Archived: Access Care Management Limited

Updated 25 June 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was undertaken by one inspector and an inspection manager.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 26 April 2021 and ended on 25 May 2021. We visited the office location on 26 April 2021 and on the 19 May 2021.

What we did before the inspection

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification tells us about important issues and events which have happened at the service. We sought feedback from health and social care professionals. The provider had been asked to complete a provider information return (PIR). A PIR is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

During our visit to the office we spoke with the registered manager and reviewed a range of records. These included care documentation and care worker records and records relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke with four people using the service and four relatives. We received written feedback from two care workers and spoke with a further five care workers. We also sought feedback from a local commissioner.

Updated 25 June 2021

About the service

Access Care Management Limited (to be referred to as Access Care throughout this report) is a community-based care agency providing self-employed care workers to live-in with people in their own homes. The service is provided nationwide. Access Care currently provide two distinct services. The main part of the business is a recruitment and introductory service only. Access Care do not have an ongoing role in managing the quality and safety of the care being provided. This side of the business is not registered with the Care Quality Commission (CQC) and we do not inspect the care being provided to these people.

A small number of people receive what the service refer to as a ‘managed’ service. For these people, Access Care are responsible for ensuring that the care being provided continues to meet their needs on an ongoing basis. This managed service is registered with the Care Quality Commission and is therefore required to meet the fundamental standards. These are standards below which the care people receive, should never fall. At the time of our inspection, the managed service was no longer on offer to new clients.

Not everyone receiving the managed service received personal care. CQC also can only inspect 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. At the time of the inspection, the registered manager told us 10 people receiving the managed service had personal care needs.

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

This inspection determined that the self-employed care workers being introduced, or matched, to people receiving the managed service were carrying on the regulated activity of personal care in the name of Access Care Management Limited. This meant that Access Care fell within the scope of registration under the Health and Social Care Act 2008 and therefore they were required to operate effective systems and processes to ensure compliance with all of the Regulations under the Health and Social Care Act 2008. It was not possible to operate a business model which meant that some of the Regulations could not be met.

This inspection identified concerns regarding risk management, oversight of incidents and accidents, record keeping and the personal development and oversight of the care workers delivering people’s care. The systems and processes to ensure the registered manager was able to assess and monitor the safety and quality of the service against each of the Regulations needed to be further developed.

We have made a recommendation about the provider’s infection, prevention and control policies.

Since the inspection, the registered manager has taken action to restructure their business model. They have acted promptly to introduce a number of changes to strengthen the governance arrangements, ensure stronger systems are in place for maintaining records and the professional development of staff. Moving forward, this will help to ensure compliance with all of the Regulations, but these developments will need to be embedded.

People and their relatives spoke positively about the service they received from Access Care Management. They consistently told us that their regular care workers knew them well and treated them with kindness, dignity and respect. People felt their medicines were managed well and were happy with how their care workers managed infection control. Feedback was that the Access Care Team were usually effective at matching clients to care workers who were suitably skilled and knowledgeable. Care workers generally felt well supported and felt that they were provided with all of the information they needed to provide care safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was ‘Good’ (published May 2017).

Why we inspected

The inspection was prompted due to the length of time since we had last inspected the service. We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment, good governance and staffing 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.