Aurora Home Care Ltd

Aurora Home Care Ltd is a domiciliary care agency providing personal care to a range of people with health and social care needs in their own homes. At the time of the inspection, 58 people received support.

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 said they felt safe, and that staff were kind and caring to them.

Care plans and risks to people's health, safety and welfare were in the process of a fully review by the new manager as a new system had been purchased and needed to be embedded.

We have made a recommendation about staffing. The provider had enough staff and had a continuous safe recruitment programme in place. People reported some calls running late and rotas often not sent out. The provider was addressing this and had employed new care coordinators to support this process, along with a new manager. The rostering system needed further work.

We have made a recommendation about governance. Quality assurance checks had improved and were starting to be fully utilised by the new manager and provider. Actions identified were not always recorded as having been followed up.

We have made a recommendation about communication. People and staff said that this was improving but further work was needed.

Medicines were generally managed well, and people received them in a timely manner. The new manager was in the process of reviewing medicines procedures.

Staff training had improved. The new manager had a training background and intended to fully review training to enhance the staff team’s abilities.

Staff followed infection control procedures and enough PPE was available to support the team.

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.

Staff worked in partnership with health care professionals to support people in their homes.

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 10 October 2022) and there were 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.

At our last inspection we recommended that the provider review their rostering system and infection control procedures. At this inspection we found the provider had acted on these recommendations and improvements had been made, although further recommendations were made.

Why we inspected

We undertook this focused inspection to check the provider 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, Effective and Well-led which contain those requirements. 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 requires improvement to good based on the findings of this inspection. Please see the safe, effective, and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aurora Home Care Ltd 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.

Aurora Home Care Ltd is a domiciliary care agency providing personal care to a range of people with health and social care needs in their own homes. At the time of the inspection, 63 people received support.

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

Quality assurance checks were poor and although the provider had numerous good systems in place, they were not fully utilised.

Risks to people's health, safety and welfare had not been consistently reviewed to make sure measures were in place to reduce the risks. Many care plans had not been regularly updated and some were still on the providers previously registered service paperwork.

Staff training was not robust, and staff told us they were not supported.

Medicines were not always managed well. For example. when people required medicines on an 'as required’ basis, the guidance for staff had not been consistently completed. Staff medicine competencies had not always been carried out effectively.

Infection control procedures were not always safe. Staff had not always followed guidance. We have made a recommendation about this.

The provider had enough staff to support people although some staff were absent due to sickness, and others were new to the organisation. The rota system for planning care calls was not well organised which made it difficult for staff to arrive on time and stay for the amount of time required. We have made a recommendation about this.

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 their relatives confirmed care staff were kind and caring. People received meals and drinks in line with their care plan. Staff worked well with other health and social care professionals.

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 3 October 2020).

Why we inspected

We received concerns in relation to the care people received and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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. Please see the safe, effective 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 Aurora Home Care Ltd 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, staffing and 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.

The service is a domiciliary care agency which provides personal care to people living in their own homes throughout Northumberland. At the time of this inspection there were 52 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

People felt safe with the staff who visited them. People’s care needs were risk assessed and risk reduction measures were in place. Accidents and incidents were investigated, recorded and acted upon to prevent a repeat occurrence.

Staff were fully aware of safeguarding procedures. Systems were in place to protect people from the risk of abuse. Medicines were managed well and there were good infection control measures in place.

Staff recruitment was safe, and the registered manager was actively recruiting more staff. Appropriate training was provided. Staff were supervised and spot checked to ensure competency.

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 provider and registered manager promoted a person-centred culture. There were good working relationships between staff, relatives and external professionals to ensure people got any extra support they needed to achieve their goals.

The registered manager and provider had met their regulatory requirements. Improvements had been made to the service and staff continued to learn and develop. The registered manager monitored the quality and safety of the service through checks of the records. The provider had oversight of this.

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 19 October 2019) where we identified three breaches of the 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.

Why we inspected

We undertook this focused inspection to check the provider 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, Effective 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 improved 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 Copper Beech Homecare Ltd 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.

The service is a domiciliary care agency which provides personal care to people living in their own homes throughout Northumberland. At the time of this inspection there were 40 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

Although there had been improvements in the service, shortfalls remained in the leadership and management of the service which impacted on the service people received. Quality assurance checks had not been effective enough to fully identify and address concerns, to drive all the necessary improvements forward.

Some policies and procedures continued to be inconsistently followed by staff. Consequently, there were aspects of the service which remained non-compliant with regulations and exposed people to the risk of harm.

The service was not entirely safe. Specific risks to people's health, safety and welfare had not always been fully assessed. Some risks were not recorded, meaning people were not always fully protected from harm. Medicines were not managed in line with best practice guidance.

Staff were not always inducted and trained appropriately. Senior staff had not always properly supervised or checked staff to ensure they had the skills and competence to carry out their role.

Better systems were in place to identify, monitor, record and report matters which may be a safeguarding issue. Safeguarding matters were now being reported as necessary to the relevant authorities.

A safer staff recruitment process was in place, however on occasions there was a failure to ensure suitable references were sought. There were enough staff to operate the service.

Formal consent to care and treatment had been obtained. Relatives who had the legal right to make decisions, were involved in how care was delivered. However, records around consent were not always clear and robust.

There was an improvement to the provider’s response to complaints, however staff were inconsistent with implementing the correct procedures which meant record keeping in this area required more improvement.

Person-centred care planning was still not fully embedded into the service. Care plans and risk assessments were inconsistently completed. Some records were vague, whilst others contained in-depth personal details to ensure care workers could look after a person in line with their needs, preferences, wishes and choices.

People told us their privacy and dignity were respected, and their care workers were caring and friendly.

We have identified three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 (report published 7 May 2019) and there were multiple 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, not enough improvement had been made and the provider was still in breach of regulations.

This service has been in Special Measures since May 2019. During this inspection the provider demonstrated that some 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 was a planned inspection based on the previous rating.

Enforcement

We have identified continued breaches in relation to safe care, staffing and the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the 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: There were significant shortfalls in the leadership and management of the service which impacted on the quality of care people received. The provider and registered manager failed to adhere to registration regulatory requirements. Robust governance was not in place and subsequently audits and checks had been ineffective in driving the necessary improvements.

Policies and procedures were not properly implemented or followed by staff. Consequently, there were many aspects of the service which were non-compliant with regulations and exposed people to the risk of harm. Most relatives raised concerns about the care their family members received and several whistleblowing allegations were made by staff.

The service was not safe. Systems to identify, monitor, record and report matters which could be a safeguarding issue were not followed properly. Safeguarding incidents and allegations of abuse had not always been properly managed or reported as necessary to the relevant authorities which meant people were at risk of a reoccurrence.

Risks to people's health, safety and welfare had not been adequately assessed. Specific risks were not recorded, meaning people were not protected as much as possible from harm. Medicines were not managed properly which led to multiple errors.

Recruitment processes were not robust. Recruitment checks were not always followed up. There were not enough staff employed to meet people’s needs and wishes. Staff were not properly inducted or suitably trained to ensure they had the skills and competence to carry out their role.

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; the policies and systems in the service did not support this practice .

Formal consent to care and treatment was not always sought. Relatives who did not hold the legal right to make decisions were instructing staff on how to deliver care to their family member. Assessments of people’s needs and the care arranged did not always meet best practice guidance. Staff were not always proactive with referring people for additional help from external professionals.

Complaints were not always managed in line with the company policy and procedure. Relatives told us they had frequently complained about the service and expressed dissatisfaction with the service their family members received.

Person-centred care planning was not embedded into the service. Care records were often generic and not related specifically to each individual. Records were not always accurate or completed.

People supported by regular, experienced care workers experienced better outcomes than those who were not. Although there had been allegations of neglect and ill-treatment of people, there were other people who told us their privacy and dignity was respected and their care workers were caring and kind.

We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding, complaints, good governance, staffing, recruitment and consent. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009, entitled, Notification of other incidents.

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

Rating at last inspection: This was our first inspection of this service since it’s registration in March 2018.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement: 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.

Follow up: At this inspection the service has been rated 'Inadequate'. Therefore, the service is now in 'Special Measures'. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months to check for significant improvements.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If enough improvement is not made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.