About the service: AVH Care is a domiciliary care agency, which provides personal care to people living in their own homes. The provider is a partnership, both partners work at the agency, one of whom is the registered manager. At the time of the inspection, the agency was providing care to six people, some of whom had complex care needs. At this inspection the service was rated as requires improvement.

People’s experience of using this service:

People were at increased risk because the provider had not effectively assessed health and safety risks or done all that was reasonable to reduce identified risks. Risk assessments and care plans lacked detail, and were not up to date. Some risks had not been identified and there was a lack of detailed guidance for staff on how to meet people’s care needs. The absence of this information meant staff did not have all the relevant information they needed to provide effective care and treatment.

Staff lacked the skills and knowledge they needed to undertake comprehensive assessments of people’s care needs and develop detailed care plans to meet those needs. People’s care records were poorly organised and were inconsistent. One person’s care plan was very brief, another person’s was missing, care records lacked relevant information and some were out of date. Documents were undated so it was not possible to see when they were created or were last updated. This increased risk people would not receive the care they needed.

However, staff knew more about people’s care needs, and how to manage them safely, than was captured in people’s care records. They worked closely with local health professionals, and followed their advice. Improvements had been made in including personalised information about people’s backgrounds. Daily records were well completed about the care people received at each visit.

Improvements in staff training had been made. Staff had received safeguarding and moving and handling training. They knew about the different types of abuse, although two incidents which should have been notified to the Care Quality Commission (CQC), as required by the regulations had not been. Improvements in recruitment systems had been made to ensure the service employed fit and proper staff.

Some improvements in quality monitoring had been made, with the introduction of ‘spot checks’ of staff practice and use of surveys to seek feedback from people. However, further improvements in the agency’s systems and processes and in record keeping were needed.

People said they felt safe and well cared for and said the service was reliable. One person said, “I’m very happy with the service,” which others agreed with. People's concerns and complaints were listened and responded to.

People said they received personalised care. They said staff respected their privacy and treated them with dignity and respect. Staff developed positive and caring relationships with people.

People received their medicines safely and on time. Staff supported some people to eat and drink enough to maintain a balanced diet. 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.

For more details please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires improvement (report published on 5 January 2018). At that inspection we found four breaches of regulations which related to safe care and treatment, good governance, staffing, and about processes for employing fit and proper persons.

At this inspection the rating remains requires improvement, with four breaches of regulations relating to safe care and treatment, staffing, good governance and notification of incidents. You can see what action we told the provider to take at the back of the full version of the report.

Why we inspected: This was a planned insp

We inspected AVH Care on 7 December 2017; this was the first inspection since the service registered in December 2016. We gave the provider 72 hours’ notice of our inspection visit. This was because AVH Care is a small service and we wanted to be sure someone would be available to meet with us.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, people with a physical and/or sensory disability and people who misuse drugs or alcohol. At the time of the inspection six people were receiving a service from AVH Care. Not everyone using AVH 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.

There was a registered manager in post. 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. AVH Care is registered as a partnership. One of the partners had left the organisation at the end of July. CQC had not received a new application to replace the partner or an application to change the registration to a single provider. This meant they were not acting in line with the conditions of their registration. We have taken this into account in the well-led section.

People had care plans in place which outlined their needs. The quality and depth of information in the care plans was inconsistent. One clearly outlined the care needed and described the person’s routines. Others were brief and information was contradictory. Systems for identifying risks were also inconsistent. Risk assessments had been completed in some cases and these highlighted when people were at risk. There was a lack of guidance for staff on the actions they could take to protect people from the risk. We found some people were at risk due to their specific behaviour or health condition. There were no risk assessments in place documenting this and no guidance for staff to follow.

Staff were not supported by a robust system of induction, training and supervision. No staff had completed safeguarding training since starting work at the service. There was no planned programme of supervisions in place. Staff meetings were not organised. Recruitment processes were not robust.

AVH Care is a small service and both the registered manager and deputy manager were involved in the delivery of care on a daily basis. The management team and staff knew people well and had an in-depth understanding of their needs. Care was person-centred and was focused on people’s emotional well-being as well as their health needs.

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.

Relatives and a healthcare professional were unanimously positive about the way in which care and support was delivered. Relatives told us staff had never missed a visit and were rarely late. Staff spent time ensuring people were comfortable and had their needs met.

We identified breaches of the Regulations. You can see what action we have asked the provider to take at the back of the full report.