Date of Assessment: 6 January to 15 January 2026. The service is a care at home service providing support to older people/younger adults/some of who maybe living with dementia, nursing needs, mental health conditions, physical disabilities. We completed this assessment remotely, which means we did not physically visit the office location. People, relatives and staff spoke positively about the culture, leadership and quality of support. Care plans sampled evidenced personalised support which was regularly updated. At our last inspection the provider was in breach of regulation in relation to risk management. We saw during this inspection risks were now clearly identified, including falls, choking, PEG care [ PEG stands for Percutaneous Endoscopic Gastrostomy and is used when someone can’t eat or drink safely by mouth, for example because of swallowing problems]. Staff understood how to support people safely, and people told us they felt safe with all carers. People praised staff for maintaining dignity, providing emotional support, and working in ways that promoted independence and choice. Care plans reflected these values, with clear instructions about privacy, communication and personal routines. Medication was managed safely overall. Medication Administration Records [MAR] audits for two people showed complete and accurate records with prompt reporting of minor errors. Staff files were well maintained and showed safe recruitment practices and strong training coverage. Staff described leaders as supportive and approachable, and feedback evidenced a positive working environment where safeguarding responsibilities were well understood. Feedback from people using the service was consistently good. People described staff as “kind”, “respectful”, “lovely”, and “very well trained”. Care plans strongly reflected dignity, choice, involvement, and people’s personal routines. Governance systems were effective and demonstrated regular auditing of care plans, medication, incidents, feedback and staff files. Staff felt valued, supported and listened to. The management team had established a positive culture where concerns were welcomed, learning was encouraged and staff described leaders as visible and caring.
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Availl (Norwich) was rated Requires Improvement overall at this February 2019 inspection, with a continued breach of Regulation 12 due to inadequate risk assessments and medication recording discrepancies that had persisted since the previous June 2017 inspection. While staff were described as caring and kind by people and relatives, governance systems, care planning, consent documentation, and staff training methods remained insufficiently effective.
Concerns (7)
criticalMedication management: “one person had a care plan that stated they were taking two medicines when their MAR chart showed they were taking six medicines.”
criticalCare planning: “One person had specific healthcare needs and had no care plan in place to support this.”
criticalConsent / capacity: “service was supporting a person who was living with dementia...their capacity to consent to their care had not been considered in line with the legislation.”
moderateRecord keeping: “audits of the care records had failed to identify where gaps in recording were.”
moderateGovernance: “audits undertaken were 'tick box' and did not include any actions. There was no evidence of issues being identified and addressed.”
moderateStaff training: “staff told us that this platform for learning did not help them understand any changes to care practices and give them the skills and knowledge they needed.”
moderatePerson-centred care: “care plans were not always focussed on how staff should support the person to mitigate the risks to their health and wellbeing.”
Strengths
· People and relatives felt safe with the service received and spoke positively about care staff being kind and caring.
· Sufficient staff available to ensure care calls were met at scheduled times with no missed calls reported.
· Safe and thorough recruitment practices followed including DBS checks, references and face-to-face interviews.
· Staff received regular formal supervision and spot checks of care practice approximately every six weeks.
· People's privacy and dignity were maintained and independence was promoted.
Quality-Statement breakdown (18)
safe: Risk assessmentsRequires improvement
safe: Medication managementRequires improvement
safe: Staffing levelsGood
safe: Recruitment practicesGood
safe: Infection controlGood
effective: Staff trainingRequires improvement
effective: Consent and Mental Capacity Act complianceRequires improvement
effective: Staff supervision and competency checksGood
Availl (Norwich) was rated Requires Improvement overall at its June 2017 inspection, with breaches of Regulations 12, 17 and 18 (HSCA 2014) and Regulation 18 (Registration Regulations 2009) identified in relation to unsafe medicines management, inadequate risk assessments, poor governance and insufficient staff training and competency checking. The service was rated Good for caring, reflecting genuinely kind and respectful staff and positive relationships with people, but systemic weaknesses in care planning, auditing and oversight undermined safe and effective care delivery.
Concerns (9)
criticalMedication management: “systems were not in place to monitor people received their medicines as the prescriber had intended... there were insufficient systems in place to manage the administration and or prompting of people's medicines safely.”
criticalSafeguarding: “only one was aware of the local authority safeguarding team... The manager should not have spoken with the relative [about money missing allegation].”
criticalGovernance: “There were insufficient systems in place to monitor the quality of the care and service provided. Audits were not taking place in relation to people's care records.”
criticalIncident learning: “We were told of a safeguarding event which involved social services but we were not informed of this [by the registered manager to CQC].”
moderateCare planning: “People's care plans did not explain and guide staff about how to meet people's needs in a safe way... a lack of personalised guidance for staff to follow.”
moderateRecord keeping: “people's daily notes were not being audited. This meant that any shortfalls in peoples care were not being identified and acted upon in a timely way.”
moderateStaff training: “Staff were supporting people who had diabetes and mental health needs and they had not received training in their induction in these areas.”
moderateStaff competency: “Some members of staff did not shadow staff before they started to provide care independently... one member of staff had not received a spot check and had been working since September 2016.”
minorConsent / capacity: “The service had not sought consent on people's behalf, to share information or raise concerns with health and social care professionals.”
Strengths
· People consistently felt safe with staff and reported no missed or late care visits.
· Staff were described as caring, kind, respectful and dignified in their approach to personal care.
· People had formed positive relationships with regular staff and felt listened to.
· Staff received regular supervisions and yearly appraisals and felt supported by the manager.
· Sufficient staffing levels were maintained; the manager did not accept new packages without adequate staff numbers.
Quality-Statement breakdown (20)
safe: Risk assessments did not fully explore risks people faced including falls, fire, diabetes and mobility.Requires improvement
safe: Medicines were not always managed safely; administration was occurring without adequate systems or care plan guidance.Requires improvement
safe: Staffing levels were sufficient and people did not experience missed or late visits.Good
safe: Recruitment checks were mostly in place but one staff file had only one reference and two files lacked full employment histories.Requires improvement
effective: Staff induction was insufficient; training did not cover individual people's conditions such as diabetes, mental health and catheter care.Requires improvement
effective: Staff competency was not checked through shadowing or spot checks on a regular or robust basis.Requires improvement
effective: Care plans lacked sufficient guidance for complex needs including moving and handling, catheter care and specialist equipment.
effective: Nutrition and hydration support
Good
caring: Kindness and compassion of staffGood
caring: Privacy and dignityGood
caring: Involvement in care planningGood
responsive: Person-centred care planningRequires improvement
responsive: Complaints handlingGood
responsive: End of life care planningGood
well-led: Governance and auditingRequires improvement
well-led: Leadership and managementGood
well-led: Feedback and engagementGood
Requires improvement
effective: Consent was not always sought before contacting health and social care professionals on behalf of people.Requires improvement
effective: Staff supported people well with nutrition and hydration, and responded appropriately to changes in health needs.Good
caring: Staff were kind, caring and formed positive relationships with the people they supported.Good
caring: People's dignity and privacy were consistently promoted by staff during personal care.Good
caring: People were involved in planning their care and staff respected their choices and preferences.Good
responsive: Care assessments and care plans were not consistently person centred or reflective of people's individual needs.Requires improvement
responsive: Reviews were not sufficiently detailed; records frequently showed only 'no change' with no meaningful evaluation.Requires improvement
responsive: People received care at times they chose, saw regular staff and were supported to avoid social isolation.Good
responsive: Complaints were managed appropriately; people had confidence concerns would be addressed.Good
well-led: Care records were not audited; shortfalls in risk assessments, care plans and daily notes were not identified or acted upon.Requires improvement
well-led: Staff competency checks were infrequent, not robust and did not observe practice in people's homes.Requires improvement
well-led: The registered manager failed to notify CQC of a notifiable safeguarding incident as required by law.Requires improvement
well-led: Staff felt supported, received regular supervision and appraisals, and had confidence in raising concerns.Good