Affection Care Services Ltd (Bucks)

Affection Care Services Ltd (Bucks) is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection 23 people were being supported who lived in the Princes Risborough or High Wycombe area of Buckinghamshire.

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

People were not routinely supported by staff who had been recruited using robust and safe processes. Not all staff had received pre-employment checks prior to supporting people. Staff received training either after their start date or well before their start date. Fifty percent of staff who provided feedback told us their training did not prepare them to support people safely. This was supported by comments from people.

People were not routinely supported with their medicines as prescribed. Pain relief medicine was given too soon to 1 person on a regular basis. Records relating to medicine were not always accurate.

People were supported by a service which needed more effective management systems and processes to drive improvement. Action plans developed and completed did not reflect the records we viewed. The provider did not ensure all regulations were met.

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; however, the policies and systems in the service could be improved to support this practice.

People told us they were happy with the support the care staff gave them. Comments included “I have no problems with the carers, they treat me with respect”, “They are kind and caring” and “I have nothing bad to say about the carers”.

Relatives told us “I find them [staff] good”, “They include me in the care and respect me” and “The manager is very responsive and nice”.

Staff had access to risk assessments and found they contained the information needed to reduce injury or harm to people/keep people safe from harm.

The service worked well with external social and healthcare professionals.

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 12 December 2019) and there were 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 the provider remained in breach of regulations.

Since the service has been registered with us on 9 October 2018 it has remained rated as requires improvement.

Why we inspected

We carried out an announced comprehensive inspection of this service on 28 and 29 October 2019. Breaches of legal requirements were found.

We have found evidence that the provider needs to make further 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.

This report only covers our findings in relation to the key questions Safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Affection Care Services Ltd (Bucks) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, staff recruitment 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.

Affection Care Services Ltd (Bucks) is a domiciliary care service providing personal care to people in their own homes. The service was registered with the commission in October 2018, this is its first inspection. At the time of the inspection 18 people were using the service.

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

This service was registered with us on 22 October 2018 and this is the first inspection. People told us they felt safe with the care the service provided.

We found the recording of the administration of medicines did not always reflect medicines had been administered in a safe way. There were no risk assessments in place for medicines and there were no “as required” (PRN) protocols in place to advise staff on when to give some medicines. The provider had a plan in place to increase the training for staff in this area, but this had not taken place at the time of our visit.

Care plans were in place for people, however some risks assessments were not in place. For example risk assessments related to people's health needs.

Staff understood how to protect people from abuse, however, the senior staff required further training in responding to allegations of abuse. This training was being sourced at the time of our visit. The information provided to staff about how to report safeguarding was not up to date or accurate. The registered manager told us they would amend this immediately.

We found sufficient checks had been carried out to minimise the risk of employing unsafe staff. There were sufficient numbers of staff to support people and care for them safely. Staff received training and support to enable them to carry out their role.

People described staff as “Super”, “Friendly and competent”. “Very helpful” and “Very Caring”. They felt comfortable raising concerns and providing feedback to the provider. People were supported with eating and drinking if this was an identified need. Where people’s health needs required external professional interventions, people were supported to receive this, and any recommendations were followed through by staff. They worked with external agencies to ensure care was consistent, appropriate, and safe.

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 service aimed to provide person centred care, records reflected how people’s individual needs had been assessed and a care plan was then devised to meet their needs. Staff were seen to go beyond expectations when they supported a person to enjoy an outing into the community. Where possible staff spent time with people discussing topics of interest.

The service was not providing end of life care but planned to do so in the future once training for staff had been undertaken. The registered manager worked hard to establish the service and was open and receptive to feedback and new ideas. They were clear of their aim to provide the best care they could to people.

People spoke positively about the management. They felt there was an open and honest culture and when issues arose these were responded to quickly and effectively. The registered manager was aware of their responsibilities under the duty of candour. They had quality assurance audits in place, but these needed to be developed to give a more detailed overview of the service, including medicines, risk assessments and records. The registered manager had been planning to address some of these areas before our visit.

You can see what action we have asked the provider to take at the end of this full report.

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

Why we inspected

We carried out this inspection as part of our inspection programme.

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.