Archived: AJs Homecare Limited

AJ’s homecare is a domiciliary care service located near Wigan town centre. The service provides care to people living in their own home. The agency currently provides support to people living within a five mile radius of the office. At the time of the inspection the service provided care and support to 23 people.

The service was last inspected on 14 April 2014 and was meeting all the regulations assessed at that time.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to good governance. You can see what action we told the provider to take at the back of the full version of this report.

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.’

People and their relatives spoke highly of the service and staff. They told us staff visited as near to the scheduled time as possible.

We saw missed visits were analysed and detailed the circumstance why the missed visit had occurred. However, we found the call monitoring system in place was not sufficient to manage the risk or prevent re-occurrence of missed visits.

We reviewed a sample of recruitment records, which demonstrated that staff had been safely and effectively recruited.

The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. Staff demonstrated a good understanding of local safeguarding procedures and how to raise a concern.

Medicines were managed safely and people did not raise concerns regarding the support received.

The service used a matrix to monitor the training requirements of staff. Staff received an induction, appropriate training and additional specialist training to meet the needs of the person they supported.

Staff had attended mental capacity training and demonstrated a good understanding of people’s needs. Staff sought consent prior to providing care and offered people choices to encourage people to make their own decisions.

People and their relatives told us they were happy with the care provided. People told us staff treated them with dignity and respect and promoted their independence

People engaged with an initial assessment and were involved in the planning of care. Regular reviews were conducted with people, their relatives and a health care professional if involved to continually monitor and adapt care to people’s changing needs.

People received a service user guide on commencement with the service which detailed the complaints procedure. People told us they were confident that if they were required to make a complaint, the management would respond and resolve their issue promptly.

We found there were systems in place to monitor the quality of the service provided to people which ensured good governance

The management were making changes to the agency which had caused some unrest amongst some of the staff team. We found the management team were transparent, open and honest about the current difficulties they faced. The measures they were undertaking to resolve the issues were required in order to maintain the financial stability of the agency progressing forward.

Without exception, people and their relatives spoke highly of the management and voiced that they would not hesitate to recommend the agency to people needing support in their own home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with six people who used the service during our inspection who told us they felt treated with respect and dignity by staff at all times. People told us they felt safe and comfortable in the presence of staff. The service had systems in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted to the local authority. This means people were safeguarded as required.

The people we spoke with told us they usually had a regular carer ,but that on occasions this changed if they were unavailable. Two people told us they were asked for their choice of either a male or female carer. Managers ensured people's care needs were taken into account when making decisions about the numbers, qualifications, skills and experience required for carers. This helped to ensure people's needs are always met.

We found medication practices were safe and thorough. Medication was stored appropriately at people's houses. The office manager told us controlled drugs would be securely stored but could be accessed easily enough in the event of an emergency. Each person we spoke with told us staff administered their medication on time in line with their care package requirements. On the day of our inspection, the service only administered medication for a small number of people, as this was done by families.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Initial needs assessments were conducted by the office manager and were done in conjunction with people who used the service and their families. Three of the people we spoke with told us they recalled staff visiting them when their care package first commenced. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw evidenced care plans were reviewed on a regular basis and then transferred onto an electronic system. This meant people's care needs could be amended if required to keep people safe.

People's houses had been checked and appropriately risk assessed to meet the needs of people with physical impairments. This covered things such as moving around the building, security, kitchen area and gas/electrics.

Is the service caring?

People were supported by kind and attentive staff. Comments from people included: 'I couldn't do without them really. They are brilliant. Sometimes they come a bit late but I can live with that. The office contact me and apologise which is good' and 'The carers are very efficient' and 'I'm supported with my medication and they do a bit of tidying up for me aswell' and 'They treat me so well. I'm glad I chose them. I would recommend them'.

People's preferences, hobbies, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Risk assessments were in place and covered falls, mobility and people's general safety. We noted comments and general observations had been made if any alterations needed to be made to keep people safe.

We spoke with a relative during our inspection who said: 'We were very careful about choosing the right service for X. We did our research and are so glad to have chosen them. They treat X really well and are responsive to any requirements. They came out to see us when the package first started to make sure everything was in place'.

Is the service responsive?

There was a complaints procedure in place. People knew how to make a complaint if they were unhappy but had never been given reason to. People can therefore be assured that complaints are investigated and action is taken as necessary when required.

Systems were in place to ensure managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

There were other various quality assurance systems in place. These included the sending of regular surveys, spot checks, telephone monitoring, staff supervision and regular carer/team meetings.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service was led by the registered manager and the office manager who demonstrated they were clear about their roles and responsibilities. There were regular office and team meetings where various information was discussed and cascaded to staff to ensure they were fully aware of any circumstances effecting people's care and support.

The people we spoke with said that the care was very good. One person who used the service said, "There are no problems whatsoever. Staff are excellent."

We found that people's needs were assessed and care was planned and delivered in line with their individual care plan. We saw in the care files of four people that an initial assessment was completed before the service commenced and that staff were matched with new people in line with their stated preferences. The care plans included areas that were most important to the individual, such as socialising, mobility, health and care needs. The care plans looked at were person centred and provided staff with clear guidance on how to meet peoples' needs.

Staff spoken with told us they were provided with a high level of training and support to enable them to carry out their caring services in the community.

We saw in the care files of four people that regular quality assurance visits were completed by the service managers with the people who use the service and any required changes or comments were noted and followed up. People who used the service commented during these visits that the care staff were compatible with them, time keeping was good and they respected their privacy and dignity.