At Home-Specialists in Care Ltd

Updated 12 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was undertaken by 1 inspector. An Expert by Experience made telephone calls to people who used the service and people’s relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 4th July 2023 and ended on 18th July 2023. We visited the location’s office on 4th and 10th July 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with 7 members of staff including care workers, a rota coordinator, registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a selection of medication administration records and the care records for five people. We spoke with 3 people who used the service and 4 relatives.

After the inspection

We received and reviewed further documentation including a variety of policies, information pertaining to training and governance.

Updated 12 August 2023

About the service

At Home – Specialists in Care Ltd is a domiciliary care agency providing personal care to people living in their own homes. The service predominantly supported older people. Not everyone who used the service received the regulated activity ‘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 our inspection there were 53 people who received personal care support.

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

Medicines records were not completed fully or in line with best practice guidance. This presented a risk people would not receive their medicines correctly. Whilst some risk assessments had been completed, these did not provide sufficient detail to guide staff and mitigate potential risks. There was a lack of oversight of accidents and incidents for people who used the service.

Safe recruitment practices help to ensure only people of suitable character are employed. Whilst most elements of the recruitment process was safe, new candidates did not provide a full work history in accordance with legislation. Staff felt there was insufficient travel time between calls which impacted on the support they provided. We found staff were not always staying the full duration of peoples’ care calls.

Services complete checks and audits to monitor safety and quality. Issues highlighted at this inspection were not picked up through the audits and led to breaches of regulatory requirements. Some similar issues were highlighted at this inspection and the previous one.

Staff were familiar with the people they cared for and spoke about people with respect and warmth. People who used the service and their relatives told us they felt safe with the carers and gave us generally positive feedback. A person who used the service told us, “I get on very well with all the carers. They are really good company for me. They treat me with respect, and I am happy with my relations with these carers. We have chats and I look forward to them coming to see me. I am very happy with the care I receive.”

There were safeguarding policies in place to guide staff should a person be at risk of harm or abuse. Staff had access to PPE and undertook infection prevention and control training to ensure they had the required knowledge in this area. Staff practice was continually monitored and included observations and spot checks of their practice.

Questionnaires were used to seek people’s feedback about the service and this was reviewed to see if there was any learning to be applied from this. Team meetings were held however actions were required to ensure this was a positive, cohesive experience for all staff. The service worked with partner agencies to holistically support people. People felt able to share any concerns they had with the office and felt these would be addressed.

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 (report published 12 June 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations and the service remains rated requires improvement.

Previous recommendations

At our last inspection we recommended the provider review their recruitment practices to ensure they were consistently following their policy and best practice. At this inspection we found they had not made the necessary improvements in this area.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at a previous inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for At Home – Specialists in Care Ltd on our website at www.cqc.org.uk.

Enforcement

At this inspection we have identified breaches in relation to safe use of medicines, management of risk and governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet 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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.