Aapna Services Ltd

Aapna House is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 35 people were using the service and receiving personal care. Not everyone who used the service received 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.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Risks to people were not always robustly managed. There was limited written information for staff around some key risks to people. People’s care plans were not always up to date, and were not always clear and consistent. Systems and procedures were not in place to ensure people’s medicines were accurately recorded, and clear guidance was not always in place for staff around people’s medicines. Safe recruitment procedures were not in place.

The management team did not have effective oversight of the service. Audits had not identified all of the issues we found on inspection and systems were not in place to robustly analyse incidents and look for trends.

Some areas of people’s care plans contained clear guidance for staff, and the provider completed environmental risk assessments to help keep staff and people safe. There were enough staff to support people and staff had received appropriate training. People were kept safe from the risk of abuse. The provider managed infection prevention and control safely.

There was a positive atmosphere amongst staff, people and relatives. People were happy with the care provided and relatives spoke about the positive impact the service had. Staff enjoyed their jobs and felt supported by management. Relatives and people told us communication was good, and people were supported to access healthcare and other professionals.

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

Rating at last inspection

The last rating for this service was good (published 6 February 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the quality of the service and organisational oversight. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aapna House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to oversight, recruitment and record keeping.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aapna House is a domiciliary care agency providing personal care and support to people living in their own homes. Not everyone who used the service received 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 inspection seven people were receiving personal care.

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

People and their relatives were very positive about the support provided by Aapna House and the positive impact staff had on their lives. People told us that they liked the staff who supported them, felt safe and that all of their needs were met.

Staff encouraged people to be as independent as possible and to maintain their social relationships. The service supported people with activities within their homes but also socially within the local community to improve their overall well-being.

Staff knew people well and were very respectful and caring about people. Staff felt supported and had access to regular training from the management team. There were enough staff available to safely support people and ensure people received a continuous level of care.

People’s needs were wholly assessed, and care plans reflected people’s individual choices and preferences. Care records included involvement and guidance from other health care professionals. Medicines were managed safely and risks to people had been fully identified and mitigated.

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 followed best practice guidance.

The registered managers were working on continuously improving the service provided. There were quality and assurance systems in place to monitor the quality of care provided to people and this was being reviewed to make sure all audits of the service were fully effective to drive improvement.

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

Rating at last inspection

The last rating for this service was good (published 22 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aapna Services is a registered charity. The service specifically caters for people from the black minority ethnic communities in the Middlesbrough area providing culturally suitable services to enable people to live independently at home. The service is registered with the CQC to provide personal care to adults aged 18 and above. The service provides staff to support people with personal care as well as domestic duties, shopping, medical appointments and social outings.

We last inspected the service in January 2016 and rated the service as ‘Requires Improvement.’ We asked the registered provider to take immediate actions and at this inspection we found some improvements had been made to meet these regulations. However further improvements are required within management systems.

The service provides support to 52 people in their own homes, five of which required support with personal care.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During our inspection we found the organisation was multi-cultural and was underpinned by values and a genuine desire to be inclusive.

People were supported by enough staff, at the right times to meet their needs safely and in a person centred way. Person centred means when a person is central to their care and treatment and their needs are met in a personalised way taking on board their preferences.

Accidents and incidents were appropriately recorded and personalised risk assessments were in place for people who used the service and staff.

People were supported to administer their own medicines safely at home.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining and verifying references from previous employers to show staff employed were safe to work with vulnerable people.

Staff received regular supervisions and opportunities for further personal development. Some staff appraisals had taken place and other were planned.

Staff were suitably trained to meet the needs of the people who used the service and an appropriate induction took place for new starters.

Training needs of the staff were recorded but they were not always monitored.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

Staff supported people who used the service with their social, cultural and religious needs. People who used the service told us that all staff were very caring in the way they supported them.

People who used the service told us they were treated with dignity and respect and felt very comfortable with their staff. They told us how they had learned from each other and had built trust and important relationships together.

People who used the service were aware of how to make a complaint if they needed too and complaints were managed appropriately.

The service had onsite facilities and activities for people to access.

Staff told us they felt supported by the registered manager and were comfortable raising any concerns.

The service had a range of audits in place to check the quality and safety of the service and actions plans and lessons learnt were part of their on-going quality review of the service. However quality assurance with the people who used the service was planned but at the time of our inspection hadn’t taken place.

The service worked in partnership with the local authority and local voluntary and community organisations in the area for the benefit of the people who used the service.

Aapna Services Limited is a registered charity. The service specifically caters for people from black minority ethnic communities providing culturally suitable services to enable people to live independently at home. The service is able to provide personal care and support to adults aged 18 and above. The service provides staff to support people with personal care as well as domestic duties, shopping, medical appointments and social outings. At the time of the inspection the service was providing personal care at home to three people.

The service had a registered manager in place. 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 service did not undertake a full environmental risk assessment to clearly identify risks within the environment, to the person or staff member providing assistance. Risks assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe.

Systems were not in place for the management of medicines to make sure that people received their medicines safely.

Staff had not received an annual appraisal. The registered manager told us mandatory training for staff was up to date; however, records were not available to confirm this. Staff had not received training in the Mental Capacity Act 2005.

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. Effective quality monitoring systems were not in place to ensure the service was run in the best interest of people who used the service.

These were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

Some improvement was needed to ensure appropriate checks were completed on staff before they started work.

There were enough staff employed to provide support and ensure that people’s needs were met.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.

Staff told us that the registered manager was supportive. We saw that staff had received supervision on a regular basis.

People were treated with dignity and respect. Staff were attentive, showed compassion and encouraged people to be independent.

People were provided with their choice of food and drinks which helped to ensure that their nutritional needs were met.

Staff at the service worked with other healthcare professionals to support people. Staff worked and communicated with social workers, occupational therapists and hospital staff as part of the assessment, ongoing reviews and care package.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

The relative we spoke with told us that the person who used the service was well supported. We were told that the agency provided a reliable service. The relative said, 'He / she is very happy with the help they get.'

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Peopled were supported by, suitably qualified, skilled and experienced staff. We found that the provider had effective recruitment procedures and that relevant checks were carried out on staff to ensure that they were suitable to work with children and young people