Availl (Norwich)

A domiciliary care agency provides personal care to people living in the community. CQC does not regulate premises used for domiciliary care because people receive this service in their own homes. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. At the time of our comprehensive inspection there were 15 people receiving a personal care service we regulate.

There was a registered manager in post at the time of our inspection. The registered manager was also the provider of the service having purchased a franchise for the branch from the wider Availl business. The registered manager was also supported by a branch manager who took on the day to day management of 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. For the purposes of this report we will refer to the provider as the registered manager.

At our last inspection in June 2017 we rated the service ‘Requires Improvement’ overall. At that inspection we found several breaches of the Health and Social Care Act 2008. We found that people did not have thorough care assessments in place. The risks which people faced had not been fully explored and care plans did not guide staff about how to meet people's needs in a safe way. People’s care assessments and reviews were not always person centred.

At that inspection we were also concerned that the competency of staff was not being checked on a regular basis and staff did not receive the training they needed to support people effectively. At our last inspection we also found that some people did not receive their medicines safely because this need had not been identified in their assessments. Staff did also not recognise when systems were not in place to support people with their medicines. We also found that there were insufficient systems in place to monitor the quality of the care and service provided and audits were not taking place in relation to people's care records.

At this inspection we found that there were some improvements, however these were still on-going and not fully embedded or effective yet. Care planning was detailed however it did not cover specific healthcare needs or support needs that some people had. Some improvements had been made to the safe management of people’s medicines however there were some discrepancies between people’s MAR charts and their care plans.

The registered manager had increased the frequency of the checks being carried out of staff competency and was ensuring that regular checks of staff practice were now being made. Staff continued to receive training however they had mixed views in how effective they found this in the format in which it was delivered.

Some improvements had been made to the auditing of people’s care records. Audits were now in place; however, they were not wholly effective. The audits undertaken did not identify the concerns that we found with gaps in care records.

The rating for the service continues to be rated ‘Requires Improvement’. We also found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated activities) regulations 2014.

People and their relatives felt safe with the service they received. Staff were clear on how to recognise potential harm and how to safeguard people. There were sufficient staff available to visit people and provider their care. Recruitment practices were thorough and made sure new staff were suitable to work with people.

The inspection took place on 20 and 21 June 2017 and was announced.

Availl Norwich provides a domiciliary care service in people’s own homes. The service was supporting 14 people with their personal care needs at the time of this inspection. Availl Norwich also provided an agency service for temporary staff in residential care homes. However the Care Quality Commission (CQC) does not inspect or regulate that type of service. Availl Norwich supports older people, some of whom are living with different forms of dementia, people with physical disabilities and people with mental health needs.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. For the purposes of this report we will refer to the registered manager as the manager.

At this inspection we found breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

People did not have thorough care assessments. The risks which people faced were not fully explored. People’s care plans did not explain and guide staff about how to meet people’s needs in a safe way. However, people told us that they felt safe when they received support from staff.

Staff knew how to identify if a person was experiencing harm or abuse in some way and knew to report this to the manager. However, staff did not know of outside agencies they could also report concerns to. Good practice was not always followed when responding to a safeguarding concern.

The competency of staff was not being checked on a regular basis and staff did not have a robust induction to enable them to support people effectively. Training was not always provided to meet people’s individual needs. The service was not observing staff practice on a regular basis to check they were effective and supported in their work. Some people did not receive their medicines safely because this need had not been identified in their assessment of need. Staff did not recognise when systems were not in place to give people their medicines in line with safe practices and continued to administer them.

People were supported by staff who sought people’s consent before supporting them. However, the service was contacting health and social care professionals on their behalf without obtaining people’s consent to do this.

People told us that they received appropriate support with their food and drinks.

Staff were caring and kind to the people they supported. People also told us that staff treated them in a way which promoted their dignity and they respected their privacy. People had formed positive relationships with staff who supported them and they had confidence in the staff’s abilities.

People told us that they saw regular staff, at times they were happy with, and they knew when and which members of staff would be visiting them on a daily basis. People did not experience late or missed calls. All the people we spoke with said they would recommend the service to others.

We found that people’s care assessments and reviews were not always person centred. They did not explore people’s needs adequately enough to enable staff and the service to know people’s needs. The service did not have personalised plans in place to meet these needs.

There were insufficient systems in place to monitor the quality of the care and service provided. Audits were not taking place in relation to people’s care records. The service had not taken sufficient steps in order to be confident, that people had robust risk assessments and reviews.