We carried out a review of the data available to us about Adriel Care Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Adriel Care Limited, you can give feedback on this service.
About the service
Adriel Care Limited is a domiciliary care service providing personal and nursing care to 11 adults and children at the time of the inspection.
Not everyone who uses the service receives 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.
People’s experience of using this service and what we found
Right Support:
Since the last inspection, the service had changed the emphasis of its work, from short, practical visits to older and physically impaired adults to whole shifts with adults and children with a range of complex needs, including people with a learning disability and autistic people. Staff had received training about learning disability and autism, in line with national requirements. However, whilst care plans addressed the practical care people needed, they were structured in a way more akin to the way the service used to provide care. The registered manager recognised the service needed to develop its practice in line with current good practice for people with a learning disability and autistic people and has since the inspection implemented plans towards achieving this.
The service worked with people’s health and social care professionals to help ensure people received the support they needed. The management team recognised circumstances in which people might not be able to give valid consent to aspects of their care and had taken the appropriate action. They had identified where people could be considered as deprived of their liberty and had liaised with care commissioners, who had applied for the necessary legal authorisation.
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 required review and updating to support this practice. We have made a recommendation in relation to care and support planning for people with a learning disability and autistic people, and regarding the provider’s safeguarding policies.
Right Care:
People and their relatives were involved in the planning and review of their care and support. Care plans were individualised and reflected people’s known preferences. They clarified any support people needed with their prescribed medicines.
Right Culture:
People, relatives and staff felt able to raise concerns with the service. Concerns were taken seriously and acted upon promptly. People and, with the appropriate permission, their relatives had access to the computerised records system, which increased transparency and made the service more responsive to their comments. Managers regularly sought feedback from people, staff and relatives and acted on this to improve people’s experience of the service.
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 this service was good (published 20 March 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 remained good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Adriel Care Limited on our website at www.cqc.org.uk.
Recommendations
At our last inspection we recommended the provider sought appropriate guidance to ensure care plans reflect the framework of the MCA. We also recommended the provider sought appropriate advice and implemented more person-centred care recording. The provider had acted on the recommendations and had made improvements in both areas.
We have made a recommendation in relation to the provider’s safeguarding policies.
We have also made a recommendation in relation to strengths-based care and support planning and positive behaviour support when the service works with people with a learning disability and autistic people.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
This announced inspection took place on 10, 12 and 15 January 2018. We gave the service two days’ notice of the inspection site visit. We gave the service notice to ensure the manager would be available and that people could be supported to make decisions about taking part in the inspection. We received further information form the service until 12 February 2018.
There was a registered manager for 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.
At our last inspection in January 2017 we identified a breach of regulation. This breach was in respect of the robustness of recruitment systems and processes. At this inspection we checked to see if the provider had made the improvements necessary to meet the requirements of the regulation. We found that staff were recruited in a way that included appropriate checks on their employment history and their suitability to work with people who may be vulnerable.
At our last inspection we also made a number of recommendations. We recommended the provider updated their complaints process. We recommended that the provider reviewed its systems for assessing and monitoring the service. We found these recommendations had been followed. There were systems in place to ensure that the quality and safety of care people received was monitored and improved. People and staff contributed to these processes both formally and informally. People felt able to raise concerns and there was information about which agencies could handle these concerns available.
We also made a recommendation that the provider evaluated how records keeping could become more accurate, contemporaneous and more readily available. We found this recommendation had been followed. However we also identified that reporting could be more person centred and we made a recommendation about this.
Staff understood how people consented to the care they provided and encouraged people to make decisions about their lives. Care plans did not however reflect that care was being delivered within the framework of the Mental Capacity Act 2005. We highlighted this and the registered manager addressed it immediately. We have made a recommendation about this.
People were happy with their care. They felt supported to maintain their independence and were confident in the skills of the staff team. They told us staff were kind.
Staff understood people’s care needs and spoke with confidence about the support people needed to meet these needs. They told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received refresher training as deemed necessary by the provider.
People felt safe. They were protected from harm because staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected the person’s preferences. Staff also knew how to identify and respond to abuse.
People told us they received the care and support they needed. They also told us they were supported to maintain their health by staff including support to access health professionals when this was appropriated. People also told us they received their medicines as they were prescribed.
People were satisfied with support they received with food and drink and there were systems in place to ensure people had enough to eat and drink if this was necessary.
People told us they received support and care from a small group of staff at times that suited them and we saw that efforts were made to accommodate people’s needs and preferences regarding the time of visits.
The provider operates a domiciliary care agency that provides personal care to people in their own homes, as well as running an employment agency that provides nurses and care staff to fill temporary vacancies. We inspected the domiciliary care service only, as the employment agency part of the business is not regulated by CQC. At the time of our inspection it had five older people on its books, although two were in hospital.
The service had a registered manager, who was also the owner of the company. 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.
People gave positive feedback on the care they received. However, some areas required improvement to ensure people received safe, high quality care.
Staff recruitment procedures were not fully robust. Criminal records checks and checks of entitlement to work in the UK were made before staff started working for the service. Employment and character references were also obtained. However, most staff files showed gaps in employment, with no written explanation of these or a record showing they had been explored at interview. Without checking gaps in employment, there was a risk unsuitable staff would be recruited. You can see what action we told the provider to take at the back of the full version of the report.
The service’s quality assurance processes had not identified the shortcomings we found in relation to checking and recording gaps in employment. We have made a recommendation that the service reviews its quality assurance systems to ensure they are fully effective.
Following the inspection the registered manager advised us that all staff files had been corrected to include a full employment history with explanation of any gaps.
Medicines were managed safely by staff who had the necessary training and had been assessed as competent to handle medicines. Some people had staff apply their prescribed creams and ointments. Staff had clear instructions for how and when to apply these. We have made a recommendation that the service reviews how staff record the administration of prescribed creams.
There was a basic contingency plan that stated the service had access to the provider’s agency staff in the event the regular staff were ill and unable to cover calls. It did not address whether or how particular people’s visits were to be prioritised, for example visits that were time-critical because of medication. In practice, within this small service the registered manager and office staff had a good understanding of people’s circumstances, including any time-critical visits. We have made a recommendation that the service reviews its contingency plan.
Complaints and concerns were encouraged, investigated thoroughly and responded to in good time. A relative told us, “If I have a query or a complaint they’re on to it straight away”. However, the service’s complaints policy incorrectly referred people to CQC if people were not happy with the way their complaint was handled. This is incorrect, as CQC has no power to follow up individual complaints, although it values hearing about people’s experiences of services. We have made a recommendation regarding updating the complaints policy.
The service had identified that keeping accurate, complete and readily available records had not been its strength. Following a commissioners monitoring visit during 2016, they had taken action to address the points raised. This included the recent acquisition of a computerised records and management system. Staff were in the process of being trained to use this before it became fully operational.
People’s individual care needs, including their nutritional, hydration and health needs, were met by a small team of caring, competent staff. Relatives told us staff generally arrived on time and that people were informed in the event there was a delay. They said staff stayed for at least the full duration of the visit and provided the care that was required, if not more. When members of staff started working with them, they usually worked a couple of shadow shifts beforehand alongside a familiar staff member, and at the very least were introduced in person by a member of the office team.
Consent was obtained for people’s care, from the person themselves or from someone who held power of attorney that authorised them to consent on the person’s behalf. The registered manager understood the requirements of the Mental Capacity Act 2005.
The management team kept in regular contact with people and their relatives to check their satisfaction with the service, and acted on their comments. Relatives referred to staff by name and said they knew them well. For example, a relative told us, “It’s like being part of the family… everybody knows everybody”.
Risks to people’s personal safety were assessed and managed.
Staff understood their responsibilities for safeguarding adults. The registered manager was due to undertake training in relation to managers’ roles in safeguarding adults. We have made a recommendation regarding updating the service’s safeguarding policies.
Staff had training to be able to perform their roles safely and effectively. New staff covered key topics during a day of face-to-face training during their induction. Following this they worked for three days alongside experienced staff and the management team checked they were competent to provide the care required before they worked on their own. No-one currently using the service had complex moving and handling needs, such as using a hoist for transfers. The Care Certificate, a nationally recognised qualification for staff new to health and social care, had been introduced in the service during 2016.
Staff felt well supported by the management team. They said they were able to raise any queries or concerns with them. Staff supervision, which is where staff meet with a more senior staff member for a supportive discussion about their work, had happened on an ad-hoc ‘open door’ basis when staff needed it. The management team had identified that more structured, regular supervision was needed and were about to introduce this.
At this inspection, we made an announced visit to the agency and checked staff recruitment files. We found that appropriate steps had been taken to ensure there was detailed information on care workers previous employment.
We found that the person's plan clearly set out how support should be provided and included details of what they were able to do themselves. People confirmed support was given as detailed in their plan.
Staff were recruited according to a set procedure. However, we found that there were some gaps in information of staff's previous employment. Relevant checks such as Criminal Records Bureau and Disclosure and Barring Service checks had been made. References had been obtained from previous employers when staff had worked in care settings.
All staff were given induction training, which they confirmed met their needs and enabled them to support people appropriately. The provider was in the process of developing ongoing training to ensure staff were competent to carry out their role.
The provider had a statement of purpose that set out the aims and objectives of the service, the regulated activity and type of service provided.