Archived: Ability 2 Achieve Limited

Updated 7 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

This inspection took place on 07 October and 14 October 2016 and was announced. We gave the service 24 hours’ notice of the inspection because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

The inspection was completed by one adult social care inspector, who is the lead inspector for the service.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Before the inspection we gained feedback from health and social care professionals who visited the service. We also reviewed the information we held about the service and the provider. This included safeguarding alerts and statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us by law.

We reviewed records and management systems used by the service for care delivery. Due to communication difficulties and complexity of people’s needs we were unable to speak or visit people’s homes. We spoke with three relatives, the registered manager, two professionals who had visited the service and six staff. We looked at four people’s care records, staff duty rosters, five recruitment files, the accident and incident records, service policies and procedures, records and service maintenance records.

Updated 7 December 2016

We carried out an announced inspection of Ability to Achieve on 07 October and 14 October 2016. Ability to Achieve is a provider of domiciliary care, supported living services and homecare. They provide individualised home and community based support to adults with a variety of needs, enabling them to remain independent within their home and local community.

This was the first inspection since the service was registered on 7 February 2014.

During this inspection we found the service to be in breach of the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014 in relation to, seeking consent, safeguarding people from abuse and improper treatment, good governance, and staff training. You can see what action we told the registered provider to take at the back of the full version of the report.

The registered manager was present throughout our inspection. 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 and associated regulations about how the service is run.

At the time of this inspection four people were using the service. We were unable to speak to people for their views about the services and facilities provided due to communication difficulties. We saw copies of satisfaction surveys that had been completed by the people. These demonstrated people were satisfied with their care and the staff who supported them. We received some comments and views on the service from three relatives we spoke with.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that staff had not received up to date training in safeguarding adults. However, they showed awareness of signs of abuse and what actions to take.

Accidents and incidents had been documented showing the support people were getting after incidents. Staff had sought advice from health professionals where necessary. There were risk assessments which had been undertaken before people started using the service. Plans to minimise or remove risks had been drawn and reviewed in line with the organisation’s policy. However, we found a lack of management oversight on the accident and incident records.

We found people’s medicines had not been managed safely. This was because the service had not assessed whether people were able to manage their own medicines safely. No checks had been carried out on people who managed their own medicines to ensure they used their medicines as prescribed. Staff had not received regular training and competence checks in safe management of medicines.

Building fire risk assessments were in place to enable safe evacuation in case of emergency however, care staff had not received fire safety training.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely. However, systems for checking whether staff continued to be safe after recruitment were not robust.

Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met. Two relatives told us they were happy with the level of staff.

We found three care plans had not been written in line with the Mental Capacity Act, 2005 (MCA). People’s consent to receiving care was not consistently recorded in their care files. Staff had not received mental capacity training. This was evident when speaking with staff. Knowledge of mental capacity among staff needed some improvement and the registered manager had limited awareness of the principles of the Mental Capacity Act and how to apply them in practice. Appropriate applications for Deprivation of Liberty Safeguards had not been made for two people who were deprived of their liberties.

There was a significant shortfall in the provider’s mandatory staff training. Staff competences were not checked regularly in various areas of practice including moving and handling.

People using the service had access to healthcare professionals as required to meet their needs. We found that people’s health care needs were assessed before they started using the service to ensure the service was able to meet their assessed needs.

Care plans showed how people and their relatives were involved in discussion around their care. Two of the relatives told us that they were consulted about their family members’ care. However one relative felt they needed to be involved more than they were.

People were encouraged to share their opinions on the quality of care and service being provided. We saw surveys had been carried out to seek people’s views and opinions about the care they received.

People’s nutritional needs were met. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

People were supported with meaningful daytime activities. We saw evidence to show people had a choice of activities and staff supported them to exercise their choices. People had been supported to have social involvement in the community.

Management systems at the service were not robust. There was a lack of robust management oversight on the service. Staff had not received regular training to support them in their role. Care staff had not received supervision regularly.

The quality assurance systems were in place however, they were not robust enough as some areas of people’s care had not been audited regularly to identify areas that needed improvement. We found audits had been undertaken for the premises and health and safety however; these were not consistently carried out. We were told the locality manager who used to do them had been away so they had not been completed. We found care records that required signing off to show they had been seen by locality managers or the registered manager had not been signed.

There was a business contingency plan to demonstrate how the provider had planned for unplanned eventualities which may have an impact on the delivery of regulated activities.

We found three instances where the service had not worked in line with its own organisational policies. This included staff supervision, care planning, mental capacity, medicines administration and undertaking criminal record checks on care staff.

Surveys we saw showed people felt they received a good service and spoke highly of their staff. Relatives told us the staff were kind, caring and respectful. Relatives told us the registered manager visited the services regularly and was pleasant and supportive.

We found the service had a policy on how people could raise complaints about care and treatment.