This inspection was carried out on the 22 and 26 March 2018.Affinity Homecare Shrewsbury is a domiciliary care agency that provides personal care and support to people living in their own homes. It provides a service to older adults some of whom are living with dementia and younger disabled adults. Not everyone using Affinity Homecare Shrewsbury receives a regulated activity. CQC only inspects the service received by people provided with ‘personal care’: for example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 83 people were receiving the regulated activity of personal care.
There was a registered manager in post who was present during our inspection. 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.
At the last inspection in August 2017, we found the provider was in breach of the regulations in relation to safe care and treatment, the governance of the service and had failed to notify of significant events in the service which they are required to do so by law.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well led to at least good.
At this inspection we found that the provider had notified us of significant events within the service in a timely manner. However, other areas we identified as requiring improvement at the last inspection had not been sufficiently improved upon. We found there were continued breaches of the regulations in regard to safe care and treatment and good governance.
Sufficient improvement had not been made in relation to how risk associated with people’s needs were identified and managed. At our last inspection risks associated with people’s needs were not accurately assessed and management plans were not always in place to guide staff how to reduce risks for people. At this inspection although risk assessments were in place these were not always specific to people’s individual needs and sometimes lacked detail about how staff could reduce the risks. However, people felt safe when staff supported them.
Sufficient improvement had not been made to ensure that quality assurance checks were completed to identify and make improvements that were required.
We also found concerns around the safe management of medicines. Although people told us they were satisfied with the support they received to take their medicines, records did not always accurately record when their prescribed medicine should be taken or when and where prescribed creams should be applied. We found gaps in recording where staff had not signed to indicate whether people had taken their medicines or had their creams applied.
People’s care plans continued to be brief and did not adequately reflect people’s needs and the support they required to meet them. People were involved in planning and reviewing their care however, their care plans were not always updated when changes were identified at the review.
Staff felt well supported by their colleagues and the management team. Staff were satisfied with the training they had received however, they were not always provided with training or information about people’s specific needs.
People were protected against abuse, avoidable harm and discrimination by staff who knew how to identify and report any concerns. There were enough staff employed to meet people’s needs.
Where required people were encouraged to eat and drink enough. Staff monitored people’s health and supported them to access healthcare professionals as necessary.
People found staff to be kind and considerate and had formed positive working relationships with them. Staff sought people’s consent before supporting them and supported them to be involved in decisions about their care.
People felt staff treated them with dignity and respect and promoted their independence to enable them to remain living in their own homes.
People and their relatives felt comfortable to raise any concerns or complaints with staff or management and were confident these would be appropriately responded to.
People, their relatives and staff found the registered manager approachable and easy to talk with. The provider sought people’s views on the service and responded to any concerns raised.
You can see what action we told the provider to take at the back of this report.