AMG Care Services Ltd

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed all quality statements within the well-led key question. We found one breach of the legal regulations in relation to good governance. During the assessment we identified several concerns with the oversight of key areas of people's care. For example, lack of guidance in some areas of risk, such as catheter care and diabetes and medicines management. We found no evidence that people had been harmed. However, staff had not received training and the service either did not have systems at all or they were not robust enough to demonstrate the leadership team had adequate oversight of the service. The service had not notified the Care Quality Commission in full about any significant events at the service which they had a legal responsibility to do. We found further development of management skills and knowledge in areas such as medicines, mental capacity assessments and safe recruitment processes is required.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not regularly see their colleagues, this meant there were limited opportunities for sharing learning about the effectiveness of people's care and treatment. Staff told us they are confident and comfortable approaching the management team for any reason. One staff member told us “The culture is good as far as I know; I don’t have problems.” However, staff have reported their concerns, including a lack of training directly to us. This indicates not all staff feel confident to raise concerns directly to the Registered Manager.

The service has been registered for under 2 years. The provider was working on developing policies and procedures that will support a shared culture and ensure their policies, practices, and decision-making processes are fair and do not disadvantage anyone with a protected characteristic. An overall business plan for the service had not yet been created.

Staff told us managers were approachable, fair and responsive. One said, ‘Yes there is no favouritism’ and another told us “I do like working for AMG, they have got it spot on.”

The registered manager is also the provider. They have previous experience as a manager in a homecare agency. However, we were not assured their skills and knowledge were up to date regarding the processes of the service. They had not conducted training in significant areas such as medicines management which meant we were not assured they had up to date knowledge. Their recruitment processes were not robust and the registered manager was not always safely recruiting staff into the service.

Staff were confident to report concerns and said the management team were approachable. We heard mixed views on whether staff had been asked for their feedback. One staff member told us (I have been) “asked for feedback, there is an open communication channel” while another told us they had not been asked for feedback but would raise any concerns they had. However, staff have reported their concerns, including a lack of training directly to us. This indicates not all staff feel confident to raise concerns directly to the registered manager.

The service had policies for raising concerns, freedom to speak up and whistleblowing. Before our inspection we received some concerns which may indicate not all staff felt safe to raise concerns directly to the registered manager. The registered manager told us staff were reminded they can raise concerns to them directly, the local authority and the Care Quality Commission (CQC). Staff had completed a survey and confirmed they knew where to report concerns, felt supported in their role and could ask for advice.

Staff all said they enjoyed their roles and had received supervision. Views varied on the benefit of the supervision process. Some staff said they would like to be asked about their well-being, while others told us they were asked. Staff said flexible working hours were available and they were happy with their hours of work. Travel time had been raised by staff as an issue at a team meeting and the registered manager had reviewed call timings because of this.

Staff received regular supervision with a member of the management team. The services' staff handbook includes key policies such as whistleblowing and safeguarding. It explains the expectations of staff in respect of anti-discriminatory behaviours and their role and disciplinary processes to be followed in the event of acts of discrimination, harassment, bullying or victimisation. The service user guide describes clearly what people can expect from the member of staff in respect of equality and diversity. However there was no evidence staff had completed equality, diversity and inclusion training which could affect the service’s ability to create and maintain an inclusive environment and respond appropriately to anti-discriminatory behaviours.

Staff had access to required information which could be accessed remotely via an app at any time. This included updates to care plans, risk assessments and reminders. Staff said they had appropriate and effective support for when they were lone working and when working out of hours. However, staff have not received an induction or training as described in the service policies. The registered manager said they were aware of the concerns in their governance arrangements and had contacted the provider of their electronic systems to develop more robust governance systems. They had received training but had not yet started to use the systems.

There was a lack of effective governance, management and accountability arrangements in place. Safe systems to manage medicines were not in place. Medication audits were not being completed. The registered manager completed some audits including care plan audits, however these had not identified missing information about people’s needs and risks. The provider did not always follow their recruitment process and ensure adequate checks were in place for new care workers. People were not supported by staff who were adequately trained and supported to meet people's assessed needs. Audits had not identified these gaps. Spot checks and supervisions were used to monitor staff; however, spot checks did not cover medicines competency and the Registered Manager did not have up to date training to be able to assess staff competency in this area. The Registered Manager told us they had an action plan for improving the service, we requested this, however we did not see this during the assessment. The Registered Manager had failed to complete mental capacity assessments or to notify CQC about an allegation of abuse. (We use notifications to monitor the service and ensure they respond appropriately to keep people safe). The Registered Manager had recently employed a Quality Compliance Officer to help with the planning and monitoring of the service. They said they had weekly meetings to drive improvements; however, there were no minutes of these meetings to show agreed actions. We found no evidence that people had been harmed. However, systems were either not in place or robust enough to provide adequate oversight of the service. This placed people at risk of harm. We identified a breach of the good governance regulation.

Some people told us they had started using the service following discharges from other healthcare services. Care arrangements had been in place before they returned home. We heard some people managed their own health appointments and referrals. However, in some instances staff contacted health professionals or had passed on information to the management team to do this when there have been health concerns.

Staff knew the process to follow if they felt a referral to an external health professional may be required. Where this process had been followed, we heard how a positive outcome had been achieved for a person.

We heard the management team were available for face-to-face reviews and review meetings. Professionals told us “They make appropriate referrals for clients and work with you to get the best possible outcome” and “I have found AMG to be good communicators who have kept (name of service) updated in relation to the person’s care and support needs and any issues.” The home has been placed into the local authority's 'provider concerns' process. This is where there are concerns around the quality of care a service is providing and the service receives increased oversight, monitoring, and support from the local authority. The provider has been working closely with the local authority to improve the quality of care.

The service works in partnership with key organisations, people, and their families. We saw evidence of joined up working with the Local authority and people, for example following a safeguarding concern the service worked with the local authority to increase a person’s care, safeguarding the person from further potential abuse or neglect. The service works with occupational therapists where a person may need support with manual handling equipment or other aids to support the person’s independence. However, we did not see evidence of good practice being shared within the service and records of communications with partners were not maintained. This meant we were not assured good practice or any agreed changes in care were implemented or included in people’s care records.

Staff told us they can check people’s call notes and communicate with each other via an app on their phones to provide updates. A change had recently been made to their access to daily notes to make this process more effective. However, there had only been 1 team meeting since the service registered in August 2022, held in March 2024. The minutes did not detail sharing of lessons learnt or future plans. Travel time was raised as an issue and recorded in minutes and the action listed stated manager to look at rota, ongoing. There was no timescale or outcome recorded to ensure this was reviewed and necessary changes made in a timely way. However the registered manager told us they had reviewed travel times.

The service has not been providing training for people to drive improvement and best practice with staff. During the assessment the registered manager showed us their plan for training going forward. An incident record we reviewed did not have any actions identified or learning from the incident recorded. The registered manager lacked knowledge about the medicines people had and their effects. For example, when reviewing a person’s Medicines Administration Record the registered manager did not know the service was supporting a person with a specific health condition. The service has implemented an electronic system to run reports for care reviews and staff supervisions. This aims to ensure reviews are monitored and carried out in a timely manner. We saw evidence of these reviews during the inspection. The registered manager told us they had an action plan for improving the service, however we did not see this during the assessment. We saw evidence of some of the improvements the service is planning, this included updating its care plans and risk assessments to include more specific risk assessments and person-centred information.