Amber Valley Total Care

Amber Valley Total Care is a domiciliary care agency providing personal care to people in their own homes. The service supports younger and older people, including people with dementia. At the time of our inspection there were 52 people using the service.

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

The governance of the service was not effective because systems were not in place to identify areas where improvements were needed. Audits were not always effective in identifying where actions needed to be taken. The provider was not sure about what incidents and events they were legally required to report to CQC in line with their regulatory requirements.

The culture of the service was not inclusive and empowering for all staff. Some staff felt unable to raise concerns due to the structure and dynamics in the management team.

Risks to people were not always assessed and plans to mitigate risk and guide staff on how to support people in relation to specific risks were not always in place.

Staff were not recruited safely; pre-employment checks were not completed thoroughly.

People were not always supported safely with their medicines because the recording of medicines were not in line with best practice guidance.

We could not be assured that people were supported to have maximum choice and control of their lives or that staff supported them in the least restrictive way possible and in their best interests; because the policies and systems were not in place to support this practise.

People felt they were safely supported by the care staff. The care staff had good awareness of abuse and neglect and knew how to report any safeguarding concerns. However, people were at increased risk of harm because staff were not safely recruited, risks were not adequately assessed, care plans were not always comprehensive and there were shortfalls in communication between the staff and management.

Care staff received appropriate training and were confident in supporting people with their care. They attended to people's needs in a timely manner and had enough time allocated to spend with people, and knew their needs well. People told us staff were caring and reliable.

People had the opportunity to provide feedback on the service. There was a complaints policy in place and formal complaints were investigated.

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 inadequate (published 1 April 2023) and there were breaches of regulations. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 26 January 2023. Breaches of legal requirements were found. The provider was issued Warning Notices requesting to improve safety of care and treatment, recruitment processes and governance of the service.

We undertook this focused inspection to check they now met legal requirements. We planned to inspect the key questions of Safe and Well led, however we found there was a concern with people’s mental capacity assessments, so we widened the scope of the inspection to also include the key questions of Effective.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

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

Enforcement

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

Amber Valley Total Care is a is a domiciliary care agency providing personal care to people in their own homes. The service supports younger and older people, including people with dementia. At the time of our inspection there were 82 people using the service.

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

There was ineffective leadership at the service and governance systems were not in place to identify areas where improvements were needed. Audits were not completed to identify where actions needed to be taken. The provider did not report incidents and events they were legally required to do to in line with their regulatory requirements.

Risks to people were not assessed and there were no risk assessments in place to guide staff on how to support people in relation to specific risks.

Systems were not in place to record and review accidents and incidents to help ensure people were safeguarded from abuse. Staff were not recruited safely; pre-employment checks were not completed thoroughly.

People were not always supported safely with their medicines. People did not always receive their prescribed medicines and the recording of medicine was not in line with best practice guidance.

Staff received training to carry out their roles, however not all staff had completed training in relation to specific health conditions.

People did not always receive personalised care, care plans did not include individual likes, dislikes and preferences. 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.

Staff felt supported in their work. People told us staff were kind, caring and reliable. People had the opportunity to provide feedback on the service. There was a complaints policy in place and complaints were acted upon in a timely manner.

The provider gave us some assurances they would start addressing the issues we found on this inspection.

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 good (published 17 October 2017).

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 safe care and treatment, recruitment and governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection took place on 6 October 2017 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the office. The service provided domiciliary care and support to people living in the Amber Valley area of Derbyshire. At the time of the inspection there were 100 people using the service. Our last inspection which took place at the providers previous location in November and December 2016, the service was rated as ‘Good.’ At this inspection, the service remained ‘Good.’

There is a registered manager at the service. 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. This service had two registered managers, who managed the service supporting each other.

The provider had completed audits to reflect the service improvements and to drive safety aspects relating to risks. Staff enjoyed working for the service and felt they received support for their role. Care plans had been reviewed and reflected the person’s current needs. Where people did not have capacity to make decisions about their own care an assessment, there was a process in place to ensure any important decisions had been made in the person’s best interest.

People felt safe when being supported by staff and that they knew how to protect them if they suspected they were at risk of abuse or harm. Recruitment checks were made to confirm staff were of good character to work with people and sufficient staff were available to meet people's support needs. Risks to people had been identified and staff understood how to support people to reduce risk. When required specific risk assessments had been completed in relation to equipment or supporting people in the community.

Staff had received updated information about people’s needs so they could provide the care that was required. People felt comfortable with staff and had developed relationships with them which were positive. The staff team that people received, was consistent and provided flexibility if changes were required. When required staff had supported people with their meal choices to ensure their nutritional needs had been met. Other people received support with their medicines or the application of creams, this was done safety and in accordance with guidance.

People were positive about the way staff treated them and said staff were kind and compassionate.

People felt comfortable raising any issues or concerns and there were arrangements in place to deal with people's complaints.

The registered manager understood their role within the organisation. They had completed notifications and had displayed the rating as required by the guidance.