APDA Homecare c/o Daycare and Development Centre

APDA Homecare c/o Daycare and Development Centre is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides care to children and older people with physical and learning disabilities. The service caters for the Asian community and at the time of inspection the service provided personal care to seven people.

People’s experience of using this service:

Risk assessments for people covered areas such as the environment, physical health and personal care. These contained guidance for minimising potential risks such as risks associated with the COVID-19 pandemic. However, we noted that some risk assessments were not available on the day of the inspection.

Systems were in place to help ensure people were protected from the risk of abuse. There were appropriate policies in place with the relevant contact details. Care workers had completed safeguarding training.

The service followed safe recruitment practices and records contained the required documentation. The staffing levels were adequate to ensure that people’s needs were met.

The registered manager confirmed the service did not administer medicines to people. We therefore did not look at how the service managed medicines during this inspection.

Feedback indicated that staff were punctual and there were no issues in relation to this. There was evidence that people received care from the same staff and there was consistency in the level of care they received.

Infection prevention and control measures were in place to keep people safe and prevent the spread of COVID-19 and other infections. Staff had received appropriate training. They had access to sufficient stocks of personal protective equipment (PPE).

Our previous inspection identified that there were a number of instances where care workers required refresher training and we found a breach of regulation in respect of this. During this inspection we found that the service had made improvements in respect of this and staff had completed relevant training.

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.

The service supported people to meet their individual dietary needs. People followed religious diets and care workers were fully aware of people’s individual dietary requirements. Care support plans included information about people's dietary needs and requirements, likes and dislikes.

We noted that there were instances where documentation was not available and well-maintained. We have made a recommendation in respect of this.

There were systems in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service through satisfaction surveys. The service also undertook checks and audits of the quality of the service.

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 25 June 2019) and there was one breach of regulation in respect of staff training. 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 improvements had been made and the provider was no longer in breach of this regulation.

Why we inspected:

We undertook this focused inspection in order to check what improvements had been made since our last inspection. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to Good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for APDA Homecare c/o Daycare and Development Centre on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

APDA Homecare c/o Daycare and Development Centre is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides care to children and older people with physical and learning disabilities. The service caters for the Asian community and at the time of inspection the service provided personal care to 15 people.

People’s experience of using this service:

People who received care from the service spoke positively about the agency. They were complimentary about care workers and raised no concerns. Relatives we spoke with said they were confident that people were safe and treated with dignity and respect when being supported by care workers. They also spoke positively about management and said they felt able to speak to them without hesitation.

Systems were in place to help ensure people were protected from the risk of abuse. There were appropriate policies in place with the relevant contact details. Care workers had completed safeguarding training as part of their induction. However, we noted that some care workers required refresher safeguarding training and raised this with the director. Care workers we spoke with were aware of the importance of their role in safeguarding people and said if they had concerns about people's safety they would immediately report their concerns to management.

Risk assessments for people covered areas such as the environment, physical health and personal care. At the time of the inspection, some people’s risk assessments were not available. Following, the inspection the service sent us evidence that these were in place.

The director and registered manager confirmed the service did not administer medicines to people. We therefore did not look at how the service managed medicines during this inspection.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

Feedback from relatives indicated that staff were punctual and there were no issues in relation to this. There was evidence that people received care from the same staff and there was consistency in the level of care they received.

We asked the director and registered manager for details of what training staff had completed. We were provided with a copy of the training matrix which detailed the training care workers had completed. We identified that care workers had completed an induction but there were a number of instances where care workers required refresher training. We did not see evidence that care workers had been consistently supported to fulfil their roles and responsibilities through regular training and found a breach of regulation in respect of this.

Staff received supervision and appraisals of their skills from the management team to help them to support people effectively.

Details about people's nutrition and hydration had been documented in the care plan.

Feedback from relatives indicated that positive relationships had developed between people using the service and staff. Relatives told us that staff had a good understanding of and were aware of the importance of treating people with respect and dignity and always did this. The registered manager and care workers were aware of the importance of ensuring people were given a choice and promoting their independence.

People who used service received care that was responsive to their needs and their daily routines were reflected in their care plan. Care plans included information about people’s interests and preference.

The service had procedures for receiving, handling and responding to comments and complaints. Relatives told us they did not have any complaints about the service but knew what to do if they needed to raise a complaint or concern. They told us that the registered manager was approachable and they would not hesitate to raise concerns directly with her.

There were systems in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service through satisfaction surveys. The service also undertook checks and audits of the quality of the service, however these were not always effective at identifying shortfalls.

Rating at last inspection: Good (Report published on 27 January 2017)

Why we inspected: This was a scheduled planned comprehensive inspection.

Follow up: We will continue to monitor the service through the information we receive.

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

At our last inspection on 11 February 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the service not appropriately assessing people’s mental capacity, some risks not being appropriately identified and effectively managed for people and care support workers having a lack of knowledge and understanding of safeguarding and whistleblowing procedures. During the inspection on 21 December 2016 we found the service had taken necessary action to address the breaches of regulations identified at the previous inspection.

There was a registered manager in post at the time of our inspection. 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.

People who used the service were children or they had some form of physical or learning disability and were unable to verbally communicate with us. We therefore spoke with their relatives who lived with them. Relatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and people were safe when cared for by the service.

At the previous inspection in February 2016 we found a breach of regulations because risk assessments were not person centred and individualised. We also found that risk assessments lacked instructions to staff detailing how to assist people with various aspects of their care. During the inspection in December 2016 we found that since the previous inspection the service had taken appropriate action and had reviewed people’s risk assessments and implemented new format risk assessments which included the appropriate information about potential risks and how to mitigate these.

The inspection in February 2016 found a breach of regulations in respect of safeguarding because care support workers we spoke with lacked knowledge and understanding of safeguarding and whistleblowing procedures. During the inspection in December 2016 we found that the service had taken appropriate action in order to improve this area. We found that there were systems and processes were in place to help protect people from the risk of harm. Care support workers had received refresher training in safeguarding adults and staff we spoke with knew how to recognise and report any concerns or allegations of abuse.

The inspection in February 2016 found that care plans lacked information about people’s capacity to make decisions and care support workers we spoke with lacked knowledge of this area. During the inspection in December 2016 we found the service had taken appropriate action to address this breach. Care support workers we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). They were aware that when a person lacked the capacity to make a specific decision, people's families, staff and others including health and social care professionals would be involved in making a decision in the person's best interests. The service had a Mental Capacity Act 2005 (MCA) policy in place. Care plans included information about people's mental health and their levels of capacity to make decisions and provide consent to their care.

Relatives told us that care support workers turned up on time and they received the same care support worker on a regular basis and had consistency in the level of care they received.

People were cared for by care support workers that were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities. Staff confirmed that they received regular supervision sessions and appraisals to discuss their individual progress and development. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, first aid and moving and handling. Staff spoke positively about their experiences working for the service and said that they received support from management.

Management staff and care support workers we spoke with had a good understanding and were aware of the importance of treating people with respect and dignity. They also understood what privacy and dignity meant in relation to supporting people with personal care. Feedback from relatives indicated that positive relationships had developed between people using the service and their care support worker and people were treated with dignity and respect.

The service had a comprehensive complaints procedure in place. Relatives we spoke with expressed confidence in the service and were satisfied that if they needed to complain about something, their concerns would be taken seriously and dealt with accordingly. It was evident from the feedback received from people and relatives that the service listened to people’s concerns and took the appropriate action.

Relatives spoke positively about the service and told us they thought it was well managed. There was a clear management structure in place with a team of care support workers, administrative assistant, deputy manager, registered manager and provider. Systems were in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service people received through review meetings and satisfaction surveys. Records showed positive feedback had been provided about the service. The service also undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

Daycare and Development Centre is a small domiciliary care agency registered to provide personal care to people in their own homes. The service caters for the Asian community and at the time of inspection the service provided care to 13 people. The service provides care to children and older people with physical and learning disabilities.

There was a registered manager in post. 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.

At our last inspection on 5 November 2013 the service met the regulations inspected.

People who used the service had some form of physical or learning disability and were unable to verbally communicate with us. We therefore spoke with their relatives who lived with them. Relatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and people were safe when cared for by the service.

Individual risk assessments were completed for each person. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. This could result in people receiving unsafe care and we found a breach of regulations in respect of this.

There were processes in place to help ensure people were protected from the risk of abuse. Despite receiving safeguarding training, the majority of staff we spoke with were unable to describe the process for identifying and reporting concerns and were unable able to give example of types of abuse that may occur.

People using the service experienced consistency in the care they received and had regular care staff. Relatives we spoke with confirmed this and said that they were happy about this.

Records showed and staff told us they received training and received support from the registered manager. Appropriate checks were carried out when staff were recruited.

Care plans lacked information about peoples’ mental health and their levels of capacity to make decisions and provide consent to their care. There was no information in people’s care plans which showed how people who had limited capacity or were not able to verbally communicate were supported to make decisions and how their consent was gained. We found a breach of regulations in respect of this.

Relatives told us that people were treated with respect and dignity. They told us that care staff were caring and helpful. Staff were able to give us examples of how they ensured that they were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care.

Care plans were individualised and addressed areas such as people’s personal care, what tasks needed to be done each day, time of visits, people’s needs and how these needs were to be met. Staff were provided with clear instructions of what tasks needed to be carried out.

The service had a complaints procedure and there was a record of complaints received. Complaints we examined had all been responded to and staff knew what action to take if they received a complaint.

Relatives and staff we spoke with were satisfied with the management at the service. They said that management were approachable and supportive.

The service had a quality assurance policy and checks of the service had been carried out by management. These involved quarterly reviews with people and their relatives, staff spot checks and satisfaction questionnaires.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We talked to staff and two relatives to check what arrangements were in place for seeking and obtaining valid consent from people using the service. Overall, the provider had systems in place to gain and review consent from people.

We looked at how the service reduced the risk of people receiving unsafe and inappropriate care. Largely, the care needs of people had been assessed, together with actions for minimising potential risks.

We asked questions to examine if people were protected from abuse, or the risk of abuse. A relative commented, 'my relative likes the staff and is not scared to go out with them'. The manager and staff were aware of procedures to follow in the event of abuse or an allegation.

Staff were properly supported to provide care by means of being provided with relevant training, along with regular supervision and appraisals. A relative told us, 'Staff come on time and they do a good job'.

People informed us that they were satisfied with the care provided. They indicated that they had been consulted and their views had been taken into account in the delivery of care. One person told us "I am involved in my care".

We found appropriate checks were undertaken before staff began work.

We were concerned that the provider had not taken all reasonable steps, in terms of training of staff, to identify the possibility of abuse and prevent abuse from happening and there were no arrangements in place to supervise staff.