Admiral Care Limited

Admiral Care Limited is a domiciliary care service providing personal care to people in their own homes. The service provides support to older people and younger adults some of whom may be living with dementia, a mental health condition and/or a physical disability or sensory impairment. At the time of our inspection there were 57 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People and relatives we spoke with told us they received safe care. However, records to support the delivery of safe care, were not always complete, up to date or accurate.

Action was taken when safeguarding allegations and concerns were raised. However, these concerns were not always shared promptly with the local authority safeguarding team or notified to CQC. Sharing this information is required to help protect and monitor people’s safety.

Information about people’s medicines and the management of medicines was not always comprehensive or up to date. This meant staff did not always have access to the guidance necessary for the safe management of people’s medicines.

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 provider’s process to show how decisions had been made in people’s best interests required improvement. We have made a recommendation about this.

The governance system had not identified the concerns we found. Policies required updating and incidents requiring notification to the CQC had not always been submitted.

Staff understood how to protect people from the spread of infections. Although at times the service was short staffed, management staff provided care to ensure people did not experience missed or shortened calls. The provider acted when things went wrong, and improvements were made as a result of lessons learnt.

People and relatives spoke highly about the quality-of-care people received. Staff told us they received the support and training they needed to carry out their role. Staff worked in partnership with other health and social care professionals to achieve positive outcomes for people.

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 good (published 31 July 2018).

Why we inspected

We received concerns in relation to allegations of neglect and unsafe practice. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Admiral Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to records concerning people’s care, management of people’s medicines, governance arrangements and notification of incidents to CQC at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This service is a domiciliary care agency. It offers personal care to people living in their own homes. It provides a service to older and younger adults, people living with dementia, learning disabilities or autistic spectrum disorder, mental health, people who misuse drugs and alcohol, people with eating disorders, people with physical disability and people with sensory impairment. At the time of our inspection there were 68 people using the service.

Not everyone using Admiral Care Limited receives regulated activity; the 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.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection, in June2017 the service had been rated 'Requires Improvement'. At this inspection, we found evidence the service had improved to support the rating of good and there was no evidence that demonstrated serious risks or concerns.

People were kept safe from abuse and harm and staff knew how to report any suspicions concerning abuse. Risk assessments identified how potential risks should be managed to reduce the likelihood of people experiencing harm. Staff understood the risks to people and delivered safe care in accordance with people’s support plans.

Incidents and accidents were recorded appropriately and investigated where necessary. If learning resulted in changes to support plans or support guidelines, these were discussed and action was taken to reduce the risk of further incidents and accidents.

Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the service. People received their medicines when they needed them from staff who had been suitably trained and had their competency checked.

People's medicines were managed safely. Staff understood how to reduce the risk of the spread of infection.

Staff received effective training to meet people's needs. An induction and training programme was in place for all staff. A detailed assessment was carried out to assess people's needs and preferences prior to them receiving a service.

The management team effectively operated a system of spot checks, supervision, appraisal and monthly team meetings which supported staff to deliver care based on best practice.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The service was working within the principles of the Mental Capacity Act, 2005 and we found people's human rights were recognised and protected.

People were protected from the risk of malnutrition and supported to eat a healthy diet of their choice by staff who had completed training in food hygiene and safety.

Staff treated people with kindness and compassion in their day-to-day support. People's dignity and privacy were respected and upheld, and staff encouraged people to be as independent as possible.

People's care records were person-centred and staff provided people with support in line with people’s preferences. People were consulted about their diverse needs which were respected by all staff.

People had access to a complaints procedure and were confident any concerns would be taken seriously and acted upon.

The registered manager carried out their role in line with their registration with the CQC. They ensured all notifiable incidents were reported to the CQC. Staff respected the registered manager who encouraged them to carry out their role in line with provider's aims and values. Systems were in place to monitor the quality of the service, which included seeking and responding to feedback from people and their relatives in relation to the standard of care and support.

We undertook this focused inspection to check whether the provider had taken action and to confirm whether they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the “all reports” link for Admiral Care Limited on our web site at www.cqc.org.uk.

This focused inspection took place on 16 May 2017. We gave the provider 24 hours’ notice so that people we needed to speak with would be available.

The previous comprehensive inspection found the provider was not meeting the requirements of regulations concerning the safe management of medicines and maintaining up to date records. This inspection found that improvements had been made in both areas. The provider was now meeting the requirements of the regulations. However there were still areas where improvements could be made with respect to people’s medicines records and the provider had not sent us a report of actions when requested. The rating for the service therefore remains requires improvement.

Admiral Care Limited provides personal care to people in their own homes. At the time of this inspection the service provided personal care to 80 people with a range of needs including people living with dementia, older people, and people with a physical disability. Admiral Care Limited also provides services to people which are outside the Care Quality Commission’s regulatory remit.

The service had a registered manager in place. A registered manager is a person who has registered with us 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 provider had taken steps to improve the consistency and clarity of records relating to people’s medicines. Where people had complex needs the registered manager only assigned experienced care workers who knew the person and understood their needs to call on them.

The provider had put in place processes and procedures to make sure records relating to people’s care and support were kept accurate and up to date.

When we inspected this service in July 2015 we found breaches of legal requirements, we gave the service a rating of inadequate and placed it in special measures. We inspected the service again in April and July 2016. We found some improvements had been made but the service was still inadequate in one key area and remained in special measures. People were not properly protected against risks to their health and wellbeing. Training was not always effective in making care workers aware of their responsibilities where people lacked capacity to make decisions. People’s care did not always take into account their preferences. Improvements were needed to management systems, quality assurance processes and people’s care records.

Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that further improvements had been made and consolidated, and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Although the service was no longer in special measures, there remained one continuing breach and one new breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of this report.

Admiral Care Limited provides personal care to people in their own homes. At the time of this inspection the service provided personal care to 57 people with a range of needs including people living with dementia, older people, and people with a physical disability.

The service had a registered manager. 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 provider did not always make sure people’s medicines were managed properly and safely. However processes were in place to protect people against other risks to their safety and welfare, including the risks of avoidable harm and abuse. The provider carried out recruitment checks to identify that care workers were suitable to work in a care setting.

Records to do with people’s care were not always accurate and up to date. The registered manager had appropriate management systems and procedures to monitor and improve the quality of the service.

The provider supported staff to deliver effective care by means of a programme of training, supervision and appraisal. Staff were aware of the need to obtain people’s consent to their care. Where people lacked capacity, staff were aware of the legal requirements to protect people’s rights. Where people’s care plans included support with people’s food and drink, the provider supported them to maintain a healthy, balanced diet. Care workers supported people to access other healthcare services as necessary.

Care workers had developed caring relationships with people they supported. People were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s independence, privacy, and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. The provider carried out checks to make sure people received care in line with their plans. People were aware of the provider’s complaints procedure, and complaints were investigated and managed in accordance with the procedure.

Admiral Care Limited provides personal care to people in their own homes. At the time of this inspection the service provided care to 88 people with a range of needs including people living with dementia, older people, and people with a physical disability. The service had 38 care staff.

The service had a registered manager. 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.

We carried out a comprehensive inspection of this service on 28 July 2015. We found breaches of legal requirements and gave the service an overall rating of inadequate. This meant the provider was placed in special measures.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months from publication of the previous report.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection we found some limited improvements had been made. However there was not enough improvement to take the provider out of special measures because we judged the service was inadequate for one key question.

We are considering the appropriate response to the shortfalls we found during this and previous inspections. Where registered persons have not been meeting the fundamental standards, we have a range of enforcement powers we can use to protect the safety, health and welfare of people who use the service. When we propose to take enforcement action, the provider can challenge our decision through a variety of internal and external appeal processes. We will publish a further report on any action we take.

The provider had made improvements in the way it managed concerns about the safety and welfare of people made vulnerable by their circumstances. However their systems for identifying, assessing and managing risks to people’s safety and welfare were not fully effective, which meant people were not fully protected from such risks.

The programme of training and supervision was not always effective. Some staff did not show sufficient knowledge in important areas. Care workers were not familiar with legal requirements when supporting people who did not have capacity to consent to their care and support.

People were satisfied the care and support they received met their needs, but it did not always conform to their preferences. Calls were not always at the time agreed, and people did not experience consistency in the care workers who supported them. The provider had started a review of all care plans, but this had not completed at the time of our inspection. People were confident they could complain if they had concerns, and the provider investigated and followed up complaints.

The provider had taken steps to improve the management of the service, but changes were recent and not embedded or sustained. The provider's systems had not identified or addressed concerns we found during the inspection. The provider’s system for obtaining feedback from people on the quality of service they received was not reliable or effective.

The provider took steps to make sure staff were suitable to work in a care setting. Appropriate processes were in place to make sure people’s medicines were managed safely.

Where appropriate people were supported to eat and drink enough and to access other healthcare services.

People had caring relationships with their care workers and had the opportunity to take part in decisions about their care and support. Care workers took steps to promote people’s independence, dignity and privacy.

We found five breaches of the Health and Social Care Act (2008) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People and their relatives told us they received a reliable and punctual service. This was also confirmed by the two health and social care professional we spoke to. Comment was made by both the health and social care professionals, and, by people, that the service 'went beyond' its contractual obligations to ensure people were safe and well cared for.

We found that each person's needs were assessed and care plans were recorded of how people's needs should be met. These included the times care was to be provided and assessments regarding moving and handling. People told us they were consulted about their care and that there was a copy of their care plan at their home. There were records to show that the service carried out checks to monitor that care staff were providing care as set out in care plans.

The service carried out checks that newly recruited staff were suitable to work with vulnerable people, although we noted these were incomplete for one staff member.

People and their relatives told us they were supplied with a copy of the service's complaints procedure.

We spoke to the manager and to two members of staff as well as a member of staff who had responsibility for ensuring the service was compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We looked at care records for three people. We found that each person receiving a service had a care plan with comprehensive details about the care and support they needed. Full details of what staff should provide to the person were recorded. There were records regarding health and safety so that staff knew what to do to safely support people and to protect themselves.

We found that the service had reviewed its procedures where staff were involved in handling needles. This included updating individual's care plans and additional training for staff in this. The manager also described how the service reviewed specific incidents but this was not recorded.