AM-R-AZ LLP

AM-R-AZ LLP is a domiciliary care agency. They provide personal care to people living in their own homes. 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 11 people were receiving personal care.

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.

People’s experience of using this service and what we found

Right Support:

We received mixed feedback on whether people knew which staff were coming to support them on each call. Some people were given a rota of staff allocated each week, however some people told us they did not have this sent to them in advance.

People’s communication needs were not always fully recorded to ensure new staff would understand and know their individual communication needs.

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 did not always support this practice.

People were supported by staff who understood and were trained in recognising the signs of abuse. The provider had a policy and procedure in place should any concerns be raised.

Right Care:

Medicine records were not always kept up to date and staff did not always have the required information to ensure medicines were given as prescribed. Staff had not always recorded the reasons for giving ‘as required’ medicines.

Risks to people were not always recorded. Care plans and risk assessments were not always in place and kept up to date to ensure staff had the information required to support people safely. Staff did not always have the training, skills or knowledge to meet people’s specific needs.

People were supported to maintain a healthy diet and adequate fluid intake. When required, staff supported people to eat and drink safely.

Right Culture:

Systems and processes were not always effective in ensuring the provider had oversight of the service and that all records were kept up to date and factual.

People, relatives and staff told us the provider had not asked them to feedback on the service. There were no formal systems in place to capture people’s feedback to learn from and improve care.

Staff told us they did not have any 1:1 time to discuss concerns or issues. The provider completed spot checks on staff to check person centred care was delivered. However, this meant that senior staff observed people having personal care completed.

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

Rating at last inspection

The last rating for the service under the previous provider was good (published on 30 April 2019)

Why we inspected

We received concerns in relation to care planning and medicine management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for AM-R-AZ LLP on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, medicines and oversight at this inspection.

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.

People’s experience of using this service:

¿ People received safe care and they were protected against avoidable harm, abuse, neglect and discrimination.

¿ Where the provider took on the responsibility, people’s medicines were safely managed.

¿ Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We have made a recommendation about mental capacity assessments.

¿ Staff had access to the support, supervision and training they required to work effectively in their roles.

¿ Staff were friendly and caring; they treated people with respect and maintained their dignity.

¿ Staff encouraged people to maintain their independence.

¿ People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s preferences.

¿ Information could be provided to people in an accessible format to enable them to make decisions about their care and support.

¿ People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

¿ The service had provided appropriate end of life care to people.

¿ The service had a positive ethos and an open culture. The registered manager was approachable, understood the needs of people, and listened to staff.

¿ There were effective systems in place to monitor the quality of the service and drive improvements.

Rating at last inspection:

Good (report published 15 September 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

There was a registered manager in post at the time of our inspection, however they were absent on planned leave until December 2016. The day to day management of the company was provided by the provider. 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 provider had values and a clear vision that were person centred and focussed on enabling people to live at home. All staff demonstrated a commitment to providing a service for people that met their individual needs. People had positive relationships with staff.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make an informed decision and encouraged people to make their own choices.

People received safe care and support. Staff understood their role in safeguarding people and they knew how to report concerns. There were enough staff with the right skills and attitudes to meet people’s needs.

Staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. Staff were clear about their roles and responsibilities in caring for people and received regular support from the provider.

Care records contained risk assessments and risk management plans to protect people from identified risks. They gave information for staff on the identified risk and informed staff on the measures required to minimise any risks. Staff were vigilant regarding people’s changing health needs and sought guidance from relevant healthcare professionals.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that if they had any concerns they would be listened to and any concerns would be addressed.

The provider monitored the quality and safety of the service and staff regularly monitored the support people received. People and staff were encouraged to provide feedback about the service and it was used to drive continuous improvement.

People told us staff explained their individual care needs to them and that staff asked for their consent before they provided any care. One person said 'I am very satisfied with the service, I know what to expect because the staff always explain things properly and provide me with the support that I need'.

One relative said 'the staff communicate with us really well and are always respectful when they come into our home, they check before they come in to make sure its ok'.

All of the people we spoke with told us they were well looked after and the staff knew how they needed and wished to be supported. One person commented 'The staff are very kind, I am so pleased with the service, and the care is excellent'. Another person told us 'the staff do a really good job they know the support that I need'.

People told us they thought the staff had the right skills to care for them safely. One person said 'the staff are excellent; I have no concerns at all'. Another person commented 'they seem to match the staff according to my routines and needs, they are very good and they know how I need to be cared for'.