Archived: Assisted Home Living

Updated 23 August 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

One inspector carried out this inspection.

Service and service type:

There was no requirement for the service to have a registered manager. The provider was the manager and oversaw the day-to-day running of the service. We have referred to the provider as the 'responsible person' throughout this report.

Notice of inspection:

We attempted to give the service 48 hours’ notice of the inspection visit. This is because it is small and the responsible person is often out of the office supporting staff or providing care. We needed to be sure that they would be in. Unfortunately, the responsible person had already arranged to support someone on the planned day of inspection. This appointment could not be moved. Therefore, the inspection was moved to the following day. This gave the service 72 hours notice that we would be inspecting.

What we did:

Before an inspection takes place, we gather information known about the service. For this service, we had not received any information since the last inspection. We had not received any notifications from the service. Notifications are information about specific events that happen at the service, and the responsible person is required to send these by law. We asked the provider to submit a Provider Information Return (PIR) and they did not do this. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. The responsible person has not submitted the PIR as requested for the last three inspections.

During the office visit on 15 March 2019, the inspector considered the care records of five people who used the service. We also looked at three staff recruitment files and other records relating to the management of the service. This included audits, policies and incident records. We then phoned three care staff about the service.

On the 19 March 2019, the inspector phoned people who used the service. The inspector spoke to three people, and three relatives. These people gave their views about the service they received.

Updated 23 August 2019

About the service:

Assisted Home living is a Domiciliary Care Agency. The care agency provides personal care and support to people living within the community. At the time of the inspection, there were eight people receiving support with personal care.

People’s experience of using this service:

Staff had not had appropriate recruitment checks to ensure they were of good character to support people. Staff had not received training and lacked knowledge which was important to keep people safe.

Care records and risk assessments were either not completed or had insufficient detail to guide safe care. Care was therefore not delivered in line with current standards. We saw that some risks have not been adequately addressed which put people at risk of harm. There were no formal processes in place to review or amend records and ensure they were appropriate.

Medicines were not managed safely. People had received ‘as needed’ medicines without reason. Medicine risk assessments were not in place for those people that took medicines themselves and were at risk of doing so. Medicine records were not completed in a safe way to ensure mistakes were not made.

People had access to health and social care professionals, however professional guidance was not recorded to guide more effective care. Where professional advice was recorded, it was not always followed.

We found ongoing concerns about the safety and governance of the service. There was a failure to create improvements at the service, despite an action plan being in place. These risks and lack of improvement raised concerns about the quality of personal care delivered by the service.

There were enough staff and people reported that staff arrived on time to support them. People spoke highly of the staff at the service and told us that they felt well cared for.Rating at last inspection: The last report was published on 21 March 2018. It was rated as ‘Requires improvement’

Why we inspected:

At the last inspection, we rated the service as ‘Requires Improvement’. The service provided us with an action plan, stating that they would make the required improvements. We completed this inspection to check whether the required improvements had been made. A comprehensive inspection was completed due to the amount of regulation breaches and previous concerns.

Enforcement:

At this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included regulations 12, 17, 18 and 19. These are continued breaches from our last inspection in March 2018.

Information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor the level of risk at the service until the next inspection visit.

The overall rating for this service is now ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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