About the service:

Austen Allen Homecare, Gravesham, is a domiciliary care agency registered to provide personal care for people who require support in their own home. The Gravesham office is one of two locations the provider has registered with CQC.

CQC only inspects the service being received by people provided with ‘personal care’ and help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, the service was supporting 75 people, all of whom received some element of personal care. Austen Allen Homecare provide care services mainly to people living in the Gravesham and surrounding areas.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe and Well-led, to at least Good. We found that the provider had undertaken actions in their action plan.

People’s experience of using this service:

• People told us they felt safe with staff. People when asked if they felt safe said, “Very”, “Absolutely” and “Without a shadow of a doubt, absolutely.”

• People had good relationships with staff, who were knowledgeable of their physical and emotional needs, as well as likes, dislikes and interests. Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

• People felt included in planning their care. People’s rights and their dignity and privacy were respected.

• People were supported to live the lifestyle of their choice. People told us they were listened to by the management of the service. One person said, “Staff regularly check to see if anything needs to be changed.”

• People could involve relatives and others who were important to them when they chose the care they wanted.

• People received a person-centred service that met their needs and helped them to achieve their goals and ambitions. People were encouraged to be as independent as possible. One relative told us, “Part of the care plan is to help my relative maintain independence and the staff are following that.”

• People were fully involved in their care planning and received information in a way that they understood. The electronic care plans now being used were consistently reviewed and updated. Care planning informed staff what people could do independently and what staff needed to do to support people.

• Staff supported people to maintain a balanced diet and monitor their nutritional health. People had access to GP’s and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

• Medicines were stored and managed safely. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

• People were protected from the spread of infection.

• People felt comfortable raising any complaints with staff and the registered manager.

• People were asked for feedback about the service they received.

• People found the registered manager approachable and supportive.

• The registered manager recruited staff with relevant experience and the right attitude to work with people. New staff were given an induction and on-going training.

• Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

• The registered manager made sure they monitored the service in various ways to ensure they continued to provide a good quality service that maintained people’s safety.

• The registered manager and staff were working with a clear vision for the service.

Rating at last inspection: This service was rated, ‘Requires Improvement’ at the last inspection on 7 and 12 February 2018.

At this inspection, we found that improvements had been made and the service met the characteristics of Good in all domain

Austen Allen Homecare – Gravesham is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in Gravesend and surrounding areas. It provides a service to older adults, people with physical disabilities and people with learning disabilities.

Not everyone using Austen Allen Homecare-Gravesham 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. At the time of the inspection the service was providing care for 88 people.

The service was last inspected on 11 January 2017 when it was given an overall rating of Requires Improvement. At that time we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were with regards to the provider failing to: Regulation 9, consistently deliver care in a person centred way; Regulation 11, act in accordance with the requirements on the Mental Capacity Act 2005 where a person lacks capacity to make an informed decision or give consent; Regulation 12, ensure people were safe from risks or avoidable harm and that medicines were managed safely; Regulation 17, operate robust auditing and quality monitoring systems; Regulation 18 ensure suitable deployment of staff.

We asked the provider to send us a plan of action which they returned in the agreed timetable, setting out what they would do to meet legal requirements in relation to the breaches. The provider told us that all breaches of regulation would be met by the end of September 2017. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

At this inspection on 7 and 12 February 2018, we found improvements had been made in all areas apart from the management of medicines.

The service was run by a registered manager who was present at the inspection visit to the office. 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.

There had been improvements in the way that medicines were managed so that information about medicines management was included in people’s care plans. Although, changes had been made to how staff recorded the medicines they gave people, there continued to be errors highlighted through the auditing process and at this inspection. The provider had identified a new method of medicines recorded and there were plans to roll this out in March 2018.

The provider had reviewed and amended quality monitoring systems and a programme of audits and monitoring were in place. These had highlighted shortfalls in the service but those in relation to medicines recording had not been fully addressed. We have made a recommendation about quality monitoring systems.

The provider had not always followed their recruitment policy when employing new staff. We have made a recommendation about recruitment practices.

A new care planning and risk assessment framework had been introduced in which potential risks had been identified and consistent guidance was in place for staff to follow to make sure that any risks were minimised.

The care planning process enabled people’s individual needs, choices, preferences to be identified together with what was important to the person and their aims in using the service. This meant that staff had detailed and personalised guidance to follow in order to meet people’s social, physical, health and emotional needs.

There had been improvements to the way that staff were deployed which included allowing time for staff to travel from one person’s home to another. This had benefitted people as they were supported by a regular team of st

We inspected Austen Allen Homecare Ltd on 11 January 2017. The inspection was announced so that we could ensure people and records we would need to see were available. Austen Allen Homecare Limited is a domiciliary care agency registered to provide personal care for people who required support in their own home.

At the time of our inspection, Austen Allen Homecare Ltd was providing care to 53 people and there were 22 care staff.

At the time of our inspection, there was a registered manager at 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.

This inspection at Austen Allen Homecare Ltd was the first inspection under our new methodology since its new registration in October 2015.

Medicines were not being effectively managed. The registered provider had not ensured that accurate information on people’s medicines was included in their care plan. There were not appropriate recording methods in place to ensure that people were taking their medicines. The registered provider had identified a new method but this had not been embedded into the service.

Risk assessments had been carried out but care plans did not give consistent guidance to staff to fully mitigate risks, for example with moving and handling.

The registered provider had not ensured that staff were deployed consistently to meet people’s needs. Staff were not given travel time and records showed incidents of staff being double booked.

There were systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns.

The registered provider had effective recruitment practices that ensured that staff were safe to work with vulnerable adults.

People’s capacity was not being assessed in accordance of the Mental Capacity Act (2005) when giving consent to care and treatment. The registered provider identified that they were aware of this and new forms had been sourced but these had not been fully embedded within the service.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff spoke positively about the training and their training was being monitored to identify when training needed to be renewed.

People were supported to have adequate food and drink. Where appropriate the registered provider used food and fluid charts to monitor how much people were eating and drinking.

People were being referred to health and social care professionals when required. Records showed the involvement of other health care professionals.

People told us they were satisfied with the care staff and the support they provided. Relatives told us they were happy with the service their loved ones received. Staff understood the importance of communicating appropriately with people. Staff had built positive relationships with people to fully understand their needs.

People and their relatives told us they were involved with the planning and reviews of their care. Records showed that people were receiving reviews.

Staff respected people's privacy and dignity at all the times. The provider had ensured that people's personal information was stored securely and access only given to those that needed it.

Care plans were not consistently person centred when providing staff with detailed information on how people like to be supported.

The provider had ensured that there were effective processes in place to fully investigate any complaints and outcomes of the investigations were communicated to relevant people.

The registered provider had not