All inspections: A1 Nursing & Homecare Agency Limited

The inspection took place on 02 May 2018 and was announced.

The service is a domiciliary care agency. It provides personal care to people living in their own homes in the Wigan and surrounding area. It provides a service to children, younger and older adults who may have a physical or learning disability and people living with dementia.

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. At the time of this inspection, seven people were receiving homecare support from A1 Nursing & Homecare Agency Limited.

A1 Nursing & Homecare Agency Limited in addition to providing homecare also provides nursing and support cover to care homes and other agencies. This was not looked at as part of this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had 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.

The registered manager was available throughout the inspection but it was the deputy manager who facilitated the inspection and they told us they would be applying to become the registered manager as they oversaw the homecare packages currently.

At this inspection we found comprehensive risk assessments were in place and support plans devised to mitigate the risks. We saw that people or their relative had been involved in planning the care provided.

The provider had appropriate systems and procedures in place which sought to protect people who used the service from abuse. Staff demonstrated a good understanding of local safeguarding procedures and how to raise a concern.

The recruitment procedures ensured appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Medicines were managed safely and there was no omissions in signatures on the medicine administration records (MAR) which showed medicines had been given as prescribed.

Staff received an induction, appropriate training and additional specialist training to meet the needs of the person they supported.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People told us staff were caring and friendly and respected their privacy and dignity.

The provider had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The provider sent a newsletter to people to maintain communication and provide updates regarding the service.

The deputy manager sought the views of people who used the service and their relatives by undertaking reviews. Following the inspection, questionnaires were being sent to ascertain people’s feedback regarding the quality of the service they received.

Staff spot checks and competency checks were undertaken regularly to help ensure consistent quality of care delivery.

This was an announced inspection carried out on 16 and 20 November 2015. 48 hours’ notice of the inspection was given so that the manager would be available at the office to facilitate our inspection. The registered manager was required to leave during the inspection due to unforeseen circumstances, but the care manager was available and facilitated the inspection during both site visits.

A1 Nursing & Homecare Agency Limited is a domiciliary care agency that provides support to adults in their own homes within Wigan and the surrounding areas. At the time of the inspection, 13 people were being supported by the agency. Seven of these people received daily visits by the agency and the remaining six people received intermittent support responsive to their needs. One of the people that was being supported frequently had complex care needs. The agency’s office is located near Wigan town centre.

At our previous inspection on 07 and 12 August 2014, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Suitable arrangements were not in place for the management of medicines. We found that appropriate arrangements were not in place to ensure medication was safely administered to people who used the service, which could have placed them at risk of harm. We also found that an effective system was not in place to regularly assess and monitor the quality of the service provided.

We asked the provider to take action to make improvements in regards to the medicine management and auditing of the service provision. We found at this inspection that this action has been completed. We found medicines and care plans had been written to reflect the medication policy to ensure medication was administered safely. Competency checks were being undertaken quarterly by the registered manger with staff administering medication so that areas of concern could be highlighted and addressed.

We had previously considered the quality assurance system to be ineffective as it didn’t highlight when appraisals or mandatory training was required. In addition, policies and procedures had not been reviewed or updated for some time. We saw that there was now a matrix for care workers to show when they had completed training, competency checks and appraisals. However, policies and procedures were not dated so we were unable to determine whether they had been reviewed or updated to reflect current best practice.

Incidents and accidents were documented and we saw that families were informed and actions had been documented to mitigate risks. A system had been implemented to review the quality of care provided which was achieved through the care manager and registered manager conducting audits.

People had a full assessment of their needs prior to the commencement of the service and the care plans devised following the assessment process were person centred and comprehensive. Care workers demonstrated a commitment to providing person-centred care and demonstrated an excellent understanding of people’s individual needs.

Staff received an induction, basic training and additional specialist training to meet the needs of the person they supported.

Should people lack mental capacity to make specific decisions, the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People’s nutritional needs were identified and being met. Information about health and social care professionals involved with people’s care and treatment was recorded so care workers could access their help if required.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. We reviewed a sample of recruitment records, which demonstrated that staff had been safely and effectively recruited.

Care workers demonstrated a good knowledge of people they supported and provided examples of how they promoted people’s independence and maintained their privacy and dignity when providing support.

Care workers told us that they felt the service was well managed and that the care manager and registered manager were available and approachable. We received positive feedback from people we spoke with about the care provided and this was substantiated further through the feedback seen that had been obtained through satisfaction surveys.

We carried out this announced 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, and to provide a rating for the service under the Care Act 2014.

A1 Nursing & Homecare Agency Limited is a domiciliary care agency that provides support to adults in their own homes within Wigan and the surrounding areas. At the time of the inspection, 13 people were being supported by the service. One of the people being supported had complex care needs. The agency’s office is located near Wigan town centre.

A registered manager was in place at the agency for the regulated activity personal care. The nurse manager was in the process of registering to become the registered manager for the regulated activity of treatment of disease, disorder or injury. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We found an effective system was not in place for the management of medicines. The agency had a clear medication policy. However, this was not being applied to how the care plans were written. Appropriate arrangements were not in place to ensure medication was safely administered to people who use the service, which could place them at risk of harm. Staff had not had their competency checked to prompt or administer medications.

A quality assurance system was in place. However, this was not fully effective in all areas of the organisation. Care plans were regularly audited and reviewed. However, some areas had not been kept up to date. For example, there wasn’t a way for the registered manager to see whose appraisals and mandatory training was due. This meant it had lapsed for some people. In addition, policies and procedures had not been reviewed and updated for some time, which meant staff did not have access to best practice guidance.

Incidents and accidents were individually identified and investigated. However, there was no overarching system to continuously review the quality of care being provided. This meant opportunities to improve the service further may have been missed.

All the feedback we received from people we spoke with and individual satisfaction surveys we viewed were extremely positive. People told us they were very satisfied with the care and support they received from the agency. In particular, people were happy to receive care from the same care workers and nurses, which they appreciated. We reviewed five people’s care packages and found good continuity of care being provided in all cases.

Staff demonstrated an excellent understanding of the needs of the people they supported. We found staff to be warm and caring and genuinely interested in providing care and support that was centred around people’s individual needs. We saw examples, of staff going beyond what was expected of them to support people to achieve a good quality of life.

Care plans were clear and comprehensive. They contained guidance for staff about the care and support that people required and also details of people’s personal preferences. We saw evidence of people’s healthcare and nutritional needs being met.

People were fully involved in their initial assessment, development of their care plan and in the reviews of their care. We looked at one person’s care plan who did not have capacity to be directly involved in developing their plan. For this person, their parents took a lead role in agreeing the care plan.

During this inspection we reviewed the remaining two outcomes that the provider had not been compliant with at the inspection conducted in May 2013. We found that the service was now compliant in the regulations as detailed in the body of this report

The manager had now completed their application to be registered for the service and this had been confirmed for the personal care element of care provided and there was now a nominated individual in post.

During this inspection we reviewed two of the outcomes that the provider had not been compliant with at the last inspection. We will inspect again to check compliance with the remaining two outcomes after the target date for their compliance has been reached.

We found that the manager for the service has not yet fully completed their application to be registered for the service but we were informed that it is still their intention to do so.

We spoke with two relatives' of service users, three service users and two members of staff who provided a variety of comments.

One person told us that '' the carers are o.k. they turn up on time and they look after me. I have no concerns.'' Another person said that they were well looked after and they had no problems, although sometimes the carers were late due to traffic. If they had a problem they would phone the office but did not know who else they could contact.

One staff member told us that the care plans were good documents to use. We noted that staff were now receiving regular supervision of their work. However, this practice should also be available to senior members of staff. Regular supervision provides a good way to support staff in their job role.

The monthly meetings between the provider and the office staff had continued.

We noted that the service does not currently have a Nominated Individual and the provider told us that they will address this issue. The manager in post is making an application to be registered.

We spoke with four relatives' of service users, one service user and four members of staff.

Overall, their comments were positive. They used words to describe the service such as ''The staff are polite and the care seems good'' and '' The staff turn up on time''. We asked people if they felt that there was anything they would change about the service. We were told that ''The support from the office could be better''.

One staff member told us that they had sufficient time to meet the needs of the service users that they supported. We noted that staff were not receiving regular supervision of their work. Regular supervision provides a good way to support staff in their job role. The provider acknowledged that some areas of supervision and monitoring had lapsed, however they were already taking action to address these shortfalls.

Another member of staff told us that there were monthly meetings between the provider and the office staff. The provider told us that they acknowledged the fact that some areas of monitoring and reviewing had lapsed due to staff shortages. For example, the three monthly 'spot checks' of observing staff at work providing care, but they were taking actions to address this such as the current review of the service users assessed needs.

The service had vacancies for staff necessary for the management of this service including a manager and a care co ordinator.

'They look after my mother very well, always very caring and respectful'.

'I can trust them when I am not there; I know my son is in safe hands'.

'The carers are brilliant, I have every confidence in leaving my son in their care, and they have been a god send'.

'They have been wonderful, the information the agency gave me was very detailed and explained everything '.

Archived: A1 Nursing & Homecare Agency Limited

All Inspections

2 May 2018

During a routine inspection

16 & 20 November 2015

During a routine inspection

7 & 12 August 2014

During a routine inspection

30 January 2014

During a routine inspection

26 September 2013

During a routine inspection

2, 21 May 2013

During an inspection looking at part of the service

1, 16 November 2012

During a routine inspection

4 August 2011

During a routine inspection