Archived: Access Care Management Limited

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.

Access Care Management Limited (to be referred to as Access Care throughout this report) is a family run care agency which provides personal care and support to people who live in their own homes across the country. The agency provides live in care workers (to be referred to as care staff throughout this report) to people via an introductory and client matching service. This is where people wishing to receive care are provided with care staff profiles which detail the staff’s skills and experience to allow them to identify the member of care staff who may be able to best meet their specific needs. Access Care offer two distinct services, people can privately employ care staff directly which does not fall within the regulation of the Care Quality Commission (CQC). However, a number of people are introduced and the care is managed by the agency to ensure it meets people’s needs. This is care which is regulated by the Care Quality Commission (CQC).

People who receive the service include those living with Alzheimer's, people living with chronic illnesses such as Multiple Sclerosis and those living with brain injuries. At the time of the inspection the agency were providing personal care to 19 people who lived in their own homes across the country.

At our previous inspection completed on 21 and 23 July 2015 we found a breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). The provider had not always ensured care staff had provided full employment histories prior to registering with the agency. This meant the provider could not assure themselves that any gaps in their employment history could be reasonable explained and were not due to reasons which would make them unsuitable to deliver care. At this inspection we found that the requirements of the HSCA were now being met with full employment histories obtained from potential care staff and any gaps in this history had been sought and reasonably explained.

Access Care has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage a service. Like registered providers they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the agency is run.

People using the agency told us they felt safe. Safeguarding training and procedures were in place and care staff were able to identify and recognise signs of abuse. Care staff understood and followed guidance to recognise and address safeguarding concerns. The agency had systems in place to notify the appropriate authorities where concerns were identified and investigate these thoroughly.

People's safety was promoted because risks that may cause them harm in their own homes had been identified and guidance provided to care staff on how to manage these appropriately. People were assisted by care staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Access Care did not directly employ care staff. Care staff were self-employed and had to register with the agency in order to be introduced to people. The registered manager ensured that care staff had a full understanding of people’s care needs and had the skills and knowledge to meet them. People received consistent support from care staff who knew them well. The agency’s registration process ensured that people were protected from the employment of unsuitable care staff.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations which could affect service delivery and to protect the loss of people’s information if a fire or flood affected the main office.

People received their medicines safely. Care staff were trained to administer medicines and were required to update this training every two years in order to remain registered to deliver care. Care staff completed medicine administration records (MARs) fully which identified people had been receiving their medicines as prescribed.

Where required people were supported by care staff to eat and drink enough to maintain a healthy balanced diet. People told us they enjoyed the meals which were prepared for them and care records documented their likes and dislikes to support care staff with meal preparation.

People were supported by care staff to make their own decisions. Whilst not all care staff we spoke with were knowledgeable about all the principles of the Mental Capacity Act 2005 (MCA) all demonstrated how they offered people choice and supported people with their decision making processes. Mental capacity assessments were undertaken by office staff and the registered manager for people who lacked capacity to make decisions. MCA assessments and associated best interest decisions were completed in conjunction with people who had the appropriate power of attorney to support people when they were no longer able to make key decisions about their life.

People's health needs were met as the care staff and the registered manager had a detailed knowledge of the people they were supporting. Care staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people's identified health care needs were met and to maintain people's safety and welfare.

Care staff had taken time to develop close relationships with the people they were supporting. This was supported by care plans which were personalised to each individual. Care plans contained personalised information to assist care staff to provide care in a manner which respected person’s individual needs and wishes. Relatives were involved at the care planning stage and during regular reviews. Relatives told us, and records showed, they were actively encouraged to be involved at the care planning stage, during regular reviews and when their relative’s health needs changed.

People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. Care staff sought to support people to participate in a range of activities to enrich their daily lives which included attending gym classes, shopping and attending further education classes.

People and relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and all staff were encouraged to provide feedback on the quality of the service during care plan reviews and through regular telephone contact with office staff.

The provider's values included providing highly individualised care in people’s home to enhance people’s ability to live independently. All staff were able to discuss the provider's values and demonstrated they knew how to deliver high quality care in a way which promoted people's dignity, provided respect and enhanced people’s independence skills. People and a relative told us these standards were evidenced in the way care was delivered.

People and relatives told us Access Care had a confident registered manager and all staff told us they felt supported by them. The registered manager provided strong positive leadership and fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the agency. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.

The provider’s quality monitoring processes involved weekly contact with people receiving a service to ensure care provided was meeting their needs. Audits were also conducted on paperwork upon its return to the office to ensure that all care was required at the time it was needed.