About the service:

Affinity Homecare (Shrewsbury) is a domiciliary care agency that provides personal care and support to people living in their own homes. It provides a service to older adults some of whom are living with dementia and younger disabled adults. Not everyone using Affinity Homecare (Shrewsbury) received a regulated activity. CQC only inspects the service received by people provided with 'personal care': for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 70 people were receiving the regulated activity of personal care.

People’s experience of using this service:

People received safe support with their medicines by competent staff members. The provider had systems in place to respond to any medicine errors should they occur. The provider completed regular checks to ensure people received the right medicine at the right time.

The provider had assessed risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the risk of harm to people. The provider had systems in place to respond to any additional risks to people. Staff members were aware of the necessary action they should take in the event of an emergency.

The provider, and management team, had good links with the local communities within which people lived. The provider had systems in place to ensure the Care Quality Commission was notified of significant events in a timely manner and in accordance with their registration.

People received safe care and support as the staff team had been trained to recognise potential signs of abuse and understood what to do to safely support people. Staff members followed effective infection prevention and control procedures when supporting people in their own homes. Staff members had appropriate personal protection equipment supplied by the provider.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision. Staff members were knowledgeable about the relevant legislations that informed their practice and supported the rights of those receiving services from Affinity Homecare (Shrewsbury).

People were supported to refer themselves for additional healthcare services when required. When appropriate people were supported to maintain a healthy diet by a staff team which knew their individual preferences.

People received help and support from a kind and compassionate staff team with whom they had positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability. People were supported to retain their independence whilst living in their own homes.

People were provided with information in a way they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

More information in Detailed Findings below.

Rating at last inspection:

Requires Improvement for the key questions ‘Safe,’ ‘Effective,’ ‘Responsive’ and ‘Well-led,’ and Good for ‘Caring.’ (Published 3 May 2018). At that inspection we found people’s medicines were not safely managed, risks were not comprehensively recorded, staff training did not account for people's specific health needs, care and support plans did not fully reflect people’s needs and the providers quality monitoring systems were not effective. At this inspection Affinity Homecare (Shrewsbury) had made the necessary improvements.

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Requires Improvement.’

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report whic

This inspection was carried out on the 22 and 26 March 2018.

Affinity Homecare Shrewsbury is a domiciliary care agency that provides personal care and support to people living in their own homes. It provides a service to older adults some of whom are living with dementia and younger disabled adults. Not everyone using Affinity Homecare Shrewsbury receives a regulated activity. CQC only inspects the service received by people provided with ‘personal care’: for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 83 people were receiving the regulated activity of personal care.

There was a registered manager in post who was present during 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.

At the last inspection in August 2017, we found the provider was in breach of the regulations in relation to safe care and treatment, the governance of the service and had failed to notify of significant events in the service which they are required to do so by law.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well led to at least good.

At this inspection we found that the provider had notified us of significant events within the service in a timely manner. However, other areas we identified as requiring improvement at the last inspection had not been sufficiently improved upon. We found there were continued breaches of the regulations in regard to safe care and treatment and good governance.

Sufficient improvement had not been made in relation to how risk associated with people’s needs were identified and managed. At our last inspection risks associated with people’s needs were not accurately assessed and management plans were not always in place to guide staff how to reduce risks for people. At this inspection although risk assessments were in place these were not always specific to people’s individual needs and sometimes lacked detail about how staff could reduce the risks. However, people felt safe when staff supported them.

Sufficient improvement had not been made to ensure that quality assurance checks were completed to identify and make improvements that were required.

We also found concerns around the safe management of medicines. Although people told us they were satisfied with the support they received to take their medicines, records did not always accurately record when their prescribed medicine should be taken or when and where prescribed creams should be applied. We found gaps in recording where staff had not signed to indicate whether people had taken their medicines or had their creams applied.

People’s care plans continued to be brief and did not adequately reflect people’s needs and the support they required to meet them. People were involved in planning and reviewing their care however, their care plans were not always updated when changes were identified at the review.

Staff felt well supported by their colleagues and the management team. Staff were satisfied with the training they had received however, they were not always provided with training or information about people’s specific needs.

People were protected against abuse, avoidable harm and discrimination by staff who knew how to identify and report any concerns. There were enough staff employed to meet people’s needs.

Where required people were encouraged to eat and drink enough. Staff monitored people’s health and supported them to access healthcare professionals as necessary.

People found staff to be kind and considerate and ha

This inspection was carried out on 9 August 2017 and was announced.

Affinity Homecare Shrewsbury is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our visit, the agency was providing a service to 41 people some of whom had complex health needs. The frequency and duration of visits across the service varied dependent on people’s needs.

There was no registered manager in post at the time of our inspection. The service is required to have a registered manager. During our inspection, we met with the new manager of the service and the provider. 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.

Risks associated with people’s needs were not always accurately assessed and management plans were not always put in place to guide staff how to reduce risks for people. People did not always feel safe with the support they received from staff. The provider did not have systems in place to record and analyse accidents or incidents.

People were at risk of receiving inappropriate care because their care plans did not reflect their needs and the support required to meet these. People’s choice was not always respected. Staff did not receive training or information about how to support people with specific health needs.

People and their relatives knew how to raise concerns or complaints but the provider did not always record or investigate complaints. The provider sought people’s views on the quality of the service but did not use this information to make improvements.

The provider lacked sufficient systems to ensure people received safe and effective care that met their needs and preferences. The quality assurance systems the provider was using had failed to identify the shortfalls we had found and were not driving improvements of the service.

Staff had not received training on the Mental Capacity Act and had limited understanding of what this meant for their practice. Staff sought people’s consent before supporting them and provided information to people in a way they could understand to allow them to make decisions for themselves.

People were satisfied with the support they received to take their medicine. Only staff who had received training in the safe management of medicine administered medicine. Staff monitored people’s health and supported them to arrange and attend appointments as necessary.

People were supported by staff who were kind and caring. Staff treated people with dignity and respected and supported them to remain as independent as possible. People were involved in decisions about their care.

You can see what action we told the provider to take at the back of this report.