Archived: Aamina Homecare Ltd

This unannounced comprehensive inspection took place on 12 and 13 April 2017.

After the inspection the Care Quality Commission were notified of an incident following which a person who used the service died. This incident is subject to an on-going investigation.

The inspection was carried out by one adult social care inspector. At the last inspection of the service in April 2015 the service was rated as ‘Good’ overall. The responsive key question was rated as ‘Requires Improvement’.

There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

During this comprehensive inspection we found multiple breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 and a breach of the Health and Social Care Act 2008 [Registration] Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is '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 registered provider's registration of the service, will be inspected again within six months. The expectation is that registered 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 registered 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 registered 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.

People did not receive safe care and support. We saw that staff failed to stay for adequate times to deliver the care and support people had been assessed as requiring safely. Call monitoring data showed people assessed as requiring 30 minutes of support received their care in six minutes or less. A person who required support for 45 minutes had their care delivered in six minutes. People who had been assessed as requiring the support of two staff to help them transfer and mobilise safely regularly received support from only one member of staff, this increased known risks such as falls. People did not receive their medicines safely or as prescribed. One person had been prescribed specific medicines that required a four hour gap between each administration. The registered provider had failed to ensure suitable gaps between their calls and subsequently staff had administered the medicines in an unsafe way.

People were not safeguarded from abuse by way of neglect. Call monitoring records showed and people we spoke with told us they experienced missed calls. This meant vulnerable people did not receive the basic care and support they required such as personal care, assistance to take prescribed medicines, mobilising and transferring and meal preparation. We saw evidence that confirmed appropriate action was not taken when safeguarding concerns were raised or when allegations of abuse were made.

The registered provider failed to ensure governance systems were in place and operated effectively. Care records, were not audited or reviewed to ensure they remained accurate and provided suitable information to enable staff to deliver effective care. This led to shortfalls in care and inadequate risk management.

People did not receive person centred care. We look at 17 people’s care records and found that appropriate guidance was not available to ensure staff could meet their needs. People preferences for how their care and support was to be provided was not recorded. Two people’s needs had not been assessed at the commencement of their care package which meant the registered provider was not fully aware of their needs.

Consent to care and treatment was not always in place and the principles of the Mental Capacity Act 2005 were not followed or adhered to. When people lacked capacity best interest meetings were not held and best interest decisions were not in place to deliver the care people required. During our discussions with staff it was clear their understanding of their obligations under the Act was limited.

Records showed that when complaints were received they were responded to with a generic letter. Complaints were not used to drive improvement across the service and prevent other people experiencing the same issues.

People were supported by care staff before the registered provider had assured themselves of their fitness to work with vulnerable people. Safe recruitment practise were not operated.

People were not always treated with dignity and respect. Staff failed to attend calls at agreed times and people were made to wait for the care and support they required. Private and sensitive information was not held confidentially and information about people’s health was shared inappropriately.

The Care Quality Commission was not notified of specific events, namely allegations of abuse, as required under regulation.

The registered provider failed to display ratings either in their premises or on their website, as required under regulation.

People did not receive effective care and support. The people who required support to prepare meals did not always receive this due to late and missed calls. When concerns with people’s dietary intake were identified appropriate action was not taken. People received support from a range of healthcare professionals but we saw their advice and guidance was not incorporated into people’s care records and there was no evidence to show staff had carried out their instructions. Staff told us they received the training and support they required to carry out their roles.

People did not always receive the support they required in a caring way. People were not always supported by caring staff. The actions of the registered provider prevented supportive relationships being developed by staff and the people who used the service and person centred care being delivered. Call monitoring records showed one person was supported by 19 different carers in a single month. Staff action’s exposed people to the risk of neglect.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

' Is the service caring?

The service is caring. People who used the service, their relatives and staff completed an annual satisfaction survey. Where suggestions or concerns had been raised the provider had listened and made changes to the service.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People and their relatives were encouraged to make their views known about their care and treatment and these views were respected.

The home had involved appropriate professionals in the planning and delivery of care.

' Is the service responsive?

The service is responsive. Staff knew the people they cared for and understood their preferences and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated as required.

When people's needs had changed the provider had altered care plans and task sheets to ensure their needs were being met.

' Is the service safe?

The service is safe. Systems were in place to ensure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

The provider had policies and procedures in relation to safeguarding vulnerable adults. Staff had completed training in how to safeguard vulnerable adults. This meant that people were safeguarded from the risk of abuse, harm or poor practice as required.

Recruitment processes were safe and thorough. People were supported by staff that had been checked with the Disclosure and Barring Service and whose references had been checked before they started work

' Is the service effective?

The service is effective. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People and their relatives were involved in discussions about their care plans. People's identified needs were monitored regularly and effectively.

' Is the service well led?

The service is well led. The service had quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

What people who used the service and those that matter to them said about the care and support they received.

We asked people who used the service if their needs were always met. One person told us, 'I'm happy with the service, I get the same girl all the time which I prefer.' Another person commented, 'I simply do not know what I would do without them (the care staff) coming to help me, I could not do without them.'

A relative we spoke with explained, 'We had a re-assessment recently just to make sure that everything was going well; I think they are great, not just the carers but the office staff too.'

The inspection gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Safeguarding procedures were in place and some staff understood how to safeguard people they supported. Other staff told us that they did not feel they had had enough training to enable them to confidently safeguard people.

Systems were revised and updated following situations where managers and staff needed to learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

Staff were not aware of risk management plans and we were unable to see examples of these, or how these were followed. People were put at unnecessary risk and were not always included in decisions about their support, leaving them unable to remain in control of their care and lives.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected. We found that the policies and procedures had not been always been followed as one staff member had started work with only one reference.

Is the service effective?

Some people told us they were involved in the development of their plans of support and were consulted about their assessment of their health and care needs. Whilst others told us they had not been involved in the process.

Is the service caring?

When speaking with staff it was clear that they genuinely cared for the people they supported and often they were staying later than their allocated time in order to support people with their care.

People who used the service and their relatives indicated they were not regularly consulted about their views concerning the way the service was provided. They told us that where shortfalls or concerns had been raised, these had not been taken on board or dealt with appropriately.

We saw a lack of evidence to show that people's preferences, interests, aspirations and individual needs were recorded or that care and support was provided in accordance with their wishes and feelings.

Is the service responsive?

People told us they knew how to make a complaint if they were unhappy about the service provided. One person said they had previously raised some concerns and were satisfied with the way the provider had dealt with these to improve the service. Other people told us,'We have been unable to get our problems sorted out ' another reason we are changing provider.' and 'No it was never resolved.'

We looked at an investigation of a concern that was recently raised, which we found was completed in line with the provider's complaints policy.

Is the service well-led?

The service had a quality assurance system, and records showed that surveys were completed on an annual basis. Where problems and opportunities to change things for the better were identified, action was taken by the provider.

Feedback from the surveys and actions taken to address any issues raised was not shared with people who used the service.

People told us they had not been asked their views about the quality of the service.

Not all staff were trained to a level where they felt fully confident in delivering care and they were not fully supported by management.

What people who used the service and those that matter to them said about the care and support they received:

People told us overall they felt safe and trusted the staff. One person who used the service told us they had asked for a carer to be stopped from coming to them as they felt they were 'nosy and pried into their personal belongings and letters'. Although they had reported this, the carer was still being sent to support them. This made them feel compromised and unsafe in their own home.

Some people told us they felt their rights and dignity were respected, whilst others told us they had not been consulted about their care plan or about new staff coming into their homes, to shadow more experienced staff. This led people to feel that their view and opinions were not important.

We spoke with fourteen people and their relatives who were supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people about this was mixed, for example; one person said, "The carers are generally good on the whole with just the odd one who is not so good.' Whilst another told us, 'The problem is with the office ' they are rubbish and totally unreliable. The carers are lovely ladies but just have too many people to visit and are only given five minutes to travel ten miles between clients.' and 'I am very satisfied with the girls, which is more than I can say about the office.'

People told us that they often experienced late or missed calls and were not always informed that carers were running late.

People told us that on occasions they only received one carer, when two carers were required to meet their needs. Comments included,"I am supposed to have two carers as they have to use the hoist, but two or three times a week only one comes, which is why we are in the process of changing the provider' and 'I am supposed to have two carers at midday, but I have never had two.'

A number of people although happy with the care they received and the staff supporting them, expressed dissatisfaction that they were not always contacted when calls were running late.

One person told us that they were dissatisfied with the service they received.

People told us they were supported to make decisions and were involved in the planning of their care. They also confirmed that staff were respectful at all times and treated them with kindness.

People who used the agency told us they were aware of how to make complaints. However three people expressed that they were not completely satisfied with how their concern had been dealt with, for example one person told us, 'Yes I made a complaint. I have asked for a rota on several occasions. I get one for two or three weeks then it goes back to getting nothing.'

Staff were recruited safely and checks were made to ensure people were not exposed to staff who should not be working with vulnerable people.

Staff received training to meet the needs of the people who used the service. People we spoke with were complimentary about the capability of staff. Comments included; 'I know how well they manage me with the hoist but I am glad they have been trained. I don't know if they need training for other people," 'When new staff do come they are usually shadowed by a carer who knows what to do. I don't think they need more training,' and 'I don't know what staff have undertaken in training. For me they are capable.'

The provider had formal recording systems in place which regularly assessed and audited the quality of service provided.

People we spoke with were positive about the care and support they received. They told us they were able to be as independent as possible and that their privacy and dignity was respected. Comments included "There is nothing I can fault them with" "The carers are first class." and "I have used the service for two years now and although there were some initial hiccups, it is now excellent."

'I am able to say what needs doing and this is in the care plan", "I was asked about the start times and they were pretty good about this and then they changed the time when I asked them to" and "I was asked if I preferred a male or female carer."

People told us that they had their needs assessed and had a care plan which had been discussed and agreed with them. They told us that the care plans were regularly reviewed and updated if necessary. One person told us "They did an assessment and care plan, we went through this and I signed it."

We found there were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. People we spoke with told us, "I am always happy with the standard of care that I receive."