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Inspection carried out on 29 March 2021

During an inspection looking at part of the service

About the service

42 Alexandra Road is a domiciliary care agency which was providing personal care to 15 people on the day of the site visit. The provider's office is located in Farnborough and they provide care to people living in both Hampshire and Hounslow. They provide care to both younger and older adults, who may have a disability, a mental health diagnosis, a learning disability or who may be living with dementia.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People and their relatives were happy with the care received. They felt care was provided by skilled, regular staff, who understood their care preferences and how to manage any risks associated with the provision of care.

The registered manager recruited sufficient staff to ensure people’s care could be provided safely. There were robust staff recruitment processes, to ensure only suitable staff were recruited. They ensured people received their medicines safely from appropriately trained staff. Staff assessed potential risks to people and measures were in place to mitigate any identified risks. People were protected from the risk of abuse by the systems and processes in place. Staff had received relevant infection control training and understood how to protect people and themselves from the risks of acquiring an infection. The registered manager ensured learning took place and this was shared with staff.

People’s needs were assessed and their care was planned in accordance with legislative requirements. Staff were supported in their role. Staff ensured people were supported to eat and drink. Staff liaised with health care professionals as required, to ensure people’s healthcare needs were met. 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.

People received care which met their needs and preferences. People were involved in planning their care which was reviewed to ensure it remained relevant. Processes were in place to enable people to raise issues and to seek feedback about their experience of the care provided. The registered manager took relevant action in response to issues raised. Staff supported people with end of life care where required.

The registered manager had implemented robust processes to monitor the quality of the service and to identify areas of the service for improvement. The registered manager promoted a positive culture focused on achieving good outcomes for people. They understood their role and ensured the additional conditions placed upon their registration following the last inspection were met. The registered manager worked openly with other agencies to provide people’s care.

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

Rating at last inspection

The last rating for this service was requires improvement (published 12 July 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 08 April 2019. Breaches of legal requirements were found. Conditions were placed on the provider’s registration, which required them to provide regular updates on their actions to improve the service.

Since this rating was awarded the registered provider has moved premises and changed the name of the location. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

We undertook this focused inspection to check they now met legal requirements. This report only covers our findings in relation to the Key Questions of safe, effective, responsive and well-led.

Inspection carried out on 8 April 2019

During a routine inspection

About the service:

¿ Virtue Care is a domiciliary care agency that was providing personal care to nine people at the time of the inspection. Although the provider’s office is based in Aldershot, they provide care to people living in Chiswick and Hounslow.

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

People’s experience of using this service:

¿ The provider had strengthened their recruitment procedures since the last inspection, but they were still not fully robust.

¿ People provided mixed feedback about the timing of their care calls.

¿ People received their medicines and topical creams from trained staff. The provider had not ensured people’s medicine needs had been fully assessed nor were people’s medicine records complete.

¿ People’s daily records were not always either complete or accurate. Electronic care plans were not fully person centred.

¿ Processes to monitor the quality of the service and drive improvements were not fully effective.

¿ People’s feedback indicated some aspects of staff’s practice in relation to infection control required improvement.

¿ The provider’s management of verbal complaints needed to be documented.

¿ People overall reported they experienced positive, kind and caring relationships with staff. One person said, "The majority are smiley, chatty and create a positive vibe."

¿ People overall told us they had been consulted about the provision of their care.

¿ People told us their privacy and dignity was upheld during the provision of their care.

¿ Risks to people had been assessed and mitigated.

¿ People received their care from staff who had received appropriate training.

Rating at last inspection:

¿ At the last inspection the service was rated requires improvement (07 July 2018).

Why we inspected:

¿ All services rated "requires improvement" are re-inspected within one year of our prior inspection.

¿ This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement

¿ We found three breaches of Regulations. Full 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.

Inspection carried out on 14 May 2018

During a routine inspection

This inspection took place on 14 May 2018 and was announced. We gave the provider prior notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office.

Virtue Care is a domiciliary care agency that provides personal care to people in their own homes. It provides a service to older adults, people living with dementia, with a physical or learning disability and mental health. The Care Quality Commission (CQC) only inspects the service being received by people provided with the regulated activity ‘personal care’; help with tasks related to personal hygiene and eating. Not everyone using the service receives the regulated activity. Where they do, we also take into account any wider social care provided. At the time of our inspection the service was providing personal care to 14 people.

The service had 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 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 inspection we found a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not follow their recruitment procedure to carry out checks before new staff were employed to work with people. They did not gather necessary information to ensure staff were suitable for their role.

You can see what action we have asked the provider to take at the end of the full version of this report.

The registered manager had quality assurance systems in place to monitor the running of the service and the quality of the service being delivered. However, they were not able to evidence these systems were effective at all times to identify issues and improvements necessary and what actions they would take. We made a recommendation about how to use and record the quality assurance system to assess and monitor quality of the service.

Staff supported people with taking their medicine by prompting them. Only the registered manager and one staff had medicine training. We could not be sure all staff knew the safe systems of medicine management without appropriate training. We asked the registered manager to address this. They confirmed they had booked staff for training after the inspection.

The registered manager had planned and booked all other training when necessary to ensure all staff had the appropriate knowledge to support people. Staff training records such as training matrix and policy indicated which training was considered mandatory.

Staff had received ongoing support however regular supervision and appraisals were not recorded. Staff felt supported by the registered manager and maintained great team work. People were complimentary of the staff support and care they provided.

People felt safe while supported by the staff. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these when necessary. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns.

People were supported by sufficient numbers of staff to meet their individual needs. People were informed about the changes to their visits as necessary. People received support that was individualised to their specific needs. Their plans of care were kept under review and amended as changes occurred. People's rights to make their own decisions, where possible, were protected and respected. Staff were aware of their responsibilities to ensure people's rights were promoted.

People were treated with respect, and their privacy and dignity were promoted. People and relatives felt the staff supported them in the way they wanted. Staff were responsive to the needs of the people and enabled them to