Archived: Care Avenues Limited

Not everyone using Care Avenues Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There were 20 people receiving regulated activity at the time of our inspection.

At our last inspection in March 2018 we identified improvements were needed under the key questions of is the service safe, effective, caring, responsive and well-led. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following our last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least good. We also issued a Notice of Decision to place conditions on the provider’s registration. A Notice of Decision is one of our enforcement powers.

This inspection took place to follow up on our previous findings. We returned to check the necessary action had been taken to improve the quality of care and reduce any risks to people. At this inspection we found that the required improvements had not been made. The provider continued to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore, the overall rating for the service remains as ‘Inadequate ‘and will remain in ‘special measures’. For adult social care services, the maximum time for being in special measures will be no more than 12 months. We are deciding our regulatory response to this and will issue an updated report once this decision is made.

The service did not have a registered manager in post. 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.

Care and risk assessment documentation were not reflective of people’s needs and did not provide staff with sufficient guidance to deliver personalised care. Not all the staff had received adequate training to deliver their roles effectively.

There were no effective quality assurance systems in place to assess, monitor and improve the service. Analysis of incidents and concerns raised had not taken place to identify patterns or trends that might reduce the risk of re-occurrence.

People told us staff were kind, caring and treated them with dignity and respect when providing care. People were supported to remain as independent as possible. People were aware of how to raise concerns or complaints and the provider had a system in place to investigate complaints.

Pre-employment recruitment checks had been completed for new staff before they began work. Staff enjoyed working for the service and felt the management were approachable.

We shared the concerns we identified during our inspection with two local authorities who commissioned care packages from the service. They told us they were suspending the commissioning of further care packages until they completed their own assessment of the care people received. We also notified local safeguarding authorities of two people who were at risk of harm.

Care Avenues Limited provides personal care to 47 people. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

Not everyone using Care Avenues Limited receives the regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; 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 the inspection the service had a registered manager who was present during our inspection visits. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. We were also accompanied at each inspection visit by the regional registered care manager who was responsible for managing the registered manager and for overseeing the quality of the service on behalf of the provider.

Adequate assessments of people’s care needs had not taken place which put people at risk of receiving inappropriate or unsafe care. Staff did not consistently demonstrate the safe management of medicines.

There were insufficient numbers of knowledgeable and experienced staff deployed to ensure people were supported on time by staff they knew. People told us they had often been supported by staff who did not know about their care needs and preferences. People experienced late and missed calls, which had resulted in some people missing meals and medicines.

People were not consistently supported by staff who wore protective equipment to prevent and control the spread of infection. The registered manager was unable to provide records that staff had received updates and refresher training so they knew good infection control practices

The registered manager had not followed local authority procedures to protect people from abuse by notifying the local safeguarding authority when people had experienced or had been placed at risk of neglect. Although people told us they had raised concerns there were no records or analysis completed to prevent untoward incidences from happing again.

People were not consistently supported to receive suitable food and drink to stay well. The provider did not regularly review or seek people’s views about the care they received.

People who were sometimes supported by unfamiliar staff who did not know their preferences or took time to interact and express compassion. People could not always speak to the registered manager or office staff to raise concerns. People told us that staff supported them to be as independent as much as possible. People said that staff who regularly supported them were kind, polite and respected their privacy.

People told us they were often supported by staff who did not know their specific care needs and the appropriate action to take. Care records did not consistently contain detailed information so staff would be able to identify and respond appropriately if people were at risk of or experiencing harm. Although no one who used the service at the time of our inspection visit was receiving end of life support, there were processes in place should they require it.

People we spoke with said staff who regularly supported them were responsive to their needs and most people said they were pleased with the support they received to take their medicines. People told us staff asked them for consent before providing care.

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 of 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.

We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report. 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.