Archived: AHSL Care At Home

Updated 9 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post. The registered manager for the service is also the provider. We refer to this person as ‘the provider’ throughout this report.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 1 September 2022 when we visited the service’s registered office address and ended on 30 September 2022.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We sought feedback from the local authority about this service. We used all this information to plan our inspection.

During the inspection

We spoke with 1 person who used the service and 2 relatives of people using the service, about their experience of the care provided. People requested that we did not use their comments in this report. We spoke with the registered manager who is also the provider, a care co-ordinator and 4 care workers. We reviewed 4 people’s care plans and risk assessments. We reviewed 9 staff files to look at the recruitment, training and supervision records.

Updated 9 November 2022

About the service

AHSL is a domiciliary care agency providing personal care in people’s own homes. At the time of the inspection the service was providing personal care to four people. Not everyone who used the service received personal care. Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene, eating and administration of medicine. Where they do, we also consider any wider social care provided.

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

Risks to people’s health and safety were not always fully assessed and care records did not consistently reflect people’s current health needs. For example, although staff were aware of a risk to a person's health, there was no risk assessment to address and manage the risk. There was a lack of detailed information in care records to make sure staff knew how to support people safely. The provider was in the process of updating their computerised care record and care planning system to address concerns but there was no evidence of how this would be managed. This meant there was not always evidence to demonstrate risks to people’s health and safety were being effectively assessed, monitored and mitigated. Systems were not followed to make sure staff were working safely. Improvements were needed in systems to audit and address issues in relation to medicines management and safe recruitment and support of staff.

Systems were in place to make sure any concerns about people’s safety were addressed and reported appropriately. People told us they felt safe when they were being supporting and were complimentary of the care staff.

Governance systems were not sufficiently robust to ensure all aspects of the service were safe or to identify areas needing improvement. Audits of systems and documentation had not been completed to measure quality and make sure people received a safe service. Safe arrangements for the management of the service were not always put in place when the provider was on leave. Concerns were shared with us about the management of the service. Staff felt their ideas for improving the service to people were listened to.

The provider had worked with the local authority to develop an action plan to improve the quality of service provision.

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 Good (published 6 November 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions safe and well led. 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 inadequate 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 AHSL 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 breaches in relation to safe care and treatment and good governance.

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 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 6 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 the 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.

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.