A1 Home Care Services was rated Good overall following a January 2016 inspection, with staff providing safe, effective and caring support underpinned by robust recruitment, strong safeguarding practice and positive relationships with people. A breach of Regulation 17 was identified under Well-Led due to absent formal supervision structures, unresolved late-visit complaints and insufficient governance systems to monitor and improve service quality.
Concerns (7)
criticalGovernance — “This is a breach of Regulation 17 of the HSCA 2008 (Regulated Activities) Regulations 2014, Good governance”
criticalSupervision / appraisal — “Staff did not receive consistent managerial support and there was no clear line of accountability. One person told us they had not received supervision in two years.”
moderateMissed or late visits — “Staff told us they had raised concerns about this informally on numerous occasions but action had not been taken... the registered manager told us that a new recruitment drive hoped to alleviate the pressure”
moderateRecord keeping — “Systems in place were informal which meant that information could be lost. We saw limited documentation which meant the information might not be communicated effectively to others.”
minorCare planning — “some care plans were not always detailed enough for people who had complex needs such as those who lived with dementia or those who needed end of life care.”
minorPerson-centred care — “one care plan informed staff that a person had cultural preferences for care, but it did not specify what these were. This meant staff might not have all the information they needed.”
minorConsent / capacity — “The registered manager had filled in forms to say that people had consented to their care arrangements but people did not sign to say they were involved in planning for their care.”
Strengths
· Robust recruitment process using values-based interview questions, DBS checks and two satisfactory references
· Staff demonstrated strong understanding of safeguarding procedures and actively used whistleblowing policies
· Comprehensive and regularly reviewed risk assessments including environmental, physical and mental health risks
· Weekly audits of medicine administration records with active investigation of errors
· Staff trained in Care Certificate and supported to undertake QCF diploma; competency observed by senior staff
Quality-Statement breakdown (20)
safe: Recruitment and staffingGood
safe: SafeguardingGood
safe: Risk assessmentGood
safe: Medication managementGood
safe: Infection controlGood
effective: Staff training and competencyGood
effective: Consent and Mental Capacity ActGood
effective: Working with other professionalsGood
effective: Supervision and observation of practiceRequires improvement
caring: Kindness, dignity and respectGood
caring: Promoting independenceGood
caring: Advocacy for people using the serviceGood
responsive: Person-centred care planningGood
responsive: Complaints handlingGood
responsive: Meeting cultural and gender preferencesGood
responsive: Partnership working to meet needsGood
well-led: Monitoring late visits and governance systemsRequires improvement
well-led: Staff supervision and accountability structuresRequires improvement
well-led: Openness, culture and whistleblowingGood
well-led: Regulatory notifications and external liaisonGood
A1 Home Care achieved a Good rating across all five key questions at its December 2019 inspection, with 102 people receiving safe, person-centred domiciliary care from well-trained and consistently deployed staff. Two recommendations were made — to strengthen risk recording in care plans and to introduce oral health care training — but no regulatory breaches were identified.
Concerns (3)
moderateRecord keeping — “we saw some inconsistencies about the quality of written guidance for staff. On some care plans it was very detailed whilst on others the guidance was minimal.”
minorMedication management — “staff were recording giving medicines in two different places which made auditing people's medicine administration records (MAR) difficult.”
minorStaff training — “staff were not currently receiving specific training in oral health care, there were plans to introduce this to the new training programme which was under development.”
Strengths
· People felt safe and staff consistently arrived on time and stayed for the full duration of agreed visits with no reported missed or late visits.
· Medicines were managed safely with all administering staff trained and assessed as competent.
· Staff received regular supervision, appraisals and induction including the Care Certificate, with a newly recruited in-house trainer redesigning the training programme.
· People were treated with dignity, kindness and respect; staff knew people well and promoted independence.
· Registered manager and provider were visible, approachable and transparent, demonstrating strong duty of candour.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
A1 Home Care was rated Good across all five key questions at its April 2017 inspection, having remediated a previous Regulation 17 breach around governance and quality monitoring. Minor ongoing concerns remained around late-visit communication, inconsistent staff rotas, gaps in supervision for some staff, and failure to honour gender preferences for care workers when short-staffed.
Concerns (6)
moderateMissed or late visits — “The staff are usually on time but if they are late they don't let me know I have to call them”
moderatePerson-centred care — “whilst they had expressed a preference for not having male staff, male staff were sent to them when the service was short staffed”
moderateSupervision / appraisal — “I have not received any form of supervision in the last year”
minorCommunication with families — “They don't always arrive on time, but they have good reason why they are late, it was more that the service did not let them know”
minorConsent / capacity — “a review of how these were completed was needed as they were not always completed correctly for each activity which needed an assessment”
minorGovernance — “I get a list but it isn't always correct and they don't let me know if they have changed it”
Strengths
· Robust recruitment system with DBS checks, references and risk assessments in place for all new staff
· Medicines administered safely and on time; staff competency in medicines management checked via observation
· Staff described as kind, caring and compassionate by people who used the service and their relatives
· Care plans were personalised and provided staff with sufficient information to deliver person-centred care
· Complaints handled in a timely and appropriate manner with a clear process in place
effective: Supporting people to eat and drink enough with choice in a balanced dietGood
effective: Staff providing consistent, effective, timely care; supporting people to live healthier lives and access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on their duty of candour responsibilityGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
well-led: Continuous learning and improving careGood