Austen Allen Homecare received an overall rating of Requires Improvement following inspection in December 2016, with five regulatory breaches identified covering safe care and treatment, staffing, person-centred care, consent and governance. Key failures included unsafe medicines management, chronic staff lateness due to absence of travel time, inadequate risk assessments, and ineffective quality monitoring systems, though the service was rated Good for caring.
Concerns (10)
criticalMedication management: “MAR sheets did not list individual medicines, prescribing instructions and were not signed in. Carers recording 'dosette box' with no record of contents.”
criticalMissed or late visits: “50 care calls were delivered more than an hour later than the agreed time. 11 were more than an hour and a half late, with some being over two hours late.”
criticalStaffing levels: “Staff members were not paid for travel time...one care call is from 08.00-08.30 and the next call for that staff member will be 08.30-09.00.”
criticalCare planning: “Some people's care had been commenced without a pre admission assessment meaning that carers were supporting people without a care plan in place.”
criticalConsent / capacity: “Bedrails were being used with no capacity assessment. Care plans contained references to mental capacity but lacked an underpinning assessment.”
criticalGovernance: “Quality audits had failed to identify several shortfalls: care plans not updated for over two years, risk assessments partially blank, medicines systems not safe.”
moderatePerson-centred care: “Care plans were not consistently person centred and did not always contain the detailed personal information required to support someone in a person centred way.”
moderateRecord keeping: “One person's care plan had not been updated in over two years. Risk assessments had several parts left blank with no mention of mobility issues.”
minorSafeguarding: “The training programme did not contain any provision for safeguarding children.”
minorStaff training: “The training manager told us that as the service only supports adults they do not cover safeguarding children in their training programme.”
Strengths
· Staff were kind, caring and treated people with dignity and respect; people spoke positively about care received.
· Safe recruitment practices were in place with thorough DBS checks, identity verification and reference checks consistently followed.
· Staff received regular supervisions, annual appraisals and were well trained with relevant specialist skills including catheter care and PEG feeding.
· Complaints were logged, investigated and responded to in line with policy, and used as an opportunity to improve the service.
· Open and supportive organisational culture with visible leadership and accessible management team.
Austen Allen Homecare was rated Requires Improvement overall at this February 2018 inspection, with ongoing concerns around unsafe medicines recording, insufficiently robust recruitment checks (breaching Regulation 19), and inadequate visit scheduling, despite improvements in care planning, risk assessments, Mental Capacity Act compliance, and staff training since the previous inspection. A breach of Regulation 19 was identified and the provider was required to submit an action plan.
Concerns (8)
criticalRecord keeping: “Gaps between staff education and employment histories were not fully explored in two out of four files reviewed.”
criticalStaff competency: “The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed.”
moderateMedication management: “one person was prescribed a PRN named Buscapan (for painful stomach cramps), but the strength, dosage and when to give were not recorded on the MAR chart.”
moderateMedication management: “Medicines had not always been recorded adequately and action required had not always been taken.”
moderateStaffing levels: “visits were not always scheduled to allow staff time to complete the required care and support, and also to travel from one person to the next.”
moderateMissed or late visits: “evening is hit and miss, they always arrive but can come as late as 9.30pm when it was meant to be 7.30pm. It is very late for my father”
moderateGovernance: “the audit and records had not been robust enough.”
minorCommunication with families: “people and care staff told us they were not satisfied with communication with office staff.”
Strengths
· Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed.
· Risk assessments had improved and were reviewed regularly, including when circumstances changed.
· Staff were knowledgeable about safeguarding and whistleblowing procedures and felt confident raising concerns.
· Care plans were detailed, person-centred, and developed in consultation with people.
· Staff received regular supervision, appraisal, and spot checks, and felt well supported.
Quality-Statement breakdown (18)
safe: Medicines managementRequires improvement
safe: Recruitment practicesRequires improvement
safe: Staffing levels and visit schedulingRequires improvement
Austen Allen Homecare (Dartford) was rated Good across all five key questions at this April 2019 inspection, having successfully addressed the Requires Improvement findings from February 2018 relating to medicine recording, recruitment and auditing. The service demonstrated person-centred care, safe medicines management, a robust recruitment process, effective governance and a well-supported, well-trained workforce.
Strengths
· People felt safe with staff and had good relationships built on consistent care rotas and knowledge of individual needs
· Medicines were stored and managed safely with appropriate training and policies in place
· Robust recruitment procedure implemented following previous breach, including full employment history checks and DBS checks
· Electronic care planning and monitoring system implemented to prevent missed calls and improve oversight
· Staff received induction, ongoing training, supervision and annual appraisal and felt well supported
effective: Mental Capacity Act and consent
Good
effective: Nutrition and hydration supportGood
caring: Respect, dignity and person-centred careGood
caring: Involvement in care decisionsGood
caring: ConfidentialityGood
responsive: Care planning and reviewGood
responsive: Complaints handlingGood
well-led: Governance and audit systemsRequires improvement
well-led: Communication with staff and service usersRequires improvement
well-led: Organisational culture and leadershipGood