Availl (Bury St Edmunds)

Availl [Bury St Edmunds] is a domiciliary care service providing personal care to people in their own homes. 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. At the time of this inspection there were 27 people using the service, 13 of which were in receipt of personal care.

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

At our previous inspection we found shortfalls in staffing, safe care and treatment and governance. The provider sent us their action plan telling us what they would do to ensure compliance.

Whilst we found some improvement in the quality of care and risk management plans the service remained in breach of the regulation. Progress to make all necessary improvements to the governance and oversight arrangements was ongoing and due to some changes in management this had impacted on progress and timescales.

Systems in place to ensure staff received appropriate induction, support and training that is necessary for their role continued to be in need of improvement.

The service had been without a registered manager since February 2021. The provider's oversight and governance of the service continued to be ineffective.

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.

Right Support: The provider had safeguarding processes in place. Staff understood how to ensure people were protected from the spread of infection. However, people told us they experienced constant changes of care staff.

Staff were recruited safely.

Right Care: People told us staff were kind and caring and were treated with respect, however some people told us they did not always have the opportunity to give feedback. Improvements had been made to the provider's systems to assess and manage risks safely for people and were ongoing to support people to have maximum choice and control of their lives and for staff to support them in the least restrictive way possible and in their best interests; the polices and systems in the service to support this practice were also being reviewed.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives.

Systems for auditing had been introduced but needed further development to consistently evidence and document the actions taken and where applicable lessons learnt.

There were mixed views about the communication from the office, some people said it was good and others said it was not good at all. Staff told us the constant change in management had impacted on morale.

The provider had an electronic call monitoring system in place which for the most part was effective. People told us overall they felt safe with all staff who supported them. Risk management plans were in place, we have made a recommendation about improving risk assessments for people with a diagnoses of epilepsy.

We recommended the provider uses a reliable system to monitor staff care calls to ensure they continued to be delivered according to people's care plans.

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 December 2021) 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 some improvements had been made but the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two inspections.

Why we inspected

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.

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

Enforcement and Recommendations

We have identified continued breaches in relation to staff training and support, governance and oversight of the service.

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Availl [Bury St Edmunds] is a domiciliary care service providing personal care to people in their own homes. 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. At the time of this inspection there were 27 people using the service, 10 of these people were receiving support with personal care.

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

Risk management plans required more information to ensure care staff were provided with the guidance they needed as to how risks to people’s health, welfare and safety were to be monitored and reduced.

Medicines were not always managed in a safe way.

Care plans were brief and required more detail. We have recommended that communication plans are developed to support people to express their views.

We recommended the provider seeks advice from a reputable source, to ensure that end of life planning is considered in line with best practice.

Systems in place to ensure staff received appropriate induction, support and training that is necessary for their role needed improvement. It was not always evident staff had received induction support and training relevant to the role they performed.

The provider’s oversight and quality monitoring systems needed improvement. The provider showed us how they planned to implement a new auditing system to enable more effective monitoring of quality and safety. However, these systems and processes were not yet in operation and needed time to embed to be fully effective.

People told us staff were kind, caring and treated them with dignity. They told us they had not experienced any missed calls and if staff were running late the office kept them informed.

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, staff were not provided with training in equality and diversity. We recommended the provider access this training to ensure staff awareness of equality, diversity and human rights, recognising this as a vital part of preparing staff for their roles.

People knew how to contact the office and raise any concerns if needed. Complaints were investigated and responded to appropriately.

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

This is the first comprehensive, rated inspection since the service was registered with us on 25/04/2019.

Why we inspected

The inspection was prompted in part due to the service not having been rated since registration and to follow up on shortfalls we identified in relation to the management of people’s medicines and the provider’s response to safeguarding concerns identified at a targeted inspection in November 2020.

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 have identified breaches in relation to safe care and treatment, good governance and staffing at this inspection.

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

Follow up

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

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.

Availl (Bury St Edmunds) is a domiciliary care agency providing personal care to people living in their own homes. 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. At the time of our visit 35 people were receiving personal care from the service.

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

We received information raising concerns how people using the service and staff were being kept safe. This related to medicines management and reporting safeguarding concerns. We had received feedback from the provider about some concerns prior to our visit to the premises.

We found some concerns relating to the safety of medicines being administered to people. These concerns were not identified by the registered manager because auditing was lacking. Action to resolve this was being taken from the day of our inspection.

People liked that they were given information about who was coming to support them and when. People said they would like more consistency of staff. Despite the challenges of the COVID-19 pandemic the consistency of staff had increased of late. People said that they trusted staff and felt safe with them in their homes.

People liked the staff supplied and said communication with the office was good. Staff said that communication from the office was good. However, we found that not all staff communicated effectively with the office about events that placed people at risk.

Rating at last inspection

This service has yet to be formally rated.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about medicines and safeguarding matters. A decision was made for us to inspect and examine those risks.

Please see the safe section of this full report.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.