Athlone Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats, including people who had had a recent stay in hospital. At the time of the inspection the service was providing care for 22 older people including people with physical disabilities and people living with dementia. The service provides care to people living in Bexley and surrounding areas.

Not everyone using Athlone Care 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.

The service was run by a registered manager who was present at the inspection visit to the office and home 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 25, 26 and 30 October 2017, the overall rating of the service was ‘Requires Improvement. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because records, including those about people’s care, were not always accessible, up to date and accurate. We asked the provider to send us a plan setting out the actions that they would take to meet this legal requirement. The provider returned the action plan within the agreed timescale and told us they had already met the breach of regulation.

At this inspection on 3, 4 and 5 December 2018, we found that the provider had made the necessary improvements to record keeping. Records were accurate and available to people who needed them.

People felt safe whilst being supported by staff. Staff had received training in how to safeguard people, knew what signs to look out for which would cause concern and how to report them.

Assessments of potential risks in the environment and with regards to people’s health and welfare had been carried. Guidance and strategies had been developed which staff followed to protect people from avoidable harm. Accidents and incidents were monitored to see if there were any trends or if lessons could be learned.

Suitable recruitment checks were in place for new staff. People had their needs met by regular staff who were available in sufficient numbers.

Staff had received training in how to give people their medicines and medicines were audited to make sure people received their medicines as prescribed by their doctor.

New staff received an induction which ensured that they had the skills they required, before they started to support people in their own homes. Staff continued to undertake training in essential areas and their practice was observed to ensure they were competent.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The provider assessed and monitored people’s health and nutritional needs. Staff were given pocket guides about different medical conditions to which they could easily refer. The provider worked in partnership with people and their family members to make sure people accessed the health care services they needed.

People's needs were assessed before they were provided with a service. Care plans were personalised and gave guidance to staff about how to care for each person's individual needs and routines. Staff knew people well and treated people with kindness and respect.

Relatives and people were informed of their right to raise any concerns about the service. The provider monitored complaints to see if there were any patterns or trends or lessons learned.

Quality assurance sys

The inspection took place on 25th, 26th and 30th October 2017 and was announced.

Athlone Care Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in Bexley and surrounding areas. It provides a service to older adults, including people with physical and learning disabilities. At the time of the inspection the service was providing care for 11 people.

At the last inspection on 7 June 2017 the service was rated as inadequate overall and placed into special measures. We took enforcement action and served two warning notices which required the provider to make improvements by 21 July 2017 in the management of medicines, the assessment and management of potential risks to people’s health and safety, and the systems in place for monitoring the quality of the service. These were continued breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also required the provider to take action to make improvements so that care plans reflected people's assessed needs and preferences, that there were effective systems to monitor potential safeguarding incidents, that any complaints were responded to and that staff were deployed so people received the care they needed when it was required. These were breaches of Regulations 9, 13, 16 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to send us a plan setting out the actions that they would take to meet these legal requirements by 17 July 2017. The provider informed us there would be a delay in providing this plan which was received on 17 October 2017. In this plan the provider told us they had met or taken initial action to meet all breaches of regulations.

At this inspection in October 2017, we found improvements in most areas, but there remained a continuous breach in record keeping and two recommendations were made to drive improvements.

The service was run by a registered manager who was also the registered provider and they were present on the days of our visit. 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.

Some records in relation to people’s care and treatment and the running of the service continued to be inaccurate and unavailable when staff needed them.

Most people said there had been improvements in the timeliness of staff so that they arrived when they were expected. However, three out of nine people said that on occasions staff continued to be up to one or two hours later than they anticipated. We asked the provider to investigate and have made a recommendation about this. .

People were informed of their right to raise any concerns about the service and these had been recorded and acted on. However, people and their relatives had mixed views about how responsive the service was to their complaints. We have made a recommendation about this.

The values and aims of the service were not consistently delivered as there were mixed views on whether the service was well managed and if people would recommend it to other people.

Comprehensive employment checks were carried out on all potential staff at the service, so they were suitable for their role.

People felt safe whilst being supported by staff. Staff had received training in how to safeguard people, knew what signs to look out for which would cause concern and how to report them. Staff carried pocket card reminders so they knew the appropriate action to help keep them safe.

A new framework had been established to assess potential risks in the environment that people lived and worked in and in relation to people’s personal care needs. This inc

This inspection took place on 7 and 8 June 2017 and was announced. Athlone Care provides care and support to a wide range of people living in their own homes including, older people, people living with dementia, and people with physical disabilities. The support hours varied from one half an hour call a day to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection 50 people were receiving care and support from the service.

The service had a registered manager in post. A registered manager is a person who is 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.

We last inspected Athlone Care in May 2016 when two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment and good governance. We made multiple recommendations including recommending the provider considered reviewing staffing levels to ensure that people's needs were being fully met and recommending that the provider ensured staff had a clear understanding of The Mental Capacity Act 2005 and how this needs to inform care.

At our inspection in May 2016, the service was rated 'Requires Improvement'. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had not met the previous breaches of regulations and further breaches were found.

There was a lack of scrutiny and oversight by the registered manager to ensure that people received safe care and treatment. Staff documented that people had fallen or had visits from health care professionals in people’s daily notes but did not call to inform the office so that any follow up action could be taken. The management team did not regularly review people’s daily notes so they were unaware of changes to people’s support or incidents that occurred and did not follow them up to ensure that appropriate action had been taken.

People’s care plans did not contain the detail needed to keep people safe including guidance for staff about how to reduce the risk of pressure sores. One person had developed a pressure sore and although staff had asked the person’s relative to contact a district nurse, they had not informed the office for over three days. They had not recognised the development of a pressure sore could be a potential safeguarding issue. Another person had become unwell and staff had told their relative to contact a doctor for advice. This had not been reported to the office, so the management team were unable to monitor and assess if appropriate action had been taken.

Some people needed assistance with eating and drinking. One person told us that they had specific dietary needs to help manage their health condition. This was not recorded in their care plan and the registered manager told us they were ‘unaware’ of this person’s needs. Care plans also lacked information on how to support people to move safely or remain independent. People’s care plans had been sampled and checked by the registered manager, but these checks had not identified these shortfalls.

People’s medicines were not always managed safely. Staff did not consistently record when they administered medicines. Medicine records had not been reviewed or checked by the management team, so these issues had not been identified.

Staff reported accidents and incidents to the office however, the management team did not review them to ensure appropriate action had been taken and to reduce the ri

The inspection took place on the 25 May 2016. This inspection was announced.

Athlone Care is a domiciliary care agency which provides personal care to people who live in their own home, including people with dementia and physical disabilities. The service provides care for people in Tower Hamlets, Bexley and North Kent area. There were 37 people receiving support to meet their personal care needs on the day we inspected.

The service had a registered manager who was also the registered provider. 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.

Most people we spoke with were positive about the service provided. We were unable to speak to relatives of people receiving care.

The service was not always safe. People were not protected from the risk of medicines management. Staff were not appropriately trained to administer medicines however, staff were administering medicines to people. The provider and staff were not following their own policy in relation to the management of medicines.

Not all risks to people had been identified and assessed. Care plans contained contradictory information in relation to risk. Risk assessments did not go on to show how risk could be mitigated.

Recruitment practices were not always safe. Gaps in employment history were not always explored. We have made a recommendation about this.

Feedback from health care professionals over staffing levels was not positive. Senior staff told us that they never committed to care packages unless they were certain they had the care staff available. We have made a recommendation about this.

Accidents and incidents were responded to appropriately.

Staff training was not always up to date but the provider had made a commitment to put all staff through the Care Certificate training regardless of the length of service with the company. Training was managed via supervisions and they had recently recruited an in house trainer for the service. Staff received supervision and appraisals and were suitably supported to carry out their roles.

Staff did not have a clear understanding of the Mental Capacity Act 2005 (MCA) and how this informed care. The provider had policies in place for MCA and for the Deprivation of Liberty Safeguards (DoLS). However, DoLS do not apply in a community based setting and therefore the policy was not relevant or fit for purpose. We have made a recommendation about this.

People were encourage to maintain a healthy and nutritious diet and daily care records showed that where there were concerns over people’s diet food and fluid intake was recorded. People were also supported to access health care professionals such as district nurses and their GP’s.

The service was caring and staff knew people they were caring for well. Staff were able to tell us how they respected people’s dignity and privacy. People’s cultural and religious needs were respected. Staff of the same religion or those that spoke the same language as people were matched to people to enable them to be supported..

People were generally supported by regular care staff for the purpose of continuity.

People were provided with a service user guide that set out what people could expect from the service. However, this was not available in an alterative format. We have made a recommendation about this.

People’s care records were kept confidentially on a password protected IT system.

People had pre assessments carried out that fed into care plans which they had been involved in drawing up. Care plans were not person centred and did not contain details of people’s likes and dislikes. The provider was in the process of transferring care plans over to a new system which was person centred. C

We spoke with the registered manager, the deputy manager, and five members of care staff. We looked at ten sets of records for people who used the service, seven personnel files, staff training records, the service's satisfaction surveys, policies and procedures. We spoke with five people who used the service and two of their relatives.

During this inspection, the inspector focused on answering our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people who used the service were protected from the risk of abuse because all care staff were trained in the safeguarding of vulnerable adults and in the principles of the Mental Capacity Act 2005. All staff had been subject to Disclosure and Barring Services (DBS) checks before they started work. We found risk assessments with clear action plans were in place to ensure people remained safe. People's consent to care and treatment was sought appropriately and people's care records were kept securely. Staff monitored people's health and referred to health professionals or alerted emergency services when necessary.

Is the service effective?

People and their relatives told us they were very satisfied with the quality of care that had been delivered. We looked at ten people's assessment of needs and support plans and we checked with people who used the service that the delivery of care was in line with their care plans and assessed needs. We found that people's needs were re-assessed when needed and that their care plans were adjusted to reflect changes in needs. People who used the service commented, "My requirements are quite specific and are being respected by the care workers who are very understanding" and "The staff are ever so kind and nothing is too much trouble". We found that the staff had received the training they required to meet the needs of people who used the service and that additional training was available.

Is the service caring?

We found that people who used the service were supported by kind and attentive staff. All the people who used the service that we spoke with were complimentary about the care workers’ approach and attitude. One person who used the service told us, "The care workers are so caring, kind and considerate". A relative of a person who used the service said, "My family member and the care workers have developed a good rapport and the care workers treat her with respect and kindness”.

Is the service responsive?

People's needs had been assessed before care and support began and their care plans were reviewed regularly to reflect any change of needs. We saw that people's care plans included their history, wishes and preferences. People and/or their representatives were involved with reviews of care plans. People's views were sought about the quality of care that they received and their views were taken into account. A relative of a person who used the service told us, "I have raised minor complaints with the deputy manager and each time they responded promptly and made alterations to put matters right ". A member of staff told us, “If I have cause to raise any concerns I am confident that they will be taken seriously and acted on”.

Is the service well-led?

We found that the registered manager had a system of quality assurance in place to identify how to improve the service. People and their relatives or representatives were regularly consulted about their level of satisfaction and survey questionnaires were provided, collected and analysed. We saw the service operated an 'open door' policy where staff were encouraged to express their views. Two members of staff told us, "This is a good company to work for, we are part of a good team", and "The manager, the deputy manager and the care assessor are very approachable, we can raise any concerns without fear". The registered manager told us, "We make sure good standards are maintained and take appropriate action if they are not". Staff's practice was regularly observed and monitored to check good care practice was maintained and to identify whether additional training or refresher courses were needed.

We spoke with two relatives of people who use the service. They were satisfied with the care and support their family member received and were happy with the way they were treated. One relative told us, "I think the care is very good. If I needed to complain or say something, I know they would listen".

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. We also noted that people were cared for, or supported by, suitably qualified, skilled and experienced staff. In addition, the provider had an effective system to regularly assess and monitor the quality of service that people received.

We arranged to speak with people who used the service over the telephone. They told us that they were happy with the care and support that was provided by the service. Comments included “The service is well run…I am happy”, “I am satisfied with the service” and “We receive an excellent service”.

People praised the staff who visited them and described them as “Respectful”, “Friendly” and “Caring”. One person said “Staff are very good at their job…. they help me with what I need”. People told us that they were visited by regular care staff who understood their needs. The people we spoke with told us staff were on time and always stayed for the agreed amount of time.

People said they were kept involved with their care. They confirmed that they had copies of their care plans at home and were involved in reviews of their care by the service. Comments included “We were kept involved at the start of the service…they took the time to ask me and my relative exactly what we needed” and “We have been given questionnaires, and have been regularly asked if we are happy with the service”.