About the service:

Assisted Home living is a Domiciliary Care Agency. The care agency provides personal care and support to people living within the community. At the time of the inspection, there were eight people receiving support with personal care.

People’s experience of using this service:

Staff had not had appropriate recruitment checks to ensure they were of good character to support people. Staff had not received training and lacked knowledge which was important to keep people safe.

Care records and risk assessments were either not completed or had insufficient detail to guide safe care. Care was therefore not delivered in line with current standards. We saw that some risks have not been adequately addressed which put people at risk of harm. There were no formal processes in place to review or amend records and ensure they were appropriate.

Medicines were not managed safely. People had received ‘as needed’ medicines without reason. Medicine risk assessments were not in place for those people that took medicines themselves and were at risk of doing so. Medicine records were not completed in a safe way to ensure mistakes were not made.

People had access to health and social care professionals, however professional guidance was not recorded to guide more effective care. Where professional advice was recorded, it was not always followed.

We found ongoing concerns about the safety and governance of the service. There was a failure to create improvements at the service, despite an action plan being in place. These risks and lack of improvement raised concerns about the quality of personal care delivered by the service.

There were enough staff and people reported that staff arrived on time to support them. People spoke highly of the staff at the service and told us that they felt well cared for.Rating at last inspection: The last report was published on 21 March 2018. It was rated as ‘Requires improvement’

Why we inspected:

At the last inspection, we rated the service as ‘Requires Improvement’. The service provided us with an action plan, stating that they would make the required improvements. We completed this inspection to check whether the required improvements had been made. A comprehensive inspection was completed due to the amount of regulation breaches and previous concerns.

Enforcement:

At this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included regulations 12, 17, 18 and 19. These are continued breaches from our last inspection in March 2018.

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

Follow up:

We will continue to monitor the level of risk at the service until the next inspection visit.

The overall rating for this service is now ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there

We carried out an announced inspection of the service on 7 February 2018.

The service is managed by the registered provider, so does not require a registered manager. Registered providers are 'registered persons' who have a 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 is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults. Not everyone using Assisted Home Living receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Assisted Home Living supports people with a variety of needs to live independently in the community. At the time of our inspection 16 people were receiving personal care as part of their care package.

At the previous inspection in November 2016 we identified some improvements were required in four key areas we inspected; ‘Safe’, ‘Effective’, 'Responsive' and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'.

At this inspection we found the registered provider had not made all the required improvements and the service was rated again ‘Requires Improvement’.

Staff were aware of their role and responsibilities of how to protect people from abuse and avoidable harm. Risks associated with people’s needs had not always been fully assessed to enable staff to have the required information to manage known risks.

Staff recruitment checks were found to be insufficient in protecting people from the risk of unsafe care and support.

Staff had not received up to date training in the safe administration of medicines. Where people required support to manage their medicines, their needs had not been fully assessed and planned for.

Staff were aware of their role and responsibilities to protect people from the risks associated with cross contamination and infection. Accidents and incidents were recorded and responded to by staff and these were reviewed to consider lessons to learn to reduce further risks.

People’s needs had been assessed but their support needs in relation to any heath related needs lacked detail in places. Consideration had been given to people’s human rights equality and diverse needs.

Staff had received a limited induction and their training needs had not been fully met. Staff did not receive formal opportunities to discuss and review their work, training and development needs.

Where people were supported with their nutritional needs, this was provided and staff were aware of these needs. People’s health was monitored and staff took action if they identified deterioration in a person’s health needs.

People’s rights under the Mental Capacity Act (2005) had not always been considered. Where people had capacity they were enabled to make decisions and their choices were respected. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

People were supported by staff who demonstrated a good understanding of their needs and were found to be caring and kind, showing empathy and compassionate in their approach. People's diverse needs, including their communication needs were known and understood by staff. People received opportunities to be involved in discussions and decisions about their care and support. People were not provided with information about how they could access independent advocates.

Staff understood people’s individual needs, routines and preferences and these were respected. Where people required support to access their community and pursue their interests and hobbies this was provided.

People had access to the provider's complaint

This announced inspection was carried out on 1 November 2016. Assisted Home Living provides support and personal care to people living in their own homes in north Nottinghamshire and south Yorkshire. On the day of the inspection there were 15 people using the service who received personal care.

The service is managed by the registered provider, so does not require a registered manager. Registered providers are ‘registered persons’ who have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported by care workers who understood the risks people could face and knew how to make people feel safe. However people may not be supported in the safest and least restrictive way possible.

People were supported by a regular individual or group of care workers who they knew, although some of them had been recruited without following all of the required recruitment procedures.

People who required support to take their medicines received assistance to do so, but the staff involved in doing this had not been assessed to be competent to provide this support.

People were provided with the care and support they wanted, although staff may not have received the training needed to provide this in the safest and correct manner. People’s human right to make decisions for themselves was respected and they provided consent to their care when needed.

People were supported to consume a sufficient amount of food and fluids that promoted their wellbeing. People received support from care workers who understood their health needs.

People were shown respect by care workers who were helpful and kind. People were involved in determining their care and support and were treated with dignity.

People’s care plans did not contain all the required information to ensure their care and support was delivered as needed. People were informed on how to express any issues or concerns they had so these could be investigated and acted upon.

There was a lack of formal systems to monitor the quality of the service and make improvements when needed. People who used the service and care workers were able to express their views about the service. The management of the service provided leadership that gained the respect of staff.

Prior to our inspection we reviewed all the information we had received about the provider. We spoke with people who were receiving personal care to determine the views on the quality of the service. We also spoke with members of staff and looked at service information and care plans.

People told us they received sufficient information with which to provide informed consent to the suitability of the agency in meeting their individual needs and felt fully involved in decisions about their care package.

People told us the care staff respected their individual decisions and felt the care they received was of a good quality. One person told us, "I never feel forced into anything, all my carers are excellent." Another person said, “I just cannot fault the care staff that come to me, they are very respectful.” People also told us that the care staff obtained their verbal consent before they undertook personal care service for them.

We found that peoples care plans documented the type of support provided to people in their own homes but lacked specific details in relation to the number of staff and the type of support needed to aid people with personal care.

People told us that there were sufficient levels of staff to meet their needs and felt the staff were of good character and competent in performing their duties.

We found that systems were in place to provide people with the opportunity to comment on the quality of service provision.

People told us they were very satisfied with the quality of the service provided by the agency. One person told us, “I am fully involved, yes, very much so. They have always been very good with me. They don’t forget what I have was said.” Another person said, “I have been very lucky having this service. They always respect me in everything they do.”

People told us that they had been involved in the formation of their care plans and felt that the care staff respected their opinions and decisions. They also told us that the care staff would always promote their privacy and dignity when providing personal care.

We asked people who used the service if they felt the care staff employed at the agency were suitable, honest and trustworthy. Comments included, “Yes, absolutely, the staff I have are absolutely brilliant,” and, “The ones I have are excellent.”

People told us that they felt confident in reporting any issues of concern or complaints to any of the staff employed at the agency and felt that any concerns would be addressed effectively by the management team. One person told us, "I have never had to make a complaint but I feel sure that any issues would be addressed,” whilst another said, “I would always talk to the manager. We work as a team and work together. I have no concerns.”