Archived: AC Homecare

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

The management team did not always notify appropriate agencies of safeguarding concerns in a timely manner. Where concerns had been raised these were not always investigated effectively. This was highlighted as part of the inspection feedback and the management team looked into these concerns.

Where people had support with medicines this was not always managed efficiently. Medicines administration records were not always completed, and people’s medicines were not always reordered promptly. This meant people did not have their medicines when required.

People had mixed views when asked about staff knowledge of their roles. Staff had not received all of the mandatory training set out by the provider, although the provider completed observations and competency checks.

Staff had access to personal protective equipment (PPE) and were tested for COVID-19 in line with guidance. People said the majority of staff were using safe practices when using PPE, although there were times where staff did not wear the PPE correctly. Staff were not cohorted into specific teams or areas to reduce the risks of cross infection by reducing the number of staff they had direct contact with. Opportunities had been missed to ensure risks were minimised in this area. This meant that staff were mixing with different staff members and people. This did not offer assurance that the provider was managing potential infection transmission risks effectively.

In December 2020 a new provider took over the service, people and staff felt there was a lack of communication with the new provider and felt unsettled with the changes. People felt the staff supporting them were kind and caring, although found some of the office staff not to be professional.

The provider did not have a robust quality assurance system in place which meant that where improvements were needed these were not identified and actioned. For example, people did not always receive their full support hours commissioned to them and people spoke about how staff were late to their support. This had not been picked up by the management team. Following the inspection, the provider spoke about a new quality assurance system they were planning on putting into place.

People told us they were involved in their care and staff listened to how they wanted their support to be given. However, there were occasions where people had contacted the management team to ask for changes to be made to their care and this was not always actioned promptly.

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 requires improvement (published 21 November 2019).

Why we inspected

We received concerns in relation to the management of medicines, safeguarding and the working culture. As a result, 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 full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement:

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 will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to potential safeguarding concerns not being reported and investigated promptly and assurance systems failing to identify improvements needed in the service.

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 for 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.

AC Homecare is a domiciliary care service. The service is registered to provide care and support for older people and younger adults who may live with dementia, sensory impairments, learning disabilities, physical impairments or mental health issues.

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

At the previous inspection we had identified shortfalls in areas such as recruitment processes, staff training, care planning and overall governance. At this inspection we found that improvements had been made. Additional systems had been introduced to help address shortfalls and improve the quality of care and support provided. We found these systems were effective, although some were still being embedded into daily practice. Recruitment processes had been improved.

The provider had improved the systems for medicine recording and monitoring and further developed people’s care plans and risk assessments. Medicine administration was monitored to help ensure people received their medicines in accordance with the prescriber’s instructions. People’s care plans were detailed and included enough information to enable staff to provide consistent, safe care. The provider had improved systems to ensure staff were trained, supervised and supported.

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; the policies and systems in the service supported this practice.

People told us their care needs were met and there were enough staff to support this. People said staff were kind and caring and promoted their dignity and privacy. People and their relatives said they would be confident to raise concerns with the management team and gave examples where they had done so to good effect.

The provider had developed robust governance systems which enabled them to have effective oversight of all aspects of the service. This included care plans, risk assessments, staff recruitment records and medicine records. People, their relatives and staff members spoke highly of the provider and told us that they were always available and supportive. People were involved in the service development and their views were continuously sought to enable the provider to provide a safe and effective service that met people’s needs.

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 31 October 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service does not have a registered manager as required so the rating for the well-led domain is limited to ‘Requires Improvement’.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

AC Homecare has been without a registered manager since January 2018. 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.

We undertook an announced inspection of AC Homecare initially on 14 August 2018 in response to whistleblowing and concerns raised about the lack of robust staff recruitment, staff training and the behaviour of the manager, who had been in place since January 2018.

We found that nine of the staff employed since January 2018 had not received any training nor correct pre- employment checks or DBS before supporting people in the community. These nine staff had to be removed immediately from working until all checks and training had been completed.

We found the manager had been dismissed from the agency on 10 August 2018.The manager had replaced the original care plans with an electronic system of care plans for staff to access. However not all information had been transferred and assessments of risks to people were not completed. People said they did not have access to care staff’s daily notes and health professionals could not access peoples medicine records.

At our last inspection on 26 May 2017 the service was rated requires improvement as further developments were needed in the assessments of activities or areas that could pose a risk to people as there was insufficient information to inform staff how to manage situations. At this inspection we found there was still insufficient information to inform staff how to manage potential risks to help maintain people’s safety.

There was a lack of systems for the provider to assess the quality and effectiveness of the management and of the service. The systems in place were reliant on the manager to complete. Systems in place for the provider to assess the quality and effectiveness of the service were ineffective as they had not identified the concerns ..

The provider responded to our findings in an open and transparent way and was committed to remedy the situation and began a significant amount of work to achieve this. The provider took on the management role of the agency together with the care supervisors to ensure that people received care and were safe. They informed Hertfordshire County Council who supported the agency by arranging the care of ten people to ensure their care needs were met.

Since the first day of the inspection the provider and care supervisors staff worked on completing assessments of areas of risks for people. They ensured each person had a folder with their care plan and information about the agency and put in place a medicine booklet to record current medicines and any allergies.

Whilst staff were suspended from active working and awaiting full employment and DBS checks they undertook training and once they received DBS and their other employment checks, they shadowed staff and before working alone were signed off as competent in their level of training .

People and their relatives said they felt safe with the care staff and that their privacy, dignity, and independence was respected and promoted.

People told us staff always asked for their consent when providing care and always encouraged and involved them.

People and their relatives had confidence in the way the provider managed a difficult time and said they had been informed of the situation and were sure the service would work through and resolve the situation.

This was the service's first inspection since registering with the Care Quality Commission on 29 April 2016.

A C Homecare provides personal care for people living in their own homes. At the time of the inspection 53 people were receiving a service from them.

The service had a manager who was registered with the Care Quality Commission (CQC). 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 found further developments were needed in the assessments of activities or areas that could pose a risk to people as they were not always detailed or contained sufficient information to inform staff how to manage situations. However, staff were clear on their role and how to keep people safe.

People’s consent was sought before care was offered and the registered manager and staff were familiar with the principles of the Mental Capacity Act 2005. People were supported to eat and drink enough to maintain a healthy diet and health professionals were contacted on people’s behalf if needed.

People were treated with dignity and respect.

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People who used the service and their relatives told us the service was flexible and able to meet their needs. People's care and support needs were kept under review to help ensure that they continued to be met.

People who used the service felt confident to raise any concerns and were confident that they would be managed appropriately. Staff said that they were fully supported by the registered manager.

People's views about the service provision were gathered regularly to help the registered manager assure themselves that the service they provided was safe and was meeting people's needs

There was a culture of openness and inclusion at the service and staff said that the registered manager inspired them to deliver a quality service. People who used the service and their relatives spoke positively about the registered manager and said the service was well run.

There were systems in place to monitor the quality of the service.