At Home Support Services Limited

At Home Support Services is a domiciliary care agency providing personal care to older people living in their own homes. At the time of the inspection there were 11 people receiving support from the service.

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

People and relatives told us they were happy with the care that was provided by At Home Support Services and felt staff knew them well and understood their needs.

The provider had failed to ensure there were accurate and contemporaneous records of the care being provided to people. This included ensuring medicines and people’s risks were documented and securely maintained. Auditing systems were ineffective and failed to pick up issues found at this inspection.

We have made a recommendation around medicines management.

People told us they received their medicines on time. Staff had received training on medicines administration. Staff understood safeguarding and how to report concerns if they felt people were at risk of abuse or harm. Staff were recruited safely, and appropriate background checks completed prior to starting work. Staff had received training in COVID-19, the use of PPE and infection control. Staff had regular access to PPE.

Staff were supported in their role through regular supervision, training and appraisal. People and relatives felt staff were well trained and understood people’s care and support needs. People were supported to eat and drink where this was a required need. 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 relatives were complimentary of the registered manager. We received positive feedback around communication with the office and being able to discuss any concerns or issues. Staff also felt supported in their role. There were regular surveys to gain people, relatives, healthcare professionals and staff feedback. The service worked in collaboration with external healthcare agencies for the best interest of people.

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 06 March 2020). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 a breach in relation to regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was around ensuring effective auditing systems and maintaining accurate and contemporaneous records of people’s care.

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

At Home Support Services Limited is a domiciliary care agency providing personal care to older people living in their own homes. At the time of the inspection there were 27 people receiving support from 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 and relatives were happy with the care provided by the service. People said they felt safe with staff when they were in their homes conducting care visits. People felt staff treated them with dignity and respect and listened to their needs.

People’s personal risks were assessed. However, there was no guidance available to staff on how to minimise the known risks. Whilst we did not find anyone was harmed because of this issue, this placed people at potential risk of harm.

At our last inspection there were significant concerns around late visits. At this inspection this had greatly improved. We received positive feedback from most people and relatives who told us staff were on time. However, some feedback indicated that late visits still happened, but much less regularly.

People received their medicines safely and on time. People and relatives were happy with the support care staff gave with medicines. There were enough staff to ensure people’s needs were met. People told us they usually had the same care staff visiting them. Staff were safely recruited.

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. Where identified as a need, people were supported with preparing simple meals and encouraged to eat and drink. Staff received appropriate supervision, appraisal and training to support them in their roles.

People and relatives were involved in planning care and care plans were reviewed regularly. People understood how to make a complaint and felt confident issues would be addressed if they did.

There was an open culture within the service that promoted learning. Any issues were discussed, and actions put in place to address them. Staff were fully informed of any changes. There were systems in place to audit various aspects of the service. Surveys encouraged people and relatives to provide feedback which was then acted on to promote a better quality and experience of care for people.

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 17 December 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

We have found evidence that the provider needs to make 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. We found no evidence during this inspection that people were at risk of harm from this concern.

Enforcement

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

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.

At this inspection we found improvements in the management of medicines and people generally received their medicines safely as prescribed. People told us that staff continued to be late and that they sometimes did not know which care worker would arrive. People were unhappy with the staff and the way the office staff planned the staffing. Despite people’s dissatisfaction and staff being late having a negative impact on people’s wellbeing, the provider had improved two weeks before this inspection.They had installed a new call monitoring system so they could see where staff were and receive an alert if a care worker was running late. This gave them opportunity to inform the customer and to provide an alternative care worker if necessary. The new system was making effective improvements in the timeliness of staff attending care visits.

At Home Support Services Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. The head office is based in Enfield and the service is provided to people living in Hertfordshire. At the time of this inspection the service was providing personal care services to 24 people. The service they received ranged between one and four visits each day to live-in care.

The service had a registered manager who was also a director of the company. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered 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.

Feedback from people using the service and their relatives was that they were not satisfied with the service.They said staff were often late and they were not happy with the conduct of some staff.They said the office staff were hard to get hold of, especially at weekends.

Staff were not safely recruited as they provider had allowed staff to start work before receiving any references to check on their conduct in previous employment.

Some people using the service said that staff did not appear to know what they were doing and had not read the care plan. The provider had retrained staff shortly before the inspection and was satisfied that improvements had been made. Staff had completed training in relevant topics. The provider had recently improved staff supervision and direct observation of staff when in people’s homes to see if they were working to a good standard.

People had care plans setting out their needs in a way that was easy for staff to follow. People said that some staff were caring but others were not respectful or friendly and were “rough” when providing personal care.

People told us their concerns and complaints were not always addressed fully or quickly. We saw some complaints were investigated well and the provider had given a full apology when things had gone wrong but some concerns had not been recorded properly.

The provider had recently improved their quality monitoring and was working with the local authority which commissioned their service in order to make improvements. The authority reported that they had suspended placements with this service (so no new people would be referred to the service) but that the provider was working with them to make the necessary improvements and people had begun to report improvements to their care.

We found two breaches of legal requirements which was due to staff not being recruited safely and lack of effective oversight of the service. You can see what action we told the provider to take at the back of the full version of the report.

This was an announced inspection and the service was given 48 hours' notice. This was to ensure that the registered manager would be available at the office to provide us with the necessary information to conduct the inspection.

This inspection was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in February 2016.

At the time of the inspection there were 32 people using the service. The service provides personal care to older people some of whom are living with dementia or have physical disabilities.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered 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.

Medicines were not always safely managed. Medicine Administration Records (MAR) contained gaps and recording errors.

We received concerning feedback about staffing levels and punctuality. The registered manager was in the process of implementing electronic call monitoring system. However, current management oversight of late and missed calls was inconsistent.

Complaints were investigated and analysed for trends for improvement. However, people and relatives told us that their complaints regarding late and missed calls had not resulted in improvements to the service they received.

People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. Staff demonstrated an understanding of the types of abuse to look out for and how to raise safeguarding concerns.

We saw evidence of a staff induction and on-going training programme. Staff were safely recruited with necessary pre-employment checks carried out. However, we found instances of insufficient documented referencing. Staff received regular supervisions.

We received positive feedback from most people and relatives who told us staff were caring and responsive to their needs.

We found that care plans were person centred. Care plans provided appropriate guidance to enable staff to deliver person centred care in line with people's needs and preferences.

The provider obtained consent for care in accordance with the Mental Capacity Act 2005.

There were quality assurance measures in place, such as regular spot checks and feedback surveys. An action plan identified areas for improvement for the service such as electronic call monitoring and improved management of medicines.