed.

People said that they knew they could contact the provider at any time, and they felt confident about raising any concerns or other issues. The provider carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the provider.

Spot checks were carried out and people could phone the office at any time.

The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

We found a breach 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 the report.

At the time of our inspection Austen Allen Homecare Ltd were providing care to 99 people who had a range of health needs from dementia, end of life care, renal failure, and catheter care amongst other conditions. The service employed 50 staff, one director, one registered manager, an assistant manager, a training manager, two co-ordinators, a care advisor, a branch administrator, a senior carer and care staff. The registered provider uses an electronic tracker where carers log in and out of care calls using a telephone line for all clients from one local authority and relies on staff to record the time of their care calls for other clients.

At the time of our inspection there was a registered manager at 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 were protected from the risk of abuse but were susceptible to the risk from avoidable harm. For example, risks were not assessed comprehensively and where hazards had been identified these had not been mitigated fully. During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

Medicines were not effectively being managed as the recording sheets used did not contain information about each medicines and prescribing instructions. In addition this information was not contained on any other part of the care plan.

Staff deployment was not sufficient to consistently meet people’s agreed care needs. Staff were not given time to travel between care calls and this meant that they were sometimes unacceptably late.

Consent had not consistently been sought and the principles of the Mental Capacity Act 2005 (MCA) had not consistently been complied with. The registered provider was not assessing people’s consent to care and treatment and their ability to consent to other treatment and support.

Care plans were not consistently person centred and did not always contain the detailed personal information required to support someone in a person centred way. Some people’s care had been commenced without a pre admission assessment meaning that carers were supporting people without a care plan in place.

Quality monitoring systems were not effective in identifying shortfalls in the service.

People had access to healthcare professionals but they were at risk of not having their health needs met as information was not consistently updated. For example one person was at risk of skin breakdown and had information for staff on how to support them, but this information had not been updated in over two years. We have made a recommendation about this in our report.

The staff were kind and caring and treated people with dignity and respect. Caring relationships were seen throughout the day of our inspection. Staff knew the people they cared for well. People spoke positively about the care and support they received from staff members.

People receive adequate food and drink and where necessary the registered provider used food and fluid charts to monitor how much people are consuming.

Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly. Staff were supervised and had annual appraisals. Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. However, the training programme did not contain any provision for safeguarding children. We have made a recommendation about this in our report.

Complaints were logged and responded to in line with the registered provider's policy.

Care plans were not always up to date. People’s preferences and views about their care were not always recorded. We have made a recommendation about this in our report.

The culture of the service was open and supportive. The management team provided leadership to the staff team and was an active presence in the service.

People we spoke to or their relatives told us that they were happy to have the consistent staff. A relative told us “They are good, the best ones my mother has had” and “They always keep to regular staff”. We were told that staff delivering support were kind, listened to people and were professional.

We found that new staff received regular induction training and all staff received mandatory training which included safeguarding and whistleblowing.

We found that the provider had taken steps to ask people who used the service or their relatives for their views on the care and support being provided and had acted upon them.

We found that the provider had an effective complaints system in place which gave people who used the service or their relatives access to raise any complaints or concerns if they wished to do so.

We were told that staff respected the privacy and dignity of people by knocking on doors and speaking appropriately to them. People told us that staff are "Polite".

People said they received care from regular staff they knew well and liked. One person said staff are "Marvellous". They told us that they tell the manager how the staff are getting on but have never received feedback questionnaires. Comments included "I haven't been asked about the service but I often tell the manager how staff are getting on" and "I can't say that I have ever been asked for feedback".

When we spoke with staff and examined associated records we found that improvements were needed around awareness of safeguarding and staff supervision. Staff told us that they would report any concerns to the manager in order for the appropriate action to be taken. However, the manager was not aware of her role in the Local Authority's reporting procedures. The Local Authority hold the lead role in investigating safeguarding concerns for registered care services.

Staff told us they felt "Supported" by their manager but had not received any formal supervision. We were told that the manager observes care in people's homes, but the records we viewed did not contain written documentation to support this activity.