Archived: Aaron Abbey Care Services Limited

Aaron Abbey Care Services Limited is a domiciliary care agency. It provides a service to people living in their own homes in Berkshire. Not everyone using the service receives 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.

At the time of this inspection staff were providing personal care to 13 people, including older and younger adults, some of whom may be living with dementia, physical disabilities and sensory impairments.

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

At the last inspection we found medicines were not always managed safely. At this inspection we found medicines were not always managed safely. Audits had not identified errors and omissions in people’s medicines electronic administration records (e-MARs).

Risks to people were assessed and documented. However, care plans did not always contain specific instructions for staff about how to protect people from identified risks.

At the last inspection the registered manager had not established effective systems and processes to monitor quality and safety in the service. At this inspection the registered managers systems for monitoring quality and safety were still not effective. Audits had failed to identify omissions and errors in people’s e-MARs, as well as the lack of specific instructions for staff about how to protect people from identified risks and the inaccuracies in people’s care plans.

At the last inspection the registered manager had failed to comply with the conditions of their registration to submit monthly action plans at a set time and date addressing compliance with the regulations 8 to 20. This was an offence of section 33 of the Health and Social Care Act 2008.

We issued a fixed penalty notice to the provider which was paid. Following this the registered manager submitted monthly action plans on time.

Enough improvement had been made and the registered manager was no longer in breach of this regulation.

At the last inspection the registered manager did not have an effective system for monitoring late or missed visits. At this inspection the registered manager used an effective system to monitor late or missed visits.

People felt safe in the care of staff and were protected from the risk of getting an infection.

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 completed training to support people with their identified needs.

People had caring relationships with staff who promoted their privacy, dignity and independence. People’s views were sought by the provider.

Staff reflected on accidents and incidents to prevent recurrences. Staff worked with professionals from health and social care to support people’s health and wellbeing.

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 requires improvement published 14 October 2019) and there were breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement:

We have identified a repeated breaches in relation to regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems and processes used to monitor quality and safety in the service were not always effectively used to ensure the service met the required fundamental standards of care.

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.

Since the last inspection we recognised that the provider had failed to comply with a condition submit monthly action plans to us. This was a breach of regulation and we issued a requirement to the provider. The provider accepted a fixed penalty and paid this in full.

Follow up:

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will follow up on issues that we identified by asking the registered manager to send us evidence of how and when the issues will be resolved. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.

Aaron Abbey Care Services Limited is a domiciliary care agency. It provides a service to people living in their own homes in Berkshire. Not everyone using the service receives a regulated activity. The Care Quality Commission only inspects the service being received by people provided with 'personal care', that means help with tasks related to personal hygiene and eating. At the time of this inspection staff were providing personal care to 28 older people and/or younger adults, some of whom may be living with dementia, physical disabilities and/or sensory impairments.

People’s experience of using this service:

¿The provider had not taken enough action to ensure the safe and proper management of medicines. They had not established an effective system that enabled them to ensure compliance with the requirements of the fundamental standards.

¿Where possible, the registered manager scheduled visits so the same staff went to see people to maintain continuity of care and support. However, the registered manager did not have an effective system to monitor late/early or missed visits at all times.

¿We have made a recommendation about seeking guidance from a reputable source to ensure principles of the Accessible Information Standard are met.

¿At the last inspection we found the registered manager had not ensured staff received appropriate support, training and supervision to carry out the duties they are employed to perform. At this inspection we found the provider had taken the necessary action to improve staff support and training.

¿People felt safe while supported by the staff team who made them feel reassured and relatives agreed with this.

¿Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns.

¿The registered manager had the knowledge to identify safeguarding concerns and acted on these appropriately.

¿The registered manager and senior staff had planned and booked training when necessary to ensure all staff had the appropriate knowledge and skills to support people. Staff had ongoing support, supervision and appraisals. They felt supported by the registered manager and senior staff, and maintained good team work.

¿People and relatives were complimentary of the staff and the support and care they provided. People received support that was individualised to their specific needs which were kept under review and amended as changes occurred. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿People were treated with respect, and their privacy and dignity were promoted. People felt the staff supported them in the way they wanted. Staff were responsive to the needs of the people and enabled them to improve and maintain their independence with personal care.

¿The staff monitored people's health and wellbeing and took appropriate action when required to address concerns. People felt confident they would be looked after well and relatives agreed with them.

¿The service assessed risks to people's personal safety, as well as staff, and plans were in place to minimise those risks.

¿The service had recruitment procedure that they followed before new staff were employed to work with people. This included ensuring staff were of good character and suitable for their role.

¿Staff felt the registered manager and senior staff were approachable and considerate. They had good communication, worked well together and supported each other.

¿The registered manager praised the staff team for their hard work and appreciated their contribution to ensure people received the best care and support.

Rating at last inspection: The service was rated Good in the domains of caring and responsive. The service was rated Requires Improvement in the domains of safe, effective and well-led. We found three breaches. Overall the service was rated Requires Improvement (Report was published 10 April 2018).

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Enforcement: We have identified breaches in relation to regulations 12 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. Medicine management was not always safe; effective systems and governance overview were not always used to ensure the service met the required fundamental standards of care. 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 (refer to end of full report).

Follow up: We have met with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will follow up on issues that we identified by asking the registered manager to send us evidence of how and when the issues will be resolved. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Aaron Abbey Care Services Limited is a domiciliary care agency. It provides a service to people living in their own homes in Berkshire. Not everyone using the service receives a regulated activity. The Care Quality Commission only inspects the service being received by people provided with ‘personal care', that means help with tasks related to personal hygiene and eating. At the time of this inspection staff were providing personal care to 31 older people and/or younger adults, some of whom may be living with dementia, physical disabilities and/or sensory impairments.

At the last inspection on 25 and 26 October 2016 we found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not carried out all required recruitment checks to make sure staff were suitable to work with people who use the service. The provider had not ensured the safe and proper management of medicines. The provider had not established an effective system that enabled them to ensure compliance with the requirements of the fundamental standards (regulations 8 to 20A of the regulations). 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. They sent an action plan which stated that all actions would be completed by 31 January 2017.

At this inspection we found the provider had taken the necessary action to improve staff recruitment. However, the provider had not taken enough action to ensure the safe and proper management of medicines and had not established an effective system that enabled them to ensure compliance with the requirements of the fundamental standards.

We found an additional breach of the regulations, the provider had not provided staff with the appropriate training and support needed to enable them to carry out the duties they were employed to perform.

The service had a registered manager as required. 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. The registered manager is also the nominated individual and one of the two directors of the provider organisation. The care manager is the second of the two directors. The registered manager and care manager were present and assisted us during this inspection.

People felt they were treated with care and kindness. They were consulted about their support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by people and relatives who provided feedback.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were asked for their consent before being provided with care and their preferences were sought and taken into account in their care plans. However, the service needed to ensure they obtain consent from people before sharing information regarding their personal care with their relatives.

People's diversity needs were identified and incorporated into their care plan. Where their package included support with food and drink, people were supported to eat and drink enough.

Staff were happy working for the service and people benefitted from staff who felt well managed and supported. Personal and environmental risks to the safety of people and staff had been assessed and actions had been taken to minimise those risks.

Recruitment processes had been improved and were followed to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

People and their relatives knew how to complain and knew the process to follow if they had concerns. They confirmed they felt the staff and management would act upon any concern raised.

This is the third consecutive time that Aaron Abbey Care Services Limited has been rated as Requires Improvement overall. 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.

Aaron Abbey Care Services Limited provides a service to people living in their own homes in Berkshire. At the time of this inspection they were providing a service to 30 people.

The service has a registered manager as required. 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. The registered manager was present and assisted us during this inspection.

Staff were available in enough numbers to meet the needs and wishes of the people they supported. Staff felt they received the training they needed to enable them to do their jobs safely and to a good standard. People were protected from abuse and staff had a good understanding of action they should take if any concerns were raised or suspected.

People's health and well-being was assessed and care plans were designed to ensure people's needs were met in an individualised way. Where included in their care package, people were supported to eat and drink enough.

People received support that was individualised to their specific needs. Their needs were monitored and care plans reviewed and amended as changes occurred. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure people's rights to make their own decisions were promoted. People confirmed they were involved in decision-making about their care and support needs.

People were treated with respect and their privacy and dignity was promoted. People said their care workers were kind and caring. Staff were responsive to the needs of the people they supported and enabled them to improve and maintain their independence. Professionals said the care and support provided by the service helped people to be as independent as possible.

People benefitted from receiving a service from staff who worked well together and felt management worked with them as a team. Quality assurance systems were in place to monitor the views of people using the service.

We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not carried completed all required recruitment checks to make sure staff were suitable to work with people who use the service. The provider had not ensured the safe and proper management of medicines by carrying out staff competency assessments before allowing staff to administer medicines. The provider had not established an effective system that enabled them to ensure compliance with the requirements of the fundamental standards (regulations 8 to 20A of the regulations), or their own policies. The provider had not maintained an accurate, complete and contemporaneous record of decisions taken in relation to the care and treatment provided to each person. You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected, which related to people's care and welfare, safeguarding people from abuse, requirements relating to recruitment of workers ,supporting workers, and assessing and monitoring the quality of service provision. We used the information to answer five key questions; is the service safe, effective, caring, responsive and well-led.

This is a summary of what we found.

Is the service safe?

People who use the service told us they felt safe when receiving personal care in their homes from the care workers. One person told us "I feel absolutely safe." Another person said "I know who to ring if I have any concerns. I would ring X (registered manager) or the local authority number on the safeguard postcard."

The service was not safe because people were not protected from the risk of inappropriate or unsafe care. This was due to risk assessments and related plans of care to ensure people's safety and welfare being incomplete. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to the planning and delivering care to ensure the welfare and safety of people.

We found all of the required pre-employment checks had not been completed for seven staff members. For example, the provision of satisfactory evidence of staff conduct in previous employment, where this was concerned with the provision of services relating to health or social care, health checks and full employment histories. The provider was unable to provide a satisfactory written explanation for gaps in the employment histories of staff. This meant the provider did not have an effective recruitment process in place. There was a risk that people who used the service would be cared for by staff who were not suitable for the role. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff.

There were no staff supervision and team meetings to support workers. Staff had received online training in subjects identified as appropriate by the provider to enable them to deliver care and treatment to people safely and to an appropriate standard. However an assessment of their competence to carry out safe moving and handling practices had not been completed. This meant there was a risk of harm to people because staff may not be competent in the use of correct moving and handling practices. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring staff receive appropriate support and have been assessed as competent to deliver all aspects of care safely and to an appropriate standard to people.

Is the service effective?

The service demonstrated effective practices through the assessment of people's health and care needs. Care plans were in place. We saw care plans had been reviewed regularly with people to confirm that all their needs were being met.

It was clear from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. For example, in relation to people's mobility and sensory impairment.

All six people we spoke with were complimentary about the care received. One person said 'Staff are very understanding of my needs.'

Is the service caring?

People were supported by kind and supportive staff. People told us staff were very caring. One person told us 'Staff looking after me are very caring. Another person said 'The staff are so friendly. They talk to me and are interested in what I do.' People told us the care workers gave encouragement when supporting them. People were able to do things at their own pace and were not rushed. One person told us 'Staff let me do as much for myself as possible. They do not rush me.'

People told us they were always asked if they were happy with the care they were receiving when staff visited or during a review of their care plan. There were processes in place to ensure people and their relatives could provide feedback to the provider about the quality of the service received. Overall, where shortfalls or concerns were raised these were addressed.

Is the service responsive?

We found the service was responsive to people because their needs had been assessed before they used the service. Records confirmed people's involvement at care plan reviews to ensure their needs were being met. Care and support had been provided in accordance with people's wishes, for example, care was delivered at their preferred time.

People knew how to make a complaint and who to go to if they were unhappy.

In each person's home we visited we saw a copy of the complaints procedure in the provider's 'Service User Guide'. We noted there were no recorded complaints. People told us when they had informed the provider of any concerns these had been addressed promptly, to their satisfaction. However, relatives of one person told us that a recent concern raised with the registered manager had still not been addressed to their satisfaction.

Is the service well-led?

We found the service was not well led because there was no system in place to ensure the feedback of all people who used the service, their relatives and staff were regularly sought by the provider to improve the service. The provider did not carry out quality spot checks to monitor the quality and safety of services provided to people in their own homes. This was confirmed by all people and relatives we spoke with.

People told us their feedback was sometimes sought when the manager visited their home to provide personal care. There was no system for recording the outcome of such visits. The provider showed us examples of actions taken in response to comments from people, such as a review of visit times to meet their wishes and suggestions. This meant the provider had acted on feedback received from some people to improve the service. However, relatives of one person we spoke with told us concerns they had raised with the registered manager had not been addressed to their satisfaction.