Availl (Bury St Edmunds)

Updated 17 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was no registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 30 March 2023 and ended on 11 April 2023. We visited the location's office on 30 March 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service and 8 relatives about their experience of the care provided. We also had contact with 10 members of staff including care staff, care coordinator, senior manager and director.

We reviewed a range of records. This included 4 people's care plans, 4 staff records in relation to recruitment, and a variety of other records relating to the management of the service were also considered as part of the inspection.

Updated 17 May 2023

About the service

Availl [Bury St Edmunds] is a domiciliary care service providing personal care to people 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 this inspection there were 27 people using the service, 13 of which were in receipt of personal care.

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

At our previous inspection we found shortfalls in staffing, safe care and treatment and governance. The provider sent us their action plan telling us what they would do to ensure compliance.

Whilst we found some improvement in the quality of care and risk management plans the service remained in breach of the regulation. Progress to make all necessary improvements to the governance and oversight arrangements was ongoing and due to some changes in management this had impacted on progress and timescales.

Systems in place to ensure staff received appropriate induction, support and training that is necessary for their role continued to be in need of improvement.

The service had been without a registered manager since February 2021. The provider's oversight and governance of the service continued to be ineffective.

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.

Right Support: The provider had safeguarding processes in place. Staff understood how to ensure people were protected from the spread of infection. However, people told us they experienced constant changes of care staff.

Staff were recruited safely.

Right Care: People told us staff were kind and caring and were treated with respect, however some people told us they did not always have the opportunity to give feedback. Improvements had been made to the provider's systems to assess and manage risks safely for people and were ongoing to support people to have maximum choice and control of their lives and for staff to support them in the least restrictive way possible and in their best interests; the polices and systems in the service to support this practice were also being reviewed.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives.

Systems for auditing had been introduced but needed further development to consistently evidence and document the actions taken and where applicable lessons learnt.

There were mixed views about the communication from the office, some people said it was good and others said it was not good at all. Staff told us the constant change in management had impacted on morale.

The provider had an electronic call monitoring system in place which for the most part was effective. People told us overall they felt safe with all staff who supported them. Risk management plans were in place, we have made a recommendation about improving risk assessments for people with a diagnoses of epilepsy.

We recommended the provider uses a reliable system to monitor staff care calls to ensure they continued to be delivered according to people's care plans.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 December 2021) and there were breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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

Enforcement and Recommendations

We have identified continued breaches in relation to staff training and support, governance and oversight of the service.

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

Follow up

We will meet with the provider following 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 continue to monitor information we receive about the service, which will help inform when we next inspect.