Archived: About Care Also known as formerly Top Notch

At the last two inspections, the service was rated Requires Improvement. At this inspection we found the service remained Requires Improvement.

About Care is a domiciliary care service providing personal care to people in their own home. On the two days of our inspection there were 15 people using the service.

At our last two inspections in January 2016 and October 2016 we identified continued breaches of regulatory requirements in relation to the lack of safe and effective systems in place regarding the recruitment and selection of staff, the lack of policies and procedural guidance to guide staff in steps they should take to protect people from the risk of harm. This meant that the health, safety and welfare of people using the service was at risk and the provider was failing to provide a safe service.

We formally notified the provider of our escalating and significant concerns following our inspection in October 2016 and shared this information with our stakeholders. We placed a number of conditions on the provider’s registration which required them to take action to protect people from the risk of harm. Whilst the provider has taken action to meet the majority of the conditions placed on their registration, they failed to submit monthly quality and safety audit reports as required.

At this inspection 15 and 17 February 2017 we found some improvements had been made. The provider was working with the local authority as part of the commissioner’s contract management plan. An action plan was in place to address the improvements required to protect the health, welfare and safety of people who used the service. This included addressing shortfalls in areas such as care records, risk management and care worker recruitment.

Although the manager provided staff with training in understanding their roles and responsibilities with regards to the Mental Capacity Act 2005 it was evident they did not fully understand their roles and responsibilities in meeting the requirements of the law.

With the support and guidance provided by the local authority, provider support team, care plans including risks assessments had been updated as required to reflect people’s changing needs and now provided staff with the guidance they needed to mitigate the risks to people’s safety.

The provider had updated their policies and staff had been provided with updated procedural guidance in managing risks to people’s health, welfare and safety including how to manage people’s medicines and financial transactions appropriately. However, further work was required to ensure planning dates for future reviews of their policies as required. This meant that there was no system in place to ensure continuous review to make sure policies and procedural guidance for staff were fit for purpose, reflecting changes in legislation and current guidance.

Previously the manager spent 50% of their time providing care in the community. Since our last inspection a deputy manager had been appointed. This enabled the manager to have more capacity to focus on the day to day management of the service and maintain management oversight of the service.

The provider is also registered as the manager of the service but is no longer in day to day management of the service. The provider had appointed a manager who had been in post two and half years. They were currently in the process of applying to register with the Care Quality Commission (CQC) and about to attend their fit person’s interview. 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.

All of the staff and people who used the service were complimentary regarding the manager and the service they received. People’s views regarding the quality of the service had been surveyed and they told us they did not have any complaints. Where people had previously expressed concerns to the manager, they told us prompt action had been taken and issues resolved to their satisfaction.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the last inspection, the service was rated Requires Improvement. At this inspection we found the service remained Requires Improvement.

About Care is a domiciliary care service providing personal care to people in their own home. On the day of our inspection there were 22 people using the service.

At our last inspection in January 2016 we had moderate concerns about the safe handling of people’s finances and the lack of robust and effective audits. Risks in the handling of people’s finances had not been identified. Effective policies and procedural guidance had not been provided for staff with guidance to enable them to know the actions they should take to protect people from the risk of financial abuse. Where people with fluctuating capacity did not have support of relatives, appropriate advocacy support had not been explored.

The provider did not have robust recruitment processes and systems in place to assess and confirm that staff were sufficiently skilled, had the required knowledge and were trustworthy and of good character. We asked the provider to send us an action plan describing how they would make improvements to meet relevant requirements.

At this inspection 4 October 2016 we identified continued breaches of regulatory requirements in relation to the recruitment and selection of staff as well the systems in place to safeguard people from the risk of financial abuse.

The provider is also registered as the manager of the service but is no longer in day to day management of the service and only visiting the service infrequently. The provider had appointed a manager who had been in post almost two years. However, they had failed to submit a satisfactory application to register with the Care Quality Commission (CQC). 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 was insufficient numbers of staff available, confirmed as suitably qualified and competency assessed. The manager spent approximately 50% of their time providing hands on care to people. This meant that they did not have time and the capacity to provide adequate leadership and oversight of the service. Both the provider and manager demonstrated a caring approach to the people they provided a service to. However there was a lack of visible leadership and oversight which meant that there was no effective process in place to monitor the care and improve the quality and safety of the service.

The provider visited the service infrequently and did not have any formal system and processes in place for monitoring the quality and safety of the service. This meant there was no system in place whereby the provider and manager would identify improvements required with actions identified and identified timescales for follow up. Care plans including risks assessed had not been updated as required to reflect their changing needs and provide staff with the guidance they needed to safeguard people and meet their needs.

During this inspection we identified a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This report only covers our findings in relation to this, focused inspection. You can read the report from previous inspections, by selecting the ‘all reports’ link for ‘About Care’ on our website at www.cqc.org.uk

Supervision was carried out by management to ensure that correct procedures were being followed by care staff.

A clear complaints procedure was in place and the service was responsive if people expressed concerns or dissatisfaction.

At the time of our inspection the service was providing care to 20 people.