Date of assessment 23 July 2025 Astoria Homecare Ltd is a domiciliary care agency. It provides support with personal care to people living in their own homes. At the time of our assessment, 12 people were receiving support with personal care. The service provides support for both younger and older adults. The last rating for the service was requires improvement (published 2 February 2024). During this assessment, we identified breaches of 3 legal regulations relating to safe care and treatment, consent to care and good governance. At this assessment, we found improvements had been made in all areas and the provider is no longer breaching any legal regulations. The new rating for this service is good. The provider had made some improvements in relation to the support provided for people to make decisions about their care, but further improvements were required. The registered manager confirmed that they would be making additional improvement to this process. Risks related to each person’s health and wellbeing were identified, assessed and guidance developed for staff on how to provide appropriate care. Following an incident or complaint lessons learned were identified and shared with staff. Medicines were administered in a safe manner and as prescribed. The provider had recruitment processes to ensure new staff had the appropriate skills for the role. Staff completed a range of training courses to enable them to undertake their roles. They felt supported by the provider. The provider used a range of quality assurance checks and audits to monitor the service provided.
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Astoria Homecare Ltd was rated Requires Improvement overall following a focused inspection in November 2023, with breaches identified in safe care and treatment (Regulation 12), consent to care (Regulation 11), and good governance (Regulation 17). Key failures included inadequate medicines management, inconsistent risk assessments, systemic non-compliance with the Mental Capacity Act 2005, and governance systems that failed to identify these concerns prior to inspection.
Concerns (9)
criticalMedication management: “We looked at one person's medicines records and found they did not have a medicines risk assessment, care plan or information about what the medicines were used for and any side effects.”
criticalCare planning: “Another person did not have risk assessments around mobility, falls or personal care. Staff were able to access information on an app, but it was basic.”
criticalConsent / capacity: “A staff member had signed off the care plan and there was no evidence the person had been involved in their care planning. The same staff member had signed a second person's consent to care form, without the legal authority to do so.”
criticalGovernance: “The provider's systems had not identified the issues seen during the inspection. Audits had not picked this up.”
moderateSafeguarding: “There was no evidence of how the investigation into the allegation was carried out or what preventative measures were in place to help prevent a similar situation.”
moderateRecord keeping: “The registered manager told us an external nurse completed medicines audits and spot checks were undertaken, however they had no written evidence of these.”
moderateIncident learning: “It was not clear how lessons learnt were used to help mitigate future risk and improve service delivery.”
moderateStaff competency: “The provider told us an external nurse completed medicines competency testing, but there was no record of this.”
moderateOther: “Recruitment procedures were inconsistent. Some staff had appropriate employment references while others did not and gaps in employment were not always accounted for.”
Strengths
· Staff understood how to protect people from poor care and abuse and the service worked with other agencies to do so.
· Staff promoted equality and diversity, understood people's cultural needs and provided culturally appropriate care.
· The service had enough appropriately skilled staff to meet people's needs; people and relatives confirmed staff arrived on time.
· Staff completed induction training in line with the Care Certificate, including specialist training for dementia, mental health and learning disabilities.
· The provider worked effectively in partnership with families and health and social care professionals, receiving positive feedback from a healthcare professional.
Quality-Statement breakdown (17)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood