Always Here Limited

Always Here Limited is a domiciliary care service providing personal care to older people, younger adults and people living with dementia, sensory impairment or physical disability. The service was supporting 27 people at the time of our inspection.

Not everyone who used the service received personal care. The Care Quality Commission (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 were at risk due to poor governance and record keeping at the service. The provider did not understand regulatory requirements and had not met these. Their quality assurance systems were not effective or robust in identifying shortfalls. Staff were committed to providing good quality care and had started to make improvements following our inspection.

People were at risk of harm as risks to their safety and medicines were not always managed effectively. We could not be sure that people had received their medicines as prescribed.

People were supported by staff that had not always received the necessary training and competency checks to enable them to perform their role. Despite this, people and their relatives felt safe with staff and told us they received support from regular staff that were familiar with their needs.

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 good (published 13 June 2018).

Why we inspected

We received concerns in relation the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

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 breaches in relation to safe care and treatment, good governance, staffing, fit and proper persons employed and statutory notifications 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The service was registered in July 2015. This was our first inspection of the service since it was registered. We contacted the service on 23 April 2018 to arrange our visit because this is a small service and we needed to be sure the registered manager would be available to speak with us and so that we could gain access to the office.

This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to older adults and younger disabled adults. At the time of our visit they were supporting 25 people living in West Cumbria, mostly in the towns of Workington, Cockermouth and surrounding rural areas.

Not everyone using Always Here 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 employed to run 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 felt safe when receiving care and support from staff. People reported that the service was very reliable and that they had never experienced a missed visit.

Staff knew how to recognise and report potential safeguarding issues and they received appropriate training in this area. Staff were safely recruited having all the appropriate checks to ensure they were suitable to work with vulnerable people.

People told us staff were very friendly, kind and caring and people highly valued the service they received. Privacy and dignity were respected and promoted by the care staff.

Risk assessments were in place to protect people from risks but also enabled them to safely carry on their day to day lives. People reported that staff had helped them to be confident and regain skills to become more independent.

People's human rights were protected because the registered manager and staff had an understanding of

the Mental Capacity Act 2005 (MCA). 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 support this practice.

People were included in planning and agreeing to the care they received. The service offered was flexible to people’s needs. They could ask for changes to their planned care and the service agreed to these where possible.

Staffing levels were sufficient to ensure people received standards of care that enhanced their welfare, safety and day to day living.

Staff told us they felt very well supported by the management team. The care staff were well trained and supported to be able to provide the care people needed, and specialist training was given to meet people’s individual support needs.

Staff received comprehensive induction when they first started work at the service and received on-going supervision and an annual appraisal of their performance. Staff professional development and staff well-being was given a high priority by the organisation.

The service had developed good links with healthcare and social care professionals to support people with their health and well-being. Healthcare professionals spoke highly of the service and the part it played in a team approach to managing people’s healthcare needs in the community.

Medicines were handled safely and people received support with their medicines as they needed. People received the support they needed to prepare meals and drinks.

People felt able, and knew how to make complaints. Where issues had been highlighted by people we saw the provider had taken prompt action to address these.

The management team had created an open culture and were passionate about ensuring the support offered to people was of consistently high standards. People’s voice was heard and sought in a number of different ways and staff contribution was valued leading to action by the service in response. Staff shared ideas and good practice.

Communication at the service was very good and staff were able to talk to the registered manager and felt empowered to play an important part in the future of the service.

The service was well managed by a team who used various monitoring and audit systems to maintain effective governance to ensure high standards across all areas of the service.

Further information is in the detailed findings below.