Archived: Aims Homecare Limited

At our last inspection we rated the service ‘good’ overall. At this inspection we found the evidence continued to support the rating of ‘good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At our last inspection we rated the service ‘requires improvement’ for the key question ‘well-led’ and found them in breach of regulation relating to good governance. Following our inspection the registered manager submitted an action plan stating what action they would be taking to address the concerns identified. At this inspection we found that action had been taken, the service was no longer in breach of regulation and the rating for the key question ‘well-led’ had improved to ‘good’. However, we found the rating for the key question ‘responsive’ had deteriorated to ‘requires improvement’.

People felt safe receiving care from Aims Homecare. Staff were aware of their responsibility to safeguard adults from avoidable harm and were knowledgeable on safeguarding adults’ procedures. Risks to people’s safety were assessed and appropriate procedures were in place to manage and mitigate those risks. There were sufficient staff to meet people’s needs, however, at times people received late visits. The registered manager was aware of this and the scheduling of appointments was being reviewed to reduce travel time between calls and improve punctuality. Safe recruitment practices were adhered to. People received support with their medicines and infection control procedures were adhered to.

People received support from staff who received regular training and had the knowledge and skills to undertake their duties. Staff were aware of people’s dietary requirements and provided any support required with meals and access to drinks. Care staff were knowledgeable about people’s medical needs and liaised with health care professionals to obtain specialist advice about how to support the person. Staff escalated any concerns about a person’s health to the relevant healthcare professional. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and relatives were complimentary about the staff. They said they had established trusting positive relationships with their usual staff member, however, the recent changes in staff allocation had impacted on the quality of these relationships. Staff were required to undertake all of their training in English to ensure their verbal and written English was up to a certain standard and ensure they could communicate with people in a way the person understood. People and their relatives were involved in decisions about the care and support they received. Information was gathered about people’s life histories and what was important to them which informed the support provided and aided conversations. Staff respected people’s privacy and dignity.

People received support with their care needs. On the whole people were complimentary about how they were supported. However, due to scheduling difficulties we heard that people had experienced a number of changes in their allocated staff member and this impacted on the quality of care they received. They felt the newly allocated staff member did not have as much knowledge about their care needs and how they liked to be supported. On the whole care records provided information about people’s needs and how they wished to be supported. However, at the time of inspection specific information was not collected about people’s end of life wishes. A complaints process was in place and we saw trends from complaints was discussed with the care staff. However, we received mixed feedback from people and relatives about how they felt their complaint was handled and responded to.

The registered manager had taken the necessary action to address the previous breach of regulation. There were processes in place to review the quality of care records. Care records had been reviewed and additional improvements were being made to incorporate feedback following a CQC inspection at the provider’s other service. There were systems in place to track staff’s compliance with training requirements and we saw regular programmes or spot checks and supervision. Action was taken to address any performance concerns identified through spot checks with the individual staff members. There were systems in place to obtain feedback from people, their relatives and relevant health and social care professionals. The provider had developed a business development plan for 2018. This looked at how they could increase recruitment, stabilise staff turnover and improve efficiencies including reducing travel time for staff. The care coordinator was in the process of amending some staff allocations to make these efficiencies which was impacting on the consistency of staff allocation currently, but would help to establish this consistency in the future. The registered manager adhered to their CQC registration requirements.

Further information is in the detailed findings below

Aims Homecare Limited delivers personal care to people in their own homes. At the time of inspection they were delivering support to 76 people and covered the areas of Epsom and Ewell, Reigate and Banstead and Elbridge. The service predominantly supports older people who may have dementia.

Aims Homecare Limited provides a variety of different services to meet people’s needs. Support calls vary from 30 minutes to 12 hours. They provider live in carers as well as wake night and sleep in support. The people are supported with a full range of tasks, including maintaining their health and well-being, personal care and support with nutrition and hydration.

We last inspected the service on 11 March 2014 where no concerns identified. This was when the service was registered as Aims Homecare Domiciliary Service.

On the day of inspection we met the registered manager. 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 relative we spoke to were happy with the support they received from Aims Homecare Limited.

The provider's quality monitoring system focused on the experience of people. It included spot checks and telephone reviews. We found that there were a lack of robust quality assurance systems to highlight any shortfalls. We found shortfalls with people’s care plans and risk assessments not reflecting their needs. We also found shortfalls in some staff training and som issues from people that had not been picked up or addressed. Due to staff knowledge the impact on people was low. We have however recommended the provider assess their quality assurance systems to ensure they are robust in all areas.

People told us they felt safe with the staff that came to their home. Staff understood the signs of abuse and their responsibilities to keep people safe. Recruitment practices were followed that helped ensure only suitable staff were employed at the service.

Risks of harm to people were identified at the initial assessment of care and staff understood what actions they needed to take to minimise risks. Staff understood people's needs and abilities.

People were supported by regular members of staff who supported people in a timely manner. Staff were confident and had the knowledge to administer medicines safely. They knew how to support people to take their medicines safely and to keep accurate records.

Staff felt they received the training and support they needed to meet people's needs effectively. Staff felt supported by the management team and were encouraged to consider their own personal development.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of MCA and DoLS. People made their own decisions about their care and support. When people lacked capacity the best interest process was followed.

People were supported to eat meals of their choice and staff understood the importance of people having sufficient nutrition and hydration. Staff referred people to healthcare professionals for advice and support when their health needs changed.

The service received compliments that highlighted the caring culture of the service. People and relatives praised staff for their caring nature. People and relatives told us staff were kind and respected their privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's wishes and preferences.

People and relatives said that the service was responsive to their needs. The service assessed people’s needs so they received support when they needed it.

People received person centred care from a service that had a flexible approach and was responsive to unforeseen circumstances.

People knew how to complain and were confident any complaints would be listened to and action taken to resolve them. When areas of improvement were recognised plans were put in place to resolve them.

People and relatives agreed that the service was managed well. Management understood the service being provided. Staff and management talked about the open door policy in place, which made the management team approachable. The registered manager understood their responsibilities in terms of notifying CQC of significant events at the service.