Archived: Axe Valley Home Care Ltd

Axe Valley Homecare is registered to provide personal care to people living in their own homes. At the time of our inspection the service was providing support to 52 people. The service was run from a location outside Dorchester.

The service had a 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.

When we last inspected the service on 27 April 2016 we had concerns about how people’s risks were managed and there were issues about communication and accurate recording of medicines. Quality assurance measures were not comprehensive and did not provide an overview of themes or trends. There were breaches in two regulations and we asked the provider to take action about these concerns. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches and told us that they would be compliant with the regulations by July 2016. At this inspection we found that they were no longer in breach, but that there were still areas for improvement.

The service did not have capacity assessments in place for people in line with legislation and did not have systems in place to assess a person’s capacity or make a decision in a person’s best interest where this might be required. We have made a recommendation about completing assessments of people’s capacity.

The service had taken steps to try to improve communication where staff did not speak English as their first language. However people reported that they struggled to communicate with some staff and this had therefore not been effectively managed. We have made a recommendation about staff language skills.

Staff received training in some topics but felt that they needed additional training opportunities in conditions people faced to ensure that they had the correct knowledge and skills to support them. This had been identified at the last inspection but no changes had been made.

People had risk assessments which identified the risks they faced and gave general information about how to manage these. The service was in process of reviewing people’s care plans and ensuring that risk assessments were individualised.

People and their relatives told us they felt safe with the staff who provided their care and support. Staff were aware of their responsibilities in protecting people from harm and knew how to report any concerns about people's safety or wellbeing.

People were supported by staff who were recruited safely and were familiar to them. Staff received supervision using an online system and were able to request face to face time with a supervisor if needed.

Where people received support from staff to eat and drink sufficiently, we saw that staff offered choices and prepared foods in the way people liked.

People told us that staff who supported them were kind and helpful and we observed that staff supported people in the way they preferred and treated people with dignity and respect.

People told us that they received a rota each week letting them know what staff were due to visit at what times. Where changes were needed to visits, or where staff were running late, people told us that the office generally made contact to let them know.

Peoples care plans included details about what people liked and how they wanted to be supported.

People told us that they were involved in reviews about their care and we saw that reviews were completed annually, or more frequently if people’s needs changed.

Feedback was gathered from people through surveys and used to identify actions to improve the service. People told us that they would be confident to complain if they needed to and we saw that complaints were recorded and responded to appropriately.

Staff and people told us that the office was easy to contact and responsive. Team meetings were in place and regular newsletters and the PASS system were used to communicate effectively with staff.

Quality assurance measures were regular and used to monitor and identify areas for improvements.

Axe Valley Homecare Ltd Dorchester Office is registered to provide personal care to people living in their own homes. At the time of our inspection, the service was providing support to 50 people. The service was run out of a central office outside Dorchester.

The service had a 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.

Risks to individuals were not safely managed by the service. The risk assessments and moving and handling assessments were not individual and did not provide information about how to manage people’s risks.

The provider’s system for highlighting people who required time critical visits was not safe. The registered manager provided us with a copy of the people who were scheduled to receive time critical visits in the week prior to the inspection. One person with diabetes was not included on this schedule and their visits varied by two and a half hours over the week.

Medicines were not recorded correctly on Medicine Administration Records (MAR). There were gaps in the recording for all of the MAR. Staff had recorded that medicines had been administered in people’s daily records. People told us that they received their medicines appropriately.

We saw that some people received their medicines from a pre-packed system which was dispensed by the pharmacy to people’s homes. These people had a MAR which recorded that the medicines in the system had been taken but did not include details of what medicines were included in this system, any prescription directions or the dosage. This did not follow current guidance for safe administration of medicines..

Most people and relatives told us that they felt safe with the support from the service and that they received visits when they should. People told us that they knew the staff who visited them and generally had the same staff.

Staff received training as part of their induction and received refresher training in certain areas annually. Staff had undertaken training in four main areas, safeguarding, mental capacity, manual handling and medication administration. Some staff felt that they had the right training to support them, but others felt they required other training opportunities. Most people, relatives and health professionals told us that they did not think staff had the right training to support people’s needs.

People and relatives all told us that communication was difficult with some members of staff. Healthcare professionals commented that communication was an issue. A district nurse had observed that a carer did not seem to interact on a visit and a relative explained that the limited English of some staff was a problem for their relative.

The registered manager told us that no-one at the service had a capacity assessment in place but that people completed consent forms for staff to administer medication and the service was currently reviewing its MCA paperwork. Staff were able to tell us how they sought peoples consent.

People and relatives told us that staff were kind. Staff knew peoples preferences and how to support them. Two members of staff told us about people that they supported and their personal preferences. For example one person had a very detailed routine and the staff member was aware and able to explain this.

The service did not always listen to peoples choices and preferences. One person said that the biggest improvement the service could make would be “to listen to what we want”.

People and relatives received a weekly rota telling them who would be visiting and when. People told us they were not consistently informed about changes to their visits.

People and relatives told us that they were involved in reviews of their support. One person told us that they were involved in the planning of their care and that this was thorough. ”. The registered manager did not have details of what had been discussed or updated at reviews or oversight of any themes or trends from peoples reviews.

Staff knew peoples preferences and how they liked to receive support. We observed relaxed and easy going support form carers who knew the people they were supporting, however staff told us that they did not always have sufficient information about how to support new people.

Quality Assurance systems at the service were not robust. Medication audits were not robust or collated which meant that the registered manager was not aware of themes in medication administration errors. There was no consistent process for frequency of staff reviews and peoples care reviews were not audited. We saw that reviews were not comprehensive and the registered manager was not able to see what areas had been discussed at review. The registered manager completed spot checks, had an overview of when reviews were due and showed us evidence of this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment of people(Regulation 12) and good governance of the service(Regulation 17). You can see what action we told the provider to take at the back of the full version of the report.