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At Home Support Services Limited Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 15 December 2018

This inspection took place on 2 October 2018 and was announced. This was the second inspection of this service since it was registered with CQC. The first inspection took place in June 2017 and we found two breaches of legal requirements at that inspection. These were due to medicines not being managed safely and staff not being deployed effectively so they were late when going to people’s homes to provide care.

At this inspection we found improvements in the management of medicines and people generally received their medicines safely as prescribed. People told us that staff continued to be late and that they sometimes did not know which care worker would arrive. People were unhappy with the staff and the way the office staff planned the staffing. Despite people’s dissatisfaction and staff being late having a negative impact on people’s wellbeing, the provider had improved two weeks before this inspection.They had installed a new call monitoring system so they could see where staff were and receive an alert if a care worker was running late. This gave them opportunity to inform the customer and to provide an alternative care worker if necessary. The new system was making effective improvements in the timeliness of staff attending care visits.

At Home Support Services Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. The head office is based in Enfield and the service is provided to people living in Hertfordshire. At the time of this inspection the service was providing personal care services to 24 people. The service they received ranged between one and four visits each day to live-in care.

The service had a registered manager who was also a director of the company. 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.

Feedback from people using the service and their relatives was that they were not satisfied with the service.They said staff were often late and they were not happy with the conduct of some staff.They said the office staff were hard to get hold of, especially at weekends.

Staff were not safely recruited as they provider had allowed staff to start work before receiving any references to check on their conduct in previous employment.

Some people using the service said that staff did not appear to know what they were doing and had not read the care plan. The provider had retrained staff shortly before the inspection and was satisfied that improvements had been made. Staff had completed training in relevant topics. The provider had recently improved staff supervision and direct observation of staff when in people’s homes to see if they were working to a good standard.

People had care plans setting out their needs in a way that was easy for staff to follow. People said that some staff were caring but others were not respectful or friendly and were “rough” when providing personal care.

People told us their concerns and complaints were not always addressed fully or quickly. We saw some complaints were investigated well and the provider had given a full apology when things had gone wrong but some concerns had not been recorded properly.

The provider had recently improved their quality monitoring and was working with the local authority which commissioned their service in order to make improvements. The authority reported that they had suspended placements with this service (so no new people would be referred to the service) but that the provider was working with them to make the necessary improvements and people had begun to report improvements to their care.

We found two breaches of legal requirements which was due

Inspection areas


Requires improvement

Updated 15 December 2018

The service was not consistently safe. The service did not follow safe recruitment processes so could not be sure staff were suitable people to provide care to older people. Staff had not been effectively deployed so people experienced late calls which had a negative impact on them. This had improved in the two weeks prior to this inspection due to the provider implementing a new monitoring system.

The provider had a good understanding of safeguarding procedures and alerted the authorities promptly if they had concerns about a person's wellbeing.

Medicines were safely managed and there were risk assessments in place to reduce risks to people’s health and safety.


Requires improvement

Updated 15 December 2018

The service was not consistently effective. Staff received training in mandatory topics to help them in their role. There had been recent improvements in the regularity of staff supervision and observation.

People gave their consent to care and staff understood the importance of seeking consent before providing care. People received support with eating and drinking.


Requires improvement

Updated 15 December 2018

The service was not consistently caring. People said some staff were caring, though they said they did not have opportunity to form relationships with them as staff changed frequently. Other people thought staff were not friendly or were “rough” and didn’t treat them with respect.


Requires improvement

Updated 15 December 2018

The service was not consistently responsive. The provider had recently made improvements in the way they managed complaints and apologised to people when they had a bad experience. People may not have experienced the improvements yet as some said that the response to complaints was slow. Some concerns were not addressed properly.

People's care plans set out their care needs and preferences clearly and were easy for staff to follow.


Requires improvement

Updated 15 December 2018

The service was not consistently well led. People using the service and their relatives expressed dissatisfaction with the way the service had been managed in the last few months.

The provider had implemented improved quality monitoring and had an action plan detailing improvements. They were working with the local authority which commissioned their service in order to improve the service.

Staff told us they felt well supported by the registered manager.