13 August 2019
During a routine inspection
Ana nursing and care services is a domiciliary care agency providing personal care to 110 younger and older adults in their own homes at the time of the inspection. The service is registered to support people with a range of different support needs, these included people who may be living with dementia and those who have physical health needs.
People’s experience of using this service and what we found
Risks were not always suitably assessed and planned for. For example, where people had diabetes and specific dietary requirements there was no guidance in place for staff to follow. There was no guidance in place for staff to follow when people had ‘as and when required medication’ and medication administration records were not always fully completed. This is a breach regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Despite what we found people told us they felt safe. There were enough safely recruited staff to meet people’s needs and people were protected from the risk of cross infection as staff wore personal protective equipment.
Governance systems were not operated effectively to assess, monitor and mitigate people’s risks and the provider did not have suitable oversight of systems in place to monitor assess and improve the quality and safety of the service. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not always provide good outcomes for people due to the inconsistency of staff, however staff told us management were approachable. The nominated individual was aware of their duty of candour and the service engaged people using the service and staff and worked in partnership with others.
People had their needs assessed, however care plans lacked detailed on how to effectively support the person in line with their support needs. Staff received training which they felt enabled them to do their job well. People told us they were supported to eat and drink enough and received access to health care when necessary.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not always support this practice.
People did not always receive personalised care that was responsive to their needs this was due to most people not receiving regular carers, so people had to explain to care staff how they liked their care to be delivered on different occasions. People had their communication needs meet and felt able to complain. When a complaint or concern was raised it was investigated. We have made a recommendation about end of life wishes.
People were supported by caring staff who respected their privacy and promoted their independence. People were supported to express their views and be involved in making decisions about their care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 28 August 2018) and there were two breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.