Care Avenues Limited

Care Avenues Limited is a domiciliary care service registered to provide personal care. At the time of the inspection the service was providing care to 60 people in their own homes.

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

Nine months after our last inspection, a new manager was appointed at the service. The new manager had identified a number of areas for action and was working to address the issues raised at our last inspection. Action plans and audits were in place to drive improvement in the service and provide the registered manager with oversight of the service. However, this remained a work in progress and was continually being re-assessed. Audits to log books were not completed in a timely manner resulting in a delay in action being taken when errors were highlighted. Audits to staff recruitment files had failed to highlight missing information which was identified during inspection.

People were happy with the service they received and told us they would recommend it. Staff felt supported in their role and were on board with the registered manager’s vision for the service, which was to provide people with person centred care. People’s views of the service were sought and acted on where appropriate.

People were supported by staff who were aware of the risks to them and how to support them safely in line with their care needs. Staff had received training in how to recognise signs of abuse and were aware of their responsibilities to report and act on any concerns that came to their attention. People were supported to receive their medication as prescribed. Staff had been recruited safely. There was a system in place to monitor calls to people and alert management to any potential late or missed calls.

Staff received an induction that provided them with the training, information and support they required to effectively and safely meet people’s needs. Staff felt supported and well trained. Staff practice was observed to ensure people were supported safely and in-line with their care needs.

People were supported to have maximum choice and control of their lives and care 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 were supported by a consistent group of care staff who were aware of people’s healthcare needs and supported them to access healthcare services, where appropriate. People were supported where appropriate at mealtimes.

Staff treated people with dignity and respect and routinely encouraged people to be involved in decisions regarding their care. Staff were described as kind and caring and people received care and support based on their individual assessment, needs and preferences.

There were systems in place to respond to and act on any complaints received. People were confident that if they raised a complaint they would be listened to and it would be acted on.

Rating at last inspection

The last rating for this service was Requires Improvement (published 25 October 2018) and there were two breaches of regulation. 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 improvement shad been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

At the last inspection on 18 October 2017, we asked the provider to take action to make improvements in relation to making sure that risks to the health and safety of people were well managed and to begin to operate effective systems to monitor and improve the quality of the service. The provider sent us an action plan to tell us how they were going to do this. At this inspection we found that while some improvements had been made, they were not sufficient to meet the law. The provider remains in breach of the law in relation to these areas.

This service provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults.

Not everyone using Care Avenues Birmingham 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.

At the time of our inspection, Care Avenues Birmingham offered support to 85 people living in the community who received personal care. The service is required to have a registered manager who was in post when we inspected, but has since left 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.

People who used the service spoke positively about the care that was provided to them. Staff members also spoke positively about the people who they supported. The service had developed personalised assessments of risks to people. However, these were not consistently done well and were not robust. We found that the assessments did not include sufficient guidance for care staff about how to manage identified risks and minimise the likelihood of harm. Staff members demonstrated that they understood how to safeguard the people who they supported. Safeguarding training and information was provided to staff. People were protected from the risk of abuse.

Staff members had received training in safe administration of medicines. However, we could not be assured that arrangements were in place to ensure that people's medicines were given safely. Staff recruitment processes were in place to ensure that workers employed by the service were suitable for the work they were undertaking. The provider had checked staff references and criminal records prior to their appointment. Staffing rotas met the current support needs of people, although there were some concerns about how the rotas were managed and may not have given staff time to travel. There was a system for ensuring that care calls were managed and monitored. Staff and people who used the service had access to management support outside of office hours.

Staff members received training to ensure that they had the skills and knowledge they required to undertake their duties, Staff members received supervision sessions with a manager. The service was meeting some of the requirements of the Mental Capacity Act. Information about people's capacity to make decisions was included in their care plans, although the registered manager was not aware of the best interest decision making process. People were asked for their consent to any care or support that was provided. Staff members spoke positively and respectfully about their approaches to care and the people that they provided care to. People told us that staff were caring and respectful. People who used the service and staff members spoke positively about its management. They knew what to do if they had a concern or complaint about their care.

We did not find any concerns in relation to infection control and noted that staff used equipment such as aprons and gloves as appropriate.

Processes were not effectively in place to monitor the quality of the service such as effective audits of records or effective spot checks of care practice. The registered manager did not have a good oversight of the service and did not check for themes and trends to improve the quality of the service.

The inspection in October 2017 was a focussed inspection and only considered the key areas of Safe and Well Led. This is the second time the service has been rated Requires Improvement.

You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

As a result of this information we undertook an unannounced focused inspection on 18 October 2017 to identify if the service kept people safe and was well-led. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection in December 2016, by selecting the 'all reports' link for Care Avenues Limited on our website at www.cqc.org.uk. We also alerted other agencies to some of the concerns we received. As a result this inspection did not examine the circumstances of these other concerns.

Care Avenues Limited provides personal care to 130 people in their own homes. At the time of the inspection the service had a registered manager although they were absent during our visit. We were accompanied during our inspection by the nominated individual for the service and the area manager. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not operate effective systems and processes to assess, monitor and improve the quality of the service. Staff were unable to confirm if all the people who used the service had received calls in line with their care needs. Audits had not identified that people’s care records lacked detailed or contained contradictory guidance for staff. Systems to store and retrieve information and records was not effective. This meant during our inspection visit staff were unable to tell us about any incidences which had occurred and any action to prevent similar incidences from reoccurring. The provider’s systems had not ensured that their latest inspection ratings were displayed on their website or that we received a formal notification when the registered manager left the service. The provider did not always fulfil their legal responsibilities to the commission.

Although people who required support to receive their medicines safely said they were happy with how they were supported we saw that people were at risk of not receiving their medicines as prescribed. Some people’s medication records were incomplete or contained contradictory guidance for staff.

People spoke affectionately about the staff who regularly supported them and said they attended their calls in line with their wishes. However several people said they were occasionally supported by staff who were not familiar with their care needs. We could not be assured that the provider’s systems for ensuring there were enough staff on duty to meet people’s care needs was robust.

Staff we spoke with did not consistently demonstrate they were aware of the action to take should they suspect that someone was being abused. Members of the management team had notified the local authority when they were concerned that people might be at risk of or experiencing abuse.

People said staff would respond promptly if they became unwell or their condition deteriorated. Staff could describe people’s specific conditions and how they managed any potential risks they presented. Records sampled did not always contain sufficient details for staff about how they could reduce the risk of harm for people.

There was clear leadership at the service. Staff told us members of the leadership team were accessible and would listen to their concerns. There were staff meetings and supervisions but it was unclear how frequently it was planned to hold them. There was no evidence that feedback from staff at supervision was used to improve the service.

People who used the service were generally pleased with how it operated and several said it had improved in the last few months. People received visits from senior staff but several people told us they had experienced poor communication with the office staff.

During this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.