The inspection took place on 16 and 20 June 2016 and was announced. The provider was given 24 hours’ notice as we needed to be sure the manager would be available to talk to us. The service was last inspected in August 2014 when it was found to be compliant with the outcomes inspected.AQT Home Care Services is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection they were providing support to 22 people.
The service had a manager in place. However, they were not registered with the Care Quality Commission. The manager had started the application process to become registered. 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.
People told us they felt safe using the service, and care workers were knowledgeable about their responsibilities to safeguard people from harm. However, the processes for escalating concerns were not operating effectively to ensure that concerns and allegations were investigated appropriately.
People were at risk of harm and poor support because care plans and risk assessments did not contain the information staff required to provide good quality safe care. Care workers relied on feedback from people, their relatives and more experienced colleagues to know what support to provide. Care plans were not kept up to date when people’s needs changed.
The service did not always have enough staff to ensure that people’s needs were met. We have made a recommendation about staffing levels.
People and their relatives told us they were supported to take their medicines as prescribed. However, records were not well maintained. We have made a recommendation about recording medicines administration.
People and their relatives told us they thought that staff were good at their jobs. Staff told us they received regular training, although this was not always reflected in the records of training received. Staff did not receive regular supervision. We have made a recommendation about supporting staff.
The service provided support to people at the end of their lives. End of life care plans did not contain the information required to ensure that people were supported at the end of their lives to have a dignified and pain free death. We have made a recommendation about end of life care.
The systems for monitoring the quality of the service were not operating effectively. Management audits of care plans and records of care delivered had not identified that more information was required to ensure high quality care was delivered.
Where the service was responsible for supporting people with eating and drinking this was recorded in the care plan. People were supported to eat and drink enough and to maintain a balanced diet. The service supported people to access healthcare services as appropriate, but did not update care plans to reflect current advice from health professionals.
The service sought consent from people and their legal representatives in line with legislation and guidance.
People and their relatives told us they thought the staff had a caring attitude. Regular care workers had developed positive relationships with the people they supported. People told us they felt they were treated with dignity and that care staff were respectful to them.
People and their relatives knew how to make complaints and records showed these were responded to in line with the provider’s complaints policy. People and their relatives told us the service responded well to any concerns they raised and made changes as requested. The provider completed annual surveys of staff and people who used the service to obtain feedback about the service.
We found five breaches of the Regulations. You can see what action we have asked the provider to take at the end of the full version of this report.