Archived: Affinia Healthcare

Affinia Healthcare is a domiciliary care agency that provides personal care to people living in a supported living setting in the London Borough of Havering. At the time of our inspection, there were three people living at the supported living site that received personal care. The supported living site was made up of 16 self-contained flats.

People’s experience of using this service

Systems for the safe management of medicines were ineffective. We made a recommendation in this area. Audits had not identified the shortfalls we found during the inspection.

Risk assessments were in place to ensure people received safe care. Relevant pre-employment checks were carried out to ensure staff were suitable to care for people safely. Safeguarding procedures were in place to and staff were aware of these procedures.

Staff had completed essential training to perform their roles effectively and felt supported in their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had access to health services and were supported with meals when required.

People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them. People were encouraged to be independent and to carry out tasks without support.

Care plans were person centred and included people’s support needs. Care plans had been reviewed regularly to ensure they were accurate.

Systems were in place for quality monitoring to ensure people and staff feedback were sought to improve the service. People and staff were positive about the management of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At our last inspection on 10 July 2018, the service was rated Requires Improvement (published 17 August 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified one breach of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will speak with the provider prior to this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We asked the provider to take action to make improvements in staff training, medicine management, risks to people, care planning, about how specific decisions of people who may lack capacity had been made and how safeguarding processes were managed. During this visit, we found some of the actions had been completed. However, further improvements were needed regarding how risks to people were assessed and information about how to communicate with people.

Affinia Healthcare is a domiciliary care agency that provides personal care to people living in their own homes and some living in supported living in the London Borough of Havering. At the time of our service, there were 13 people using the service, three of whom were receiving personal care in a supported living set up.

There was no registered manager in place as the registered provider was in day to day charge of the service. 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.

We found that the risks associated with people’s support were not always fully assessed, which could have an impact on the safety of people.

Care plans did not mention people’s ability to communicate and how staff should communicate with people. Records showed that some people required information through a communication passport and in an easy read format. This was not available at our inspection.

The service had an efficient system to manage accidents and incidents and learn from them so they were less likely to happen again. The provider had safeguarding policies and procedures in place. Staff had received training about how to safeguard people from abuse.

Systems were in place to make sure people received their medicines safely and for the monitoring and prevention of infection.

The provider employed enough staff to meet the needs of people. There was a recruitment system in place that helped the provider make safer recruitment decisions when employing new staff.

Staff had the knowledge and skills to care for people effectively and responded promptly to their needs. They had a structured induction at the beginning of their employment and received regular supervision and an annual appraisal.

Staff demonstrated a good understanding of the requirements of the Mental Capacity Act 2005. The consent of people was sought appropriately. Referrals were made to health care professionals for additional support or guidance if people’s health needs changed.

An initial assessment of people was carried out before they started using the service. People or their representatives had been involved in writing their care plans. People received care and support in accordance with their preferences, interests and diverse needs.

Staff had a good knowledge and understanding of people's needs. People who required support with meals were provided with food and drinks which met their nutritional needs. People’s privacy and dignity were respected.

People were supported to be as independent as possible and had access to advocacy services to represent them where applicable. People were happy with the support they received from staff.

There were systems to monitor and improve the quality of service provided. The views of people and relatives had been sought and acted upon. However, we noted that further improvement was needed on how audits were carried out.

There was a complaints policy and procedure in place. Confidentiality of people’s personal information was maintained.

People, relatives and staff felt the service was managed well. Staff felt supported by the management team and were aware of their roles and responsibilities. They felt confident they could contact the provider at any time and were satisfied with the response they received.

This inspection was completed on 24 October and 31 October 2017. Affinia Healthcare is a domiciliary care agency that provides personal care to people living in their own homes and some living in supported living in the London borough of Havering. At the time of our service there were 55 people using the service nine of which were receiving personal care in a supported living set up.

At the time of our visit there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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

At our last inspection in October 2016 the service met the regulations we inspected. However at this inspection we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

People we spoke with told us they felt safe and that they were treated with dignity and respect. However we found risks were not always effectively assessed reviewed or managed in order to protect people from harm. Safeguarding processes in place were not always followed. This resulted in delayed safeguarding investigations and demonstrated staff knowledge gaps as to what and where to report different types of abuse. The updated electronic policy did not have any local authority contact details.

Medicines were not always administered as prescribed. We found several instances where medicine administration records had not been completed in order to evidence that people had received their medicines as prescribed. We also saw medicine record transcribing errors which resulted in people receiving less that their prescribed medicines.

People were not always supported by staff that had undergone the necessary training to enable them to deliver support effectively. There were shortfalls in the systems in place to monitor and ensure staff attended all relevant training and were kept up to date with practice.

There were inadequate care planning systems in place which did not ensure people’s needs were accurately documented.

Staff demonstrated limited understanding of the Mental Capacity Act 2005 beyond considering consent before care was provided. Capacity assessments were not always completed properly and did not always reflect how specific decisions of people who may lack capacity had been made.

This resulted in decisions being made by people who had no legal delegation to do so.

We found several failings in the current governance systems in place which had failed to identify and address issues we found at our inspection. These included breaches of information governance as staff could still access the service’s records whilst no longer actively requiring access to people's personal information. People’s records were not reviewed in a timely manner and were not completed to reflect a complete an accurate account of care delivered. The provider had failed to ensure an open and transparent culture.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.