Awesome Healthcare Solutions Limited

Awesome Healthcare Solutions Limited is a domiciliary care service which provides personal care to people living in their own homes. The service mainly provides support to older people, some of whom are living with dementia. At the time of our inspection, the service was providing personal care to 76 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do receive personal care, we also consider any wider social care provided.

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

Governance and audit systems were not effective at identifying and reducing risks to people's safety. There was a lack of effective leadership and oversight of the service.

The provider had not identified the shortfalls we found during the inspection process as part of their audits and checks. There were systems in place for managing complaints, safeguarding concerns, accidents and incidents. However, we found these were not robust and feedback from people and relatives on how the provider dealt with complaints and concerns was very poor.

People were not protected from abuse because the systems and processes in place were not robust to keep people safe. Staff we spoke with were aware of their responsibilities to keep people safe Care plans were personalised. However, risk assessments regarding people's health needs, such as epilepsy and diabetes where not sufficient to ensure staff knew how best to support the person. We could not be assured peoples medicines were safely managed.

Feedback from people and relatives was mixed. The main complaint raised by people and their family members was the lateness, shortness of calls and missed care calls. We found from call records and rotas short, late and missed calls had occurred. People felt the communication with the office staff and their responses were unsatisfactory.

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 requires improvement (published 05 March 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to missed and late calls, staff not staying the correct length of time, poor standards of care. As a result, we undertook a focused inspection to review the key questions of safe and well-led. 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 requires improvement to inadequate based on the findings of this inspection.

We have found evidence the provider needs to make improvements. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Awesome Healthcare Solutions 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 three breaches in relation to safe care and treatment, safeguarding service users from abuse or improper treatment and good governance.

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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Awesome Healthcare Solutions Limited is a domiciliary care agency. It provides personal care to people living in their own home. It provides a service to older adults and younger disabled adults. At the time of our inspection the service was providing personal care for approximately 51 people. Not everyone who used the service received personal care. 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 spoken with told us they felt safe and did not express any concerns about their safety. Relatives spoken with felt their family member was safe. The system in place to safeguard people from the risk of abuse required improvement. We saw examples where a person’s social worker had been informed about concerns, but these had not been shared appropriately with the local safeguarding authority. We also found concerns being dealt with via the services disciplinary procedures, but they had not been reported to the local safeguarding authority. The registered manager told us immediate action would be taken to ensure any safeguarding concerns would be reported to the local authority.

Most people and relatives spoken with were satisfied with the quality of care provided. People told us support staff were respectful and treated them in a caring and supportive way.

At our last inspection, some people using the service did not receive regular calls and some people experienced missed calls so they did not experience continuity of care. At this inspection people and relatives feedback showed the delivery of people’s calls had improved. However, we saw further improvement was required to ensure people did not experience missed calls particularly when they started using the service. For example, the service ensured calls started on the right date.

We saw action had been taken by provider to ensure accidents and incidents including missed calls were investigated and resolved. Systems were in place to make sure managers and staff learn from events such as incidents, concerns and investigations had improved.

The provider completed pre-employment checks for new staff, to check they were suitable to work at the service. Staff received a range of training and support relevant to their role. Staff told us they felt fully supported, listened to and valued.

At our last inspection we found the provider did not have adequate systems in place to ensure the safe handling, administration and recording of medicines to keep people safe. We saw action had been taken by the provider to improve the management of medicines at the service. However, we found further improvement was required. The registered manager was currently reviewing the arrangements in place with the local authority.

At our last inspection we found concerns about the assessment of people’s potential risks and guidance in place. At this inspection we found some improvement had been made. However, we found further improvement was required to ensure some people’s specific health risks were fully assessed. We shared this feedback with the registered manager and the provider. They assured us immediate action would be taken. Environmental risk assessments were completed which considered risks to both staff and people receiving care.

People’s care plans were person centred. People were supported with their dietary needs, where this was part of their plan of care. Where required people were supported to access healthcare professionals and guidance provided was followed. Care workers understood the importance of respecting people’s diverse needs and promoting independence.

At our last inspection we found the provider did not always work within the principles of the Mental Capacity Act (MCA). At this inspection we found some improvements had been made. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We have made a recommendation to the provider to ensure the systems in place fully support this practice.

At our last inspection we saw the provider’s complaints process required updating as it lacked important information. At this inspection we found action had been taken by the provider to review the policy. A copy of the new procedure, a complaint’s form and self-addressed envelope had been sent to people using the service. Some people and relatives told us they had raised concerns with the service. They had been listened to and action had been taken to resolve their concerns.

We found the quality assurance systems in place to monitor the quality and the safety of the service had been improved since the last inspection. Our findings during the inspection showed that some systems required further improvement. We have made a recommendation to the provider.

Rating at last inspection:

At our last inspection Awesome Healthcare Solutions Limited was rated requires improvement (supplementary report published 18 January 2019) and we found three breaches of the regulation. The provider was sent a warning notice about the governance of the service. The provider sent us an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had been made and the provider was no longer in breach for these regulations. However, we found a new breach for regulation 13 (Safeguarding service users from abuse and improper treatment).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Awesome Healthcare Solutions Limited is a domiciliary care agency which provides care and support for people in their own homes. Care is provided for a range of people including older people and people with dementia. Not everyone using Awesome Healthcare receives a 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 the inspection there were 55 people using the service.

The service had a registered manager. 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 provider had an appropriate recruitment policy but did not always adhere to it to ensure suitable staff were selected to support vulnerable people as we found inconsistencies with references during staff recruitment. Staff we spoke to were aware of safeguarding processes. Staff were able to tell us the different types of potential abuse people may experience and were aware of how to report concerns to outside agencies. Medication records contained omissions and lacked information. Risks to people's health, safety and well-being had not always been identified and the information to guide staff about how to support people in a way that minimised these risks was insufficiently detailed.

We received mixed responses regarding the measures in place to minimise the spread of any infection. Staff told us they had a plentiful supply of equipment such as, gloves and aprons. However, some people told us, “Some of these carers are messy and leave their disposable gloves around the house when they’ve finished with them,” and “My carers wear gloves, but I’ve never seen an apron being worn.”

Accidents or incidents that had occurred had been appropriately recorded but not sufficiently investigated or resolved. For example, the missed or late calls had been identified by the provider’s electronic monitoring system. These had then been recorded and reported to the local authority. However, the longstanding nature of the issue in people’s experience did not demonstrate that lessons had been learned.

The provider did not always work within the principles of the Mental Capacity Act (MCA). Capacity assessments and best interest decisions were not always in place where required. Care records lacked detail on the specific decisions people who were assessed as lacking capacity would require support to make. Staff told us they sought people's verbal consent before they provided care and support.

The training schedule and records we looked at showed staff were up to date with their training.

People often received support which was much earlier or later than their preferred time, or sometimes did not receive support at all. They told us the uncertainty made them feel anxious. Where required, people were prepared food in line with their preferences and dietary needs.

People told us that they were supported by caring staff. One person told us, " The staff are kind and they treat me with respect, for example they always listen and act on what I say. The staff respect my privacy and dignity for example they protect my modesty when they are delivering personal care. They cover me with a towel and close the door."

People did not always receive support at the time they wanted it. We received a significant amount of feedback from people about poor timekeeping of staff. Although people were asked what time they wanted support to be provided as part of their assessment, the person's preferred times were not always met. People told us the inconsistency could have a negative impact on them.

We looked at the provider’s complaints policy and found it did not direct complainants to any source of external remedy. The registered person told us policies were regularly reviewed and updated, but these reviews had failed to recognise that the complaints policy lacked this important information. People’s comments on complaints included, “We have tried to complain, but there’s been no success,” “In terms of our recent complaints, I would have hoped that things would have changed, but nothing’s changed. I am completely disillusioned with it all.”

Accidents and incidents were recorded, although any review and action was not sufficient to minimise the risk of them happening again. Environmental risk assessments were completed which considered risks to both staff and people receiving care. Where required people were supported to access healthcare professionals and guidance provided was followed.

Quality assurance processes were not always effective in ensuring that any shortfalls in the service were identified and acted upon.

We found three 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 the report.

Awesome Healthcare Solutions Limited provides assistance to people who require support with daily tasks and personal care in their own homes. The service was supporting approximately 45 people when the inspection took place.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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 found three 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 the report.

The provider had appropriate policies and procedures in place to ensure that people received their medicines safely but did not use them effectively. People's records were not always clear as to what support they received with their medicines and were not being robustly checked to ensure they received them safely.

Staff had the skills that they needed to provide people's care safely. Arrangements were in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support. Staff had been provided with sufficient training in key areas such as safeguarding, mental capacity and manual handing but did not always receive regular supervision.

The provider followed safe recruitment procedures and ensured that necessary risk assessments had been completed as part of the staff selection process. People could always be assured that their care visits would be attended by the appropriate number of staff needed to meet their care needs appropriately.

People were protected from harm arising from poor practice or abuse; there were clear safeguarding procedures in place for care staff to follow if they were concerned about people's safety. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

People were supported by staff to make choices with their daily care needs. Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA2005) and there were systems in place to assess people's capacity for decision making under the Mental Capacity Act 2005.

The provider did not meet the CQC registration requirements regarding the submission of notifications about specified events, for which they have a legal obligation to do so.

The provider did not have sufficient oversight of the service. Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the service had not always been identified, and there had been on-going shortfalls as a result, including missed care visits.

People and their relatives knew how to make a complaint and were comfortable approaching staff if they needed to, although some people found it difficult to contact the office.

Awesome Healthcare provides a domiciliary care service. It is registered to provide personal care to people living in their own homes. The service provided personal care to 52 people on the day of our inspection.

A registered manager was in post and was present during our inspection. 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 with the service provided to them and staff were aware of how to protect them from the risk of potential abuse. People were protected from the risk of harm because staff were aware of their responsibility of identifying possible risks and to avoid them happening. There were enough staff to ensure people's needs were met and to support them to take their prescribed medicines.

People were supported by staff who had been checked to make sure they were suitable to work in their homes. Employment and criminal records checks were carried out on all staff before they started work at the service. Staffing levels were kept under review and people saw the same staff regularly which helped to make sure they had consistency of care.

People were treated with respect and their privacy and dignity was promoted. People said their care workers were kind and caring. Staff were responsive to the needs of the people they supported and enabled them to maintain their independence as much as possible.

People were cared for by staff who were skilled and who received regular support and supervision. People's human rights were protected because staff applied the principles of the Mental Capacity Act in their care practices.

Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training.

People's care needs were assessed and measures were in place to manage risks. People were involved in the development of their care plans which provided staff with guidance on how to support people safely whilst promoting their independence. The provider had recognised care planning as an area they wished to develop greater detail.

There was a complaints procedure and people knew how to use it. People and their relatives were confident that any concerns raised would be responded listened to and addressed.

People benefitted from receiving a service that was managed well. Quality assurance systems were in place to monitor the quality of the care and support being delivered and the running of the service.