42 Alexandra Road

42 Alexandra Road is a domiciliary care agency providing personal care to people through either live-in or domiciliary care. The service provides support to both younger and older adults, who may have a disability, mental health needs, a learning disability or be living with dementia. At the time of our inspection there were 8 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not provide care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

People and their relatives were satisfied overall with the care provided. They were happy with the care staff.

People were protected from the risk of abuse as staff had received relevant safeguarding training and understood what to report, to whom and how. Staff assessed and managed potential risks to people. They understood the importance of reporting incidents which were then reviewed. The registered manager operated safe staff recruitment processes and there were enough staff . Processes were in place to ensure people received their medicines safely from trained and competent staff. People were protected from the risk of getting an infection.

The registered manager understood their role and had worked to improve communications with both people and staff. Overall people told us improvements had been made, but this was still being worked on. The registered manager was working with staff to promote a person centred focus from staff, to improve people’s experience. People’s views on the care provided were sought by the registered manager and used to make improvements. Processes were in place to monitor the quality of the service provided.

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

The last rating for this service was requires improvement (published 03 February 2023).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 42 Alexandra Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

42 Alexandra Road is a domiciliary care agency providing personal care to people. Since the last inspection, most people supported receive live-in care, but 2 people still receive domiciliary care calls. The service provides support to both younger and older adults, who may have a disability, people with mental health needs, a learning disability or people with dementia. At the time of our inspection there were 9 people using the service.

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

People and their relatives reported the quality of care provided since the last CQC inspection had improved. They said the care was now, “Pretty good,” “The care is fine” and “On the whole very good.”

The registered manager had made the required improvements to medicines management and people received their medicines safely. Some further work was required, in order to continue to embed the improvements made and to ensure continuity. The medicines audit process required further work to ensure it was fully effective. The registered manager needed to further review some aspects of people’s records, to ensure they were accurate. They also needed to continue to work on improving communications between the office staff, people and relatives.

The last inspection report had not been displayed as legally required, this was addressed immediately. It will take time for the provider to be able to demonstrate they have met the additional condition placed upon their registration following the last CQC inspection.

People were protected from the risk of abuse, through the processes and staff training in place. Potential risks to people had been re-assessed and they were appropriately supported by staff to enable them to stay safe. There were sufficient staff to provide people’s care. As the service grows and staffing increases, people will need to be given more choice over the staff providing their care. Staff had been recruited safely. People were protected from the risks of acquiring an infection. Staff were encouraged to report incidents which were then reviewed and required actions taken.

Staff were sufficiently skilled for their role and they received regular supervision and support. Staff supported people to eat and drink enough for their needs. No-one currently supported was at risk around swallowing food or drinks, but the registered manager understood the need to refer people to professionals if required and was arranging relevant training for staff. People’s care and support needs had been assessed and were delivered in accordance with legislative requirements and national guidance. People’s healthcare needs had been identified and where the person wished staff to be involved, they liaised with professionals for them.

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 and relatives reported staff were kind, compassionate and respectful. Staff ensured people’s privacy, dignity and independence were upheld. People were supported to be actively involved in decisions about their care provision.

People’s care was planned and personalised to their needs and preferences about how they wanted their care to be provided. Staff were trained and supported to care for people at the end of their life.

People and staff’s feedback on the service had been sought. The registered manager had promoted a more positive and open working culture. They had ensured staff understood their role and responsibility to keep people safe. They had informed CQC of significant events as required. Staff audited aspects of the service and when issues were identified, relevant actions had been taken. People’s complaints were listened to, investigated and any learning identified in order to make improvements. Staff worked in partnership with external stakeholders and professionals to provide people’s care and to make improvements to the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

The last rating for this service was inadequate (published 18 August 2022) and there were 10 breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 18 August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on actions we required the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 42 Alexandra Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. We will also monitor the provider’s compliance with the additional condition CQC placed upon their registration following the last inspection.

42 Alexandra Road is a domiciliary care agency which was providing personal care to 24 people on the day of the site visit. Staff provided people either with care calls or 24 hour live-in care. The provider's office is located in Farnborough and they provide care to people living in Hampshire, Southampton 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 relative’s feedback about the service was overall negative. One relative described the service as ‘absolutely atrocious’. People and their relatives expressed their anger and frustration with the management of the service which they felt was the underlying cause of the issues. They felt unheard and several told us they were seeking alternative care. Feedback about the care staff was, they were generally nice, but lacked the required skills and time to provide people with effective and compassionate care.

People did not always receive their medicines safely. The registered manager had not recruited staff safely, nor did they ensure there were sufficient staff to provide people’s care as commissioned. People were not adequately protected from the risk of abuse, as although staff had received training, they were not all fully aware of the relevant information required to keep people safe. People were at potential risk from unsafe care and incidents were not always reported. People were not always protected from the risks of acquiring an infection.

The registered manager had failed to ensure staff were always sufficiently skilled for all aspects of their role or to provide ongoing supervision. They had not ensured professional guidance was sought when people presented with swallowing problems or ensured peoples’ dietary wishes were respected. People did not always feel well-supported, cared for or treated with dignity and respect.

There had been a failure to fully mitigate the risks related to people’s safety and welfare or to maintain accurate and complete records. There was also a failure to effectively assess and improve the quality of the service provided or to use people’s feedback to improve the service. There had been a failure to inform CQC of a notifiable injury. There was not always an open and accountable culture.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There was not evidence to show people’s relatives had always been involved in best interests decisions where they lacked capacity to make decisions about their care.

Staff assessed people’s care needs as required, but the information was not always transferred to their care plan.

People’s care plans were not always personalised to their needs, preferences and interests.

Staff involved people’s relatives in decisions about their care where they had the capacity to determine they wanted them involved. Staff liaised with professionals and relevant agencies about the delivery of 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 and update

The last rating for this service was requires improvement (published 17 November 2021) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

A focused inspection of safe and well-led was prompted due to our ongoing monitoring of the service and then concerns were received about a person’s care. A decision was made for us to inspect and examine those risks. During the inspection, further concerns were identified, and the inspection was expanded to include effective, caring and responsive.

We have found evidence the provider needs to make improvements. Please see all sections of this full report.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 42 Alexandra Road on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified multiple breaches in relation to safe care, staffing, safeguarding, good governance, consent, person centred care, dignity and failure to notify. A condition has been placed on the provider's registration.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

42 Alexandra Road is a domiciliary care agency which was providing personal care to 19 people on the day of the site visit. Staff provide people with either care calls or 24 hour live-in care. The provider's office is located in Farnborough and they provide care to people living in Hampshire, Bracknell 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 did not always receive their medicines safely. The provider had not ensured all staff understood their medicines training and were fully competent at managing people’s medicines safely. Staff did not always have the required guidance to direct them in the administration of medicines prescribed for use, ‘as required.’

There had been a failure to fully mitigate potential risks to people from shortened care calls or to maintain accurate and complete records of the delivery of people’s care. The provider had failed to submit to CQC two notifications of events at the time they occurred.

Staff had completed safeguarding training and understood what to report. The provider co-operated with safeguarding investigations, but was not able to demonstrate their response to identified issues had always been fully effective in ensuring the required changes were made.

The provider had assessed potential risks to people and where risks had been identified, measures were in place to manage them. Some relatives did report specific issues in relation to risk management, which they felt created potential risks. There was evidence staff meetings had been held when things went wrong, in order to share information and learning from incidents.

Overall there were sufficient staff for their role. Not all staff had the required level of competence and skill to provide people’s care safely. Staff had received relevant infection control training and followed relevant guidance to protect people and themselves from the risks of acquiring an infection.

People and their relative’s reported although they liked the registered manager, they were not always consistently effective at leading the service and ensuring people experienced good outcomes from their care. Not all staff understood the fundamental need to provide a quality service.

The provider audited various aspects of the service and used their audits to identify potential areas for improvement. The provider overall worked collaboratively with external partners.

Rating at last inspection

The last rating for this service was good (published 28 April 2021).

Why we inspected

We had received concerns in relation to medicines, safe care and the quality of care provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 42 Alexandra Road on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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. The rating from the previous comprehensive inspection for the key question of caring which was not looked at on this occasion was used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 42 Alexandra Road 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.

¿ 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.

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 improve and maintain their independence with personal care.

The staff monitored people's health and wellbeing and took appropriate action when required to address concerns. The service assessed risks to people's personal safety, as well as staff and visitors, and plans were in place to minimise those risks.

Staff felt the registered manager was supportive and approachable. They had good communication, worked well together and supported each other, which benefitted the people. People and relatives felt they could contact the registered manager if they needed to and their concerns would be addressed.

Further information is in the detailed findings below.