Background to this inspection
Updated
4 August 2023
The inspection
We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.
Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.
Inspection team
This inspection was carried out by 1 inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
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 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started on 09 June 2023 and ended on 28 June 2023.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and safeguarding team. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used this information to plan our inspection.
During the inspection
This performance review and assessment was carried out without a visit to the location’s office. We used technology such as video calls and telephone calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation. We commenced the inspection on 07 June 2023. On 9 June 2023 we spoke with people and relatives. On 16th June 2023 we reviewed documentation, met with the nominated individual and spoke with staff, concluding the inspection on 28 June 2023.
We spoke with 2 people who used the service and 5 relatives. We spoke with 4 members of staff including the registered manager. We reviewed a range of records which included 4 people's care and medication records. We reviewed a variety of records relating to the management of the service, including audits, training records, policies and procedures.
Updated
4 August 2023
About the service
Axiom Home Care Hemel Hempstead is a domiciliary care agency (DCA). The service provides personal care services to people in their own homes. At the time of our inspection 7 people were receiving personal care 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 did not always have assessments carried out when needs were identified. The lack of assessments placed people at risk of avoidable harm. People felt safe with the care provided and staff reported concerns when needed, although there were delays by the provider in investigating those concerns.
People received their medicines as required but improvements were required in maintaining medicines records. People received care from a consistent staff team, however they also told us their agreed times were not always met promptly.
Staff had received training, but the quality of this training did not always enable them to meet people's needs effectively. Training in some key areas had not been provided to staff. Staff felt supported by the management team, but further improvement was required to plan, develop, and review staff performance.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People were not always supported to have a choice about who provided their personal care. We have made a recommendation about ensuring people's dignity is met.
There was a lack of oversight of the quality of care provided with shortfalls that had not been identified by the provider. Staff had not ensured they maintained good records in relation to people's support needs.
People were happy with the care provided. They told us staff treated them with respect, promoted their independence and were kind and caring when supporting them. People were confident that concerns or complaints would be managed promptly.
People received care they felt was appropriate to their needs and kept them safe from harm. The ongoing risks associated with people's individual care needs were managed safely.
Staff wore personal protective equipment [PPE] when providing care to people to keep them protected.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 17 November 2020, and this is the first inspection.
Why we inspected
This was a routine inspection based on information we held about the service.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, person centred care, training and development, consent, and governance.
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, which will help inform when we next inspect. 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.
This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.