Adina Homecare Services is a care agency providing personal care and support to people in their own homes. The agency is registered to provide care to children and adults. At the time of the inspection, only adults were using the service. The agency cared for people with a learning disability, people with physical disabilities, people with mental health needs and older adults. A total of 82 people were using the service at the time of our assessment. The assessment started on 25 June 2024 and ended on 28 June 2024. We reviewed records the provider sent to us and had a meeting with the provider on the 28 June 2024. We conducted this assessment to follow up on concerns we identified at the last inspection. These included breaches of Regulations relating to staffing, fit and proper persons employed and good governance. The last rating for this service was requires improvement (published 22 December 2022). At this assessment we found improvements had been made and the provider was no longer breaching any regulations. 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. The service was able to demonstrate how they were meeting all the underpinning principles of right support, right care, right culture.
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Adina Home Care Services was rated Requires Improvement overall following an August 2022 inspection, with breaches of Regulations 17, 18 and 19 identified in relation to governance, staffing support and training, and unsafe recruitment practices. Caring was rated Good, reflecting respectful and dignified care delivery, but significant failures in oversight, staff competency, communication and complaints handling placed people at increased risk of harm.
Concerns (10)
criticalStaffing levels: “The provider did not consistently ensure that staff recruited were assessed as safe to work with people. We reviewed eight recruitment records and found issues with all of them.”
criticalStaff training: “Apart from the Care Certificate induction, no information was retained to demonstrate that staff had received appropriate training to enable them to carry out their role.”
criticalSupervision / appraisal: “Care workers did not receive regular spot checks and supervision. Records showed that not all staff were receiving regular one to one meetings with their line manager.”
criticalGovernance: “The provider lacked oversight of the service. The provider was unaware of the issues identified during the inspection.”
moderateIncident learning: “The provider had not carried out a root cause analysis to ensure that the underlying as well as immediate causes of accidents and incidents were understood.”
moderateMissed or late visits: “One relative told us, 'I have had missed calls a couple of times. In fact, I phoned up and there was no answer from the agency.'”
moderateCommunication with families: “Some care workers come who cannot speak English, and I have to tell them all what to do.”
moderateComplaints handling: “We received variable feedback regarding whether people were listened to when they complained. Some people felt their concerns and complaints had not been appropriately addressed.”
moderatePerson-centred care: “People did not consistently receive person centred care because their communication needs were not met.”
moderateRecord keeping: “A medicines audit that was carried out in March, April and May had identified repeated gaps in recording and probable missed doses of medicines.”
Strengths
· Risks to people's safety were assessed and plans put in place to minimise risk of harm; risk was regularly reviewed and care plans updated.
· Systems were in place to ensure medicines were managed appropriately and daily records showed people had received their medicines as prescribed.
· People were protected from the risk of harm and abuse, with accessible safeguarding policies and staff trained to identify and report concerns.
· Infection prevention and control policies were in line with national guidance and staff had access to adequate PPE.
· People's privacy and dignity were respected and care plans were individualised, reflecting preferences, likes and dislikes.
Quality-Statement breakdown (19)
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Staff working with other agencies; supporting people to access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Ensuring people are well treated; respecting equality and diversity; supporting people to express their viewsGood
responsive: Meeting people's communication needs; planning personalised careRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff clear about roles; understanding quality, performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving care; engaging people and staff; working in partnershipRequires improvement
well-led: How the provider understands and acts on the duty of candourGood