Aroma Care - Cotswold

Aroma Care – Cotswold is a domiciliary care service that provides personal care and support to people living in their own homes. At the time of our inspection there were 63 people using the service.

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

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.

We received mixed feedback from people, relatives and professionals in relation to staffing and consistency of care. The records we sampled confirmed that people’s visits were not always being delivered in accordance with their assessed need.

Governance and oversight across the service was in place. However, it had not always been effective in ensuring timely action had been taken to drive the necessary improvements with regard to staffing and consistency of care. The registered manager told us they were working to ensure audits were completed reliably and consistently. During our visit we did not see these improvements as they were yet to be reviewed and embedded.

Staff had access to the provider’s safeguarding and whistleblowing policies which were kept up to date. Staff told us they felt comfortable and confident to raise any concerns.

Staff spoke positively about the registered manager and told us they felt supported in their role.

Staff had received infection control training and had access to personal protective equipment (PPE) to safely manage and control the prevention of infections.

The registered manager understood their responsibilities around the duty of candour and to be open and honest with people when something goes wrong.

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 23 September 2020).

Why we inspected

We received concerns in relation to staffing and consistency of care. 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.

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 Aroma Care - Cotswold on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to staffing 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 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.

Aroma Care-Cotswold (the service will be referred to as Aroma Care throughout this report) is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 34 people at the time of the inspection.

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 positive about the caring nature and approach of staff. They told us they felt safe when staff visited and were confident that any concerns would be dealt with promptly. Appropriate numbers of staff were employed to deliver the care and support people required. Where people were supported with medicines, they received support from staff who had received training around this and medicines were managed safely.

Infection prevention measures had been established within the service. Staff had a good understanding of these procedures and people confirmed staff were wearing protective equipment when visiting people in their homes.

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.

The manager acted on concerns to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm. Any concerns or accidents were reported and acted on.

The manager had developed a variety of quality assurance systems to monitor the overall quality of the service provided to people. These systems had led to improvements in the quality of the service being provided to 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)

The last rating for this service was requires improvement (published 11 March 2020) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 27 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe Care and Treatment and, Good Governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were 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 Aroma Care-Cotswold 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.

Aroma Care-Cotswold (the service will be referred to as Aroma Care throughout this report) is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 31 people at the time of the inspection.

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

The management of medicines within the service was not always safe. Staff practices in relation to medicines were not always in line with national guidance or the provider’s policy.

The management monitored the delivery of care through staff observations and feedback from people. However, we could not be satisfied that the quality assurance systems used within the service were always effective. Shortfalls within the service were not always identified. Where shortfalls had been identified, there was a lack of evidence as to what action had been taken to address the shortfalls. Subsequently, these shortfalls were still present at the time of the inspection.

Staff had received safeguarding training. However, staff understanding in relation to whistleblowing was not always clear. The staff we spoke with were unable to state which outside agencies they could escalate concerns to if they felt management had not taken appropriate action regarding safeguarding and whistleblowing concerns.

People and their relatives were positive about the caring nature and approach of staff. People told us they were supported by staff who were kind. They told us they felt safe when staff visited and were confident that any concerns would be dealt with promptly. Appropriate numbers of staff were employed to deliver the care and support people required.

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 had been developed in partnership with them and their representatives. People and relatives told us their opinions had been considered when developing their care plans. Where people were supported with their nutritional needs, they told us staff offered them a choice as to what they would like to eat and took their preferences into account.

Staff had received training which was appropriate to their role. Staff told us they received regular support from management. Staff told us they could seek advice from the manager and senior carers. The service communicated and engaged with others such as family members to improve the lives for people who used the service.

The manager acted on concerns to ensure people received care which was safe and responsive to their needs. Any concerns or accidents were reported and acted on.

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 18 April 2019) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s medicines and staffing levels within the service. A decision was made for us to inspect and examine those risks.

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 Aroma Care-Cotswold on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of medicines and quality assurance systems 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.

People’s experience of using this service:

¿ People told us they had established relationships with their regular care workers and were satisfied with the care they received from these care workers.

¿ Improvements had been made and people’s care visits had not been missed. People, however, still experienced late care visits and they told us this impacted negatively on their experience of their care and meant they were often waiting for their care. They were not always told their care was running late and at times did not know who was attending to their visits.

¿ The provider monitored the quality of the service and asked people for their feedback about their care. We found what people told us about their experience and satisfaction of the service did not correspond with the positive feedback that had been recorded by the service.

¿ The provider’s action plan following our previous inspection had addressed some shortfalls but had not made the required improvements to the timeliness of people’s care visits.

¿ Recruitment processes had improved and people were supported by staff that had been appropriately vetted to ensure they were suitable to support people.

¿ Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns.

¿ The service assessed risks to people's personal safety, as well as staff, and plans were in place to minimise those risks.

¿ People were supported by staff that had received the training and support to provide effective care.

¿The information in people’s care plans had improved and gave staff guidance about people’s care tasks. The service was planning further improvements to ensure some information about people’s preferences and wishes would also be included.

Rating at last inspection: At the last inspection on 18 and 20 December and 8 January 2018 the service was rated Requires Improvement. (This report was published on 18 February 2018).

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions, Is the service safe, effective, responsive and well-led? to at least Good

We met with the provider in March 2018 who told us they were introducing an electronic planning and monitoring tool to ensure there was a system in place to monitor missed and late care visits and ensure areas of concern found at our last inspection would be monitored effectively.

Why we inspected: We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We also followed up on progress against agreed action plans to address the breaches in regulation we found at our previous inspection in December 2017 and January 2018. Previous CQC ratings and the time since the last inspection were also taken into consideration.

The overall rating for the service remains rated as Requires Improvement.

Follow up: We will ask the provider to complete an action plan to show what they would do and by when to meet the legal requirements and to improve the key questions ‘Is the service Responsive?’ and ‘Is the service Well-led?’ to Good.

We found what people told us about their experience and satisfaction of the service did not correspond with the positive feedback that had been recorded by the service. We asked the Services Manager to contact people and explore the reasons for this conflicting information and to report back to us their findings.

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

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

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.

The provider was given 48 hours’ notice because the service provides a domiciliary care service; we needed to ensure we would be able to meet with people where they were receiving the service. At the time of the inspection, the service was supporting 44 people in their own homes.

Not everyone using Aromacare - Cotswold receives a regulated activity; CQC only inspects the service being received by people provided with the regulated activity of ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We carried out this inspection as a social worker shared information with us in November 2017 which indicated potential concerns about the care being provided and the management of the service. This inspection also examined these concerns.

Aromacare - Cotswold is a newly registered service and this was their first inspection and rating. We rated the service as ‘Requires Improvement’.

Aromacare - Cotswold registered with CQC in July 2017. The service had taken over people’s care from another care provider at short notice. We found some areas that require improvement and discussed these with the director and registered manager of the service. They were already aware of some of these concerns and had drawn up a detailed improvement plan with timescales during our inspection to start addressing the concerns we found.

There was a registered manager in post at 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was not always safe. People’s care visits had not always taken place as planned and people had experienced late and missed visits. Individualised contingency plans had not always been noted in people’s care plans to ensure consistent action would be taken to keep people safe when their staff were running late.

Staff had been provided with training on how to recognise abuse and how to report allegations and incidents of abuse. However, CQC had not always been notified of missed care visits which would require action from the service to ensure people were protected and safeguarded from neglect. Criminal checks had been completed for all new employees however records of references and work history were not always completed appropriately to ensure all staff were suitable for their roles.

The service was not always effective. When people’s care ran late people were not always supported to eat and drink at their planned times and in line with their preferences. We made a recommendation about individualised meal time support.

Training completed by staff included, first aid, safeguarding vulnerable adults, medication administration and moving and handling. Staff told us they had the training and skills they needed to meet people's needs. The service was adhering to the principles of the Mental Capacity Act 2005(MCA). Staff were receiving regular supervisions and attending team meetings.

Care and support plans were not always person centred. They had been updated and reviewed however important information was missing or not available to ensure staff would have all the information they needed to provide personalised care.

The service was not organised in a way that always promoted safe and quality care through effective monitoring systems. Some effective monitoring systems were in place but further systems and processes needed to be implemented and maintained in order to improve the standard and delivery of care which was being provided. People and their relatives were not always confident with the management of the service and told us they did not always feel like their concerns were listened to.

People were supported to access healthcare professionals when they became unwell.

We found four breaches of 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.