Astoria Homecare Ltd

About the service

Astoria Homecare Ltd is a domiciliary care agency providing personal care and support to people living in their own homes. The service is registered to offer support to older and younger adults, adults with learning disabilities, physical disabilities and people with mental health needs.

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 the inspection, 18 people were receiving support with personal care.

People’s experience of the service and what we found

Overall, the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture, but we found a number of areas where improvements were required.

Right Support

In terms of consent to care, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff focused on people's strengths and promoted what they could do. Staff communicated well with people.

Right Care

We found risk assessments and risk mitigation plans were not always in place. Medicines were not always managed in a safe way. Staff understood how to protect people from poor care and abuse and the service worked with other agencies to do so. Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People were supported to access healthcare services.

Right Culture

The provider had systems to evaluate the quality of the service being delivered, but these were not always effective as they had not found the concerns identified during the inspection. The values of the organisation, management and staff helped people to feel included and empowered. Staff were supported through supervision and training and told us they felt supported by the registered manager.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 15 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

During the inspection we found there was a concern with consent to care, so we widened the scope of the inspection to include the key question of effective.

Enforcement and Recommendations

We have identified breaches in relation to safe care, consent to care and good governance. We recommended the provider consider current guidance around safe recruitment and establish systems to help ensure lessons are learnt and to take action to update their practice accordingly.

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.

The service was registered on 30 January 2017 and had not been inspected before.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of our inspection there were three people using the service, all of whom were older adults with a range of care needs, including those related to mental health and dementia.

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.

The risks to people's wellbeing and safety had been assessed, and there was information on people’s records about how to mitigate these risks, however, individual risk assessments were at times basic and lacked information. The provider agreed to address these promptly.

People's needs were assessed prior to receiving a service and care plans were developed from the assessments. Care plans contained the necessary information for staff to know how to support people. However some sections were basic and lacked detail.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff’s absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised. However, not all gaps in staff’s employment histories had been explained.

Staff followed the procedure for the management of people’s medicines and people told us they were receiving their medicines as prescribed.

There were procedures for safeguarding adults and staff were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

The provider had systems in place to manage incidents and accidents and took appropriate action to minimise the risk of reoccurrence.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act 2005 (MCA) and staff had received training on this. People had consented to their care and support and had their mental capacity assessed prior to receiving a service from Astoria Homecare Ltd.

People's health and nutritional needs had been assessed, recorded and were monitored to ensure these were met.

Care staff received an induction and appropriate support before delivering care and support to people.

Feedback about the service from people and their relatives was positive. People said they had regular staff visiting which enabled them to build a rapport and get to know them.

People we spoke with and their relatives said that they were happy with the level of care they were receiving from the service.

There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

People, staff and relatives told us that the registered manager and senior team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People and staff were supported to raise concerns and make suggestions about where improvements could be made.