Availl (Norwich)

Updated 6 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We gave the service 48 hours’ notice of the inspection visit because it is a domiciliary care service and we needed to be sure that someone would be available to talk to us and arrange for people’s consent to be sought for us to contact them for their views. This inspection was undertaken by an inspector, an assistant 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.

Inspection site visit activity started on 28 November 2018 and ended on 7 December 2018. It included a visit to the provider’s office location on 28 November 2018 to meet with the registered manager and office staff; to review care plans and other records. In the following days we made telephone calls to people who used the service and their relatives, calls to members of staff and contacted healthcare professionals for their opinions of the service.

Before the inspection, we requested that the provider complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was received from the provider.

Providers are required to notify the Care Quality Commission about events and incidents that occur including unexpected deaths, injuries to people receiving care and safeguarding matters. Before the inspection we reviewed information that we held about the service such as statutory notifications. We also contacted commissioners (who fund the care for some people) of the service and asked them for their views.

During the inspection we spoke with four people who were receiving a personal care service from Availl (Norwich), We also spoke with the relatives of five people. We spoke with three members of care staff as well as the registered manager, the branch manager and care co-ordinator. Following our visit, we left our contact details for any other staff wishing to contact us and provide feedback on the service, however none did.

We reviewed five people’s care records in detail including their daily records and where applicable, their medicine administration records (MAR). We looked at four staff recruitment files.

Updated 6 February 2019

Availl (Norwich) is a domiciliary care agency. It provides a service to a range of people including older adults, adults who have learning disabilities, physical disabilities and mental health needs.

A domiciliary care agency provides personal care to people living in the community. CQC does not regulate premises used for domiciliary care because people receive this service in their own homes. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. At the time of our comprehensive inspection there were 15 people receiving a personal care service we regulate.

There was a registered manager in post at the time of our inspection. The registered manager was also the provider of the service having purchased a franchise for the branch from the wider Availl business. The registered manager was also supported by a branch manager who took on the day to day management 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. For the purposes of this report we will refer to the provider as the registered manager.

At our last inspection in June 2017 we rated the service ‘Requires Improvement’ overall. At that inspection we found several breaches of the Health and Social Care Act 2008. We found that people did not have thorough care assessments in place. The risks which people faced had not been fully explored and care plans did not guide staff about how to meet people's needs in a safe way. People’s care assessments and reviews were not always person centred.

At that inspection we were also concerned that the competency of staff was not being checked on a regular basis and staff did not receive the training they needed to support people effectively. At our last inspection we also found that some people did not receive their medicines safely because this need had not been identified in their assessments. Staff did also not recognise when systems were not in place to support people with their medicines. We also found that there were insufficient systems in place to monitor the quality of the care and service provided and audits were not taking place in relation to people's care records.

At this inspection we found that there were some improvements, however these were still on-going and not fully embedded or effective yet. Care planning was detailed however it did not cover specific healthcare needs or support needs that some people had. Some improvements had been made to the safe management of people’s medicines however there were some discrepancies between people’s MAR charts and their care plans.

The registered manager had increased the frequency of the checks being carried out of staff competency and was ensuring that regular checks of staff practice were now being made. Staff continued to receive training however they had mixed views in how effective they found this in the format in which it was delivered.

Some improvements had been made to the auditing of people’s care records. Audits were now in place; however, they were not wholly effective. The audits undertaken did not identify the concerns that we found with gaps in care records.

The rating for the service continues to be rated ‘Requires Improvement’. We also found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated activities) regulations 2014.

People and their relatives felt safe with the service they received. Staff were clear on how to recognise potential harm and how to safeguard people. There were sufficient staff available to visit people and provider their care. Recruitment practices were thorough and made sure new staff were suitable to work with people.