Afresh Healthcare Limited

Updated 20 June 2023

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 team consisted of 1 inspector.

Service and service type

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

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

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 the registered manager would be in the office to support the inspection.

Inspection activity started on 10 May 2023 and ended on 1 June 2023. We visited the location’s office on 15 May 2023.

What we did before the inspection

We reviewed information we held about the service since they registered with the CQC. 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 used all this information to plan our inspection.

During the inspection

We spoke with 1 person who used the service about their experience of care provided. We spoke with 4 members of staff including the registered manager and care workers.

We reviewed a range of records. This included one person’s care records. We looked at 3 recruitment files and staff supervision documentation. We also reviewed a range of documents relating to the management of the service including policies and procedures and the provider’s training matrix.

We reviewed documents during our visit to the office but continued to review documents via our secure electronic file sharing platform.

Updated 20 June 2023

About the service

Afresh Healthcare Limited is a domiciliary care service providing personal care to people living in their own homes. The service provides support to people living with dementia, older people, and younger adults. At the time of our inspection there was 1 person using the service.

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

Risk management needed to be improved. Risk assessment documentation was not in place for a person who had been previously assessed by the registered manager as being at risk of developing pressure sores. This meant staff would not know how to identify and manage those risks.

Enough staff were employed to provide the care people needed but the registered manager was unable to demonstrate staff had been recruited safely.

People’s medicines were not always managed safely. People told us that when they needed support with their medicines staff were there to support them. However, medicines administration records (MARs) which were written by the service did not have sufficient information on them to ensure the possible risk of administration was mitigated. For ‘when required’ medicines, also known as PRN medicines, these were not listed on the MAR chart or in the care plan and clear directions for staff on how PRN medicines should be taken or given was not evident.

People were asked to give their consent for support and the principles of the Mental Capacity Act were followed. People were supported to have a 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. However, staff had variable knowledge about the MCA.

People were at risk of poor care and support because the registered manager did not have effective auditing and governance systems in place to monitor the quality of the service. Audits had not been robust to identify the concerns and shortfalls we found on the inspection. Opportunities to learn lessons could have been missed.

People felt safe with the care and support provided by the service. All staff had received safeguarding training and knew how to protect people from potential harm.

The services infection prevention and control policies and procedures were being adhered to, ensuring both staff and people using the service were protected from cross contamination.

People’s needs were assessed prior to using the service. People felt listened to, respected, and involved in decisions about their care and support. Each person had a personalised care plan in place which detailed their care needs and preferences and gave staff guidance on how to provide safe and effective care. These were reviewed regularly.

Staff had completed all mandatory training and some staff were being supported by the registered manager to achieve further accredited training. Observational checks of staff practice were taking place.

Staff treated people with respect and upheld their privacy and dignity. People described staff as very polite, respectful, kind, and caring. Staff knew people well and encouraged them to be as independent as possible.

People and staff were positive about the registered manager. Staff said the registered manager was approachable, welcomed ideas, and always responded.

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

Rating

This service was registered with us on 25 January 2022, and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection. We have also made recommendations that the provider considers current guidance in relation to managing medicines and recruitment of new staff.

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.