A care provider has been ordered to improve by inspectors after they found risks for people with breathing difficulties were not always properly managed.

Aapna House, on Eastbourne Road in Middlesbrough, received a ‘requires improvement’ rating following inspections by the Care Quality Commission on November 8 and November 16. Inspectors found that medical records were not up to date and safe recruitment procedures were not in place.

In response, the provider said this was a ‘hiccup’ along the way to providing the best service and an action plan to address the concerns raised is now in place. Aapna House provides support for people in their homes and at the time of the inspection 35 people were using the service and receiving personal care.

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Inspectors found that risks to people were not always managed robustly – there was not enough information for staff about risks for people who had breathing difficulties and those who had a feeding tube. However, staff were trained to support these clients and there was no evidence to suggest anyone had been harmed.

The care plans of people who used the service were not always up to date and some contained old information. In one instance, a person’s care file said they had a urinary catheter in place when that was no longer the case.

It wasn’t always clear what tasks were the responsibility of care staff, in one person’s plan it stated that staff would give medicines, however, workers said family members did this. While another client’s plan said staff were to assist with evening exercises but workers told inspectors it was the family’s responsibility.

However, plans did provide clear guidance around environmental risk assessments so people could be cared for safely in their own homes. In the report, it states that systems were not in place to ensure medicines were accurately recorded and staff did not always note when medicine was given.

There was not always guidance in place when medicines were prescribed on a ‘when required’ basis and the maximum dosages or how frequently a cream or lotion was to be applied was also not consistently recorded.

Inspectors found that the provider did not obtain full employment histories or appropriate references. While it did obtain DBS checks, on one occasion it did not fully consider a positive result – the service has since completed a risk assessment on this.

The report stated that accidents and incidents were not properly reviewed as they were not always included in the monthly reports so trends could not be identified. It added: “The quality of the service had deteriorated since our last inspection.”

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These issues meant that the management team did not have effective oversight of the service, according to the report.

However, there were enough staff to support people and workers had received suitable training. People were kept safe from the risk of abuse and staff understood how to report safeguarding concerns.

Clients who spoke to the inspectors said they felt safe. One said, “I feel safe and comfortable with the care workers” while another said, “the staff are very good, they are polite and respectful.”

People who used the provider also said they were “happy”, “comfortable” and were “treated like family.” Staff told inspectors they enjoyed their jobs and were able to get to know the service users.

Relatives felt that the service had a positive impact. One said: “They make a big difference to [person’s] quality of life.” They also felt like the communication from the provider was good. One relative told inspectors: “They are good at letting us know about any changes, and they pop round and ask how things are going.”

A spokesperson for Aapna House said: “The current rating is due to the fact that due diligence to run the service was not used by the previous home care management team. An action plan has already been put in place since to overcome these inconsistencies and we are working as a team to work through the action plan to meet the shortfall.

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“Aapna Services is constantly aiming to work towards providing the best possible care and working alongside their clients and staff. We feel that this is a hiccup on the way and will rise above this and come out to be a more sustainable and prospective company.”