Archived: Aspects Care Limited - Grimsby

Aspect Care Ltd – Grimsby is a domiciliary care service providing care and support to older people and younger adults, as well as people who may be living with a learning disabilities or autistic spectrum disorder, dementia, mental health need, or a physical disability.

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 inspection only three people were being supported with personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control and choice. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

At the last inspection the provider had rushed recruitment processes so that the service sometimes let staff start shadowing before their checks were through or references were confirmed. Staffing numbers were insufficient and care coordinators were relied on to make visits and so worked extra hours. People did not have the benefit of a quality assurance system that identified shortfalls in all areas of the service or that were analysed for trends and reported on. We made recommendations about these.

People’s experience of using the service and what we found.

At this inspection, while some improvements were made, people did not always have the benefit of a service that was positive, inclusive and forward-looking. There was no registered manager for the past 12 months. This had been an unsettled period for everyone, due to a lack of direction for staff, some of whom had left along with the previous manager. People received an inconsistent service with these changes and the increased use of agency staff. Ineffective checks on how well the service was provided meant the quality assurance and monitoring systems were still ineffective. People had not always experienced support with independence. People told us they were not encouraged to live as independently as they wished to.

People continued to receive a good service in other areas. They were safe from harm. Systems and appropriately recruited staff supported this. People's risks were safely managed. Sufficient numbers of staff were employed to support them in taking risks. People were safely supported with handling medicines and with keeping their home clean.

Staff were trained, skilled and well supported by the provider. People had good relationships with the staff who protected their rights to lead a normal life in many areas. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us staff were kind and caring. People said their privacy and dignity were respected and staff were discreet.

Staff were now motivated to provide person-centred care based on people's choices and preferences. Staff had experienced an unsettled period where direction was missing. They were now demonstrating a change in attitude because supervision and guidance from the manager had improved. This meant people were better supported to do the things they wanted to. Any dissatisfaction in receiving the service was addressed and resolved.

Documents held in the office were secure to ensure confidentiality of people's information.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control and choice.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice, control and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills.

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

Rating at last inspection

The last rating for this service was requires improvement (published 23 August 2018), but there were no breaches of regulation. Since this rating was awarded the service has moved premises.

We have used the previous rating to inform our planning and decisions about the rating at this inspection, where we found there had been some improvement in the areas we identified last time. However, insufficient improvement in one area meant a new breach of regulation was identified.

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

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aspect Care Limited - Grimsby on our website at www.cqc.org.uk.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we rated the service as ‘requires improvement’. This was because care had not always been taken with recruitment processes, staffing levels were too reliant on care coordinator cover and the management of the service was not as efficient as it might me. However, there was a newly registered manager who had been in post for the last two months and the provider was no longer in breach of their registration requirements in this regard. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Aspects Care Limited – Grimsby located in the town centre of Grimsby in North East Lincolnshire has an office on the first floor of a privately rented building. The building offers a lift to all floors and provides car parking spaces to the front.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults and younger disabled adults. The service was supporting 15 people at the time of our inspection. Five of these people live in their own homes. Six people live in their own ‘supported living’ flats in Willow House, Crosland Road and four live in a shared bungalow on Station Avenue, all of which are in the Grimsby area. People that live in supported living have tenancy agreements with their prospective housing associations. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living and therefore this inspection looked at people’s personal care and support.

This service provides care and support to people living in two 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Aspects Care Limited – Grimsby receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance, with regards to the supported living houses. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At this inspection we found that staff recruitment processes were rushed so that the service sometimes let people start shadowing before their checks were through and references were often received via the telephone or were testimonials only. We made a recommendation about this.

Staffing numbers were insufficient as delegation of work tasks were unequal, with care coordinators taking up visit duties to ensure everyone received the support they required. This was because the two care coordinators employed were frequently covering staff sickness and visits that could not be allocated to support staff. There was also some inconsistency in the timely compilation of staffing rotas. While people had not been at risk or experienced any harm, it was clear that staffing numbers were insufficient at times of unforeseen circumstances to cover the number of care packages that the agency was allocated. We made a recommendation about this.

The provider’s quality assurance system was not always effective at identifying shortfalls in the service. Audits, satisfaction surveys, meetings, and spot checks on staff were carried out, but they were not extensive enough to cover all areas of practice. Nor were the findings of the quality assurance system formally analysed and reported on. We made a recommendation about this.

People were protected from the risk of harm and staff were trained in and knowledgeable about safeguarding people from abuse. Risk was safely managed. The management of medicines was safe and systems in place demonstrated there was an effective audit trail for handling all drugs. Staff followed good hygiene for safe infection control and prevention. Systems in place acknowledged and recorded when things went wrong and lessons were learnt to ensure problems or mistakes were not repeated.

Staff encouraged people to make choices and decisions wherever possible to exercise control over their lives. People were cared for and supported by qualified and competent staff who were themselves regularly supervised and received annual appraisals of their personal performance. Staff respected the diversity of people and met their individual needs. People’s nutrition and hydration needs were appropriately supported to aid their health and wellbeing.

People’s mental capacity was appropriately assessed, but by the local authorities that contracted packages of care. Their rights were protected even though the service did not carry out its own capacity assessments. People were supported to exercise choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager followed the ‘best interests’ route where people lacked capacity to make their own decisions. Consent for support to take place was respected so that staff always sought people’s cooperation and agreement before completing any support tasks.

People were supported with compassion by kind staff who knew about people’s needs and preferences. People were involved in their care and their right to express views was respected. Wellbeing, privacy, dignity and independence were also respected. This ensured people felt satisfied and enabled to make choices regarding their lives.

Support plans laid the foundations for good care. They reflected people’s needs well and were regularly reviewed. People were encouraged to maintain family connections and support networks and their communication needs were assessed and met. An effective complaint procedure in place ensured people’s complaints were investigated without bias. The service sensitively managed people’s needs with regards to end of life preferences, wishes and care.

The culture of the service was friendly and caring, which ensured good outcomes for people, but it was not inclusive of or empowering for people and staff. This was discussed with the Nominated Individual, who had already identified some areas for improvement in the management systems being operated, and was providing support to the manager. The registered manager understood their responsibilities, but practiced a management style that was not always based on shared responsibilities or included everyone employed at Aspects Care Limited – Grimsby in the running of the service. The registered manager aimed to achieve continuous learning and good practice. The service fostered good partnerships with other agencies and organisations.

Further information is in the detailed findings below.