AVH Care

AVH Care is a domiciliary care agency which provides personal care in people’s own homes. It currently provides care and support for three people.

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

People and their relatives expressed a high level of satisfaction for the care and support delivered by this service. Comments included “They are all very compassionate and come when they say they will. They are excellent.”

There was a small staff team of four, which included the registered manager and provider of the agency being involved in the delivery of each care package. This meant care was consistent and staff knew people and their needs very well.

There had been improvements to the care plans and risk assessments which allowed staff to deliver safe and consistent care to people. Plans were much more person centred and included health conditions and what staff should do to best support people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people were taking risks because they wished to remain in their own home, the service had considered how best to reduce such risks. This had been done in conjunction with the advice of other healthcare professionals.

Since the last inspection, some key staff training had taken place, but this was still work in progress. This was because they were a very small staff team so finding the right times for training sometimes proved difficult.

The registered manager had worked hard to ensure quality audits were being used meaningfully to help drive up improvement. For example, in medicines management. However, it was too soon to judge whether this was fully embedded and could be sustained. The provider had deliberately chosen to restrict the service to support only three people. These people had been having a service for some time, so their needs were well known. We were unable to judge how robust systems and improvements will be sustained once the service grows and takes on more people.

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

Rating at last inspection and update.

At the last inspection this service was rated requires improvement (Published 14 May 2019) We found breaches in regulation 12 – safe care and treatment and 17- good governance. We issued warning notices in respect of these breaches. We also issued requirement notices in respect of Regulation 18 Registration Regulations 2009 Notifications of other incidents and Regulation 18 HSCA RA Regulations 2014 Staffing. The provider had sent us an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made to show the warning notices and requirements had been met. Improvements had been made in respect of staff training but it was too early to see if this new approach could be sustained.

Why we inspected

This inspection was a planned focused inspection to review whether the warning notices in relation to safe care and treatment and good governance, had been met. We checked to see if they had followed their action plan and met legal requirements.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for AVH Care on our website at www.cqc.org.uk.

Follow up

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

People’s experience of using this service:

People were at increased risk because the provider had not effectively assessed health and safety risks or done all that was reasonable to reduce identified risks. Risk assessments and care plans lacked detail, and were not up to date. Some risks had not been identified and there was a lack of detailed guidance for staff on how to meet people’s care needs. The absence of this information meant staff did not have all the relevant information they needed to provide effective care and treatment.

Staff lacked the skills and knowledge they needed to undertake comprehensive assessments of people’s care needs and develop detailed care plans to meet those needs. People’s care records were poorly organised and were inconsistent. One person’s care plan was very brief, another person’s was missing, care records lacked relevant information and some were out of date. Documents were undated so it was not possible to see when they were created or were last updated. This increased risk people would not receive the care they needed.

However, staff knew more about people’s care needs, and how to manage them safely, than was captured in people’s care records. They worked closely with local health professionals, and followed their advice. Improvements had been made in including personalised information about people’s backgrounds. Daily records were well completed about the care people received at each visit.

Improvements in staff training had been made. Staff had received safeguarding and moving and handling training. They knew about the different types of abuse, although two incidents which should have been notified to the Care Quality Commission (CQC), as required by the regulations had not been. Improvements in recruitment systems had been made to ensure the service employed fit and proper staff.

Some improvements in quality monitoring had been made, with the introduction of ‘spot checks’ of staff practice and use of surveys to seek feedback from people. However, further improvements in the agency’s systems and processes and in record keeping were needed.

People said they felt safe and well cared for and said the service was reliable. One person said, “I’m very happy with the service,” which others agreed with. People's concerns and complaints were listened and responded to.

People said they received personalised care. They said staff respected their privacy and treated them with dignity and respect. Staff developed positive and caring relationships with people.

People received their medicines safely and on time. Staff supported some people to eat and drink enough to maintain a balanced diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

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

Rating at last inspection: Requires improvement (report published on 5 January 2018). At that inspection we found four breaches of regulations which related to safe care and treatment, good governance, staffing, and about processes for employing fit and proper persons.

At this inspection the rating remains requires improvement, with four breaches of regulations relating to safe care and treatment, staffing, good governance and notification of incidents. You can see what action we told the provider to take at the back of the full version of the report.

Why we inspected: This was a planned inspection based on the rating at the last inspection to check if the required improvements had been made.

Enforcement: We have served a warning notice on the provider and registered manager. This requires them to comply with the more serious concerns by 28 May 2019.

Follow up: We will be meeting with the provider and commissioner to discuss our concerns, and will seek an improvement action plan to demonstrate how the improvements will be made. 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.

This service 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, people with a physical and/or sensory disability and people who misuse drugs or alcohol. At the time of the inspection six people were receiving a service from AVH Care. Not everyone using AVH Care receives 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.

There was a registered manager in post. 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. AVH Care is registered as a partnership. One of the partners had left the organisation at the end of July. CQC had not received a new application to replace the partner or an application to change the registration to a single provider. This meant they were not acting in line with the conditions of their registration. We have taken this into account in the well-led section.

People had care plans in place which outlined their needs. The quality and depth of information in the care plans was inconsistent. One clearly outlined the care needed and described the person’s routines. Others were brief and information was contradictory. Systems for identifying risks were also inconsistent. Risk assessments had been completed in some cases and these highlighted when people were at risk. There was a lack of guidance for staff on the actions they could take to protect people from the risk. We found some people were at risk due to their specific behaviour or health condition. There were no risk assessments in place documenting this and no guidance for staff to follow.

Staff were not supported by a robust system of induction, training and supervision. No staff had completed safeguarding training since starting work at the service. There was no planned programme of supervisions in place. Staff meetings were not organised. Recruitment processes were not robust.

AVH Care is a small service and both the registered manager and deputy manager were involved in the delivery of care on a daily basis. The management team and staff knew people well and had an in-depth understanding of their needs. Care was person-centred and was focused on people’s emotional well-being as well as their health needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Relatives and a healthcare professional were unanimously positive about the way in which care and support was delivered. Relatives told us staff had never missed a visit and were rarely late. Staff spent time ensuring people were comfortable and had their needs met.

We identified breaches of the Regulations. You can see what action we have asked the provider to take at the back of the full report.