Archived: Amber Healthcare Personnel Limited

There was a registered manager in post. 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.

At our last inspection on 30 March 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). In that the service did not always effectively manage the risks associated with people’s care. Staff responsible for the administration of medicines did not always have the competencies checked. The provider did not have effective systems in place to monitor the quality of service.

At this inspection we found the service had made significant improvements to address these concerns. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. The service had systems to assess the quality of the service provided. Learning was identified and action taken to make improvements which improved people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

People were safe. Staff understood their responsibilities in relation to protecting people from the risk of harm. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified. People received their medicine as prescribed.

People told us they benefitted from caring relationships with the staff. There were sufficient staff to meet people’s needs and people received their care when they expected. Staffing levels and visit schedules were consistently maintained. The service had safe, robust recruitment processes.

Staff had a good understanding of the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected.

People told us they were confident they would be listened to and action would be taken if they raised a concern. We saw a complaints policy and procedure was in place.

Staff spoke positively about the support they received from the registered manager. Staff supervision and meetings were scheduled. Staff told us the registered manager was approachable and there was a good level of communication within the service.

People told us the service was friendly, responsive to people’s individual needs and well managed. People knew the managers and staff and spoke positively about them. The service sought people’s views and opinions and acted upon them.

The service did not have 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.

People’s care records did not always contain up to date and accurate information to enable staff to mitigate the risks associated with people’s care. People received their medicines as prescribed. However, staff responsible for the administration of medicines were not always up to date with their medicine training and had not always had their competencies checked.

The service was responsive to people’s changing needs. However, people’s care needs were not always reassessed following significant changes in their circumstances.

There were systems in place to monitor the quality of the service. However, these systems were not always effective. Accidents and incidents were not always reported in line with the provider’s policies and procedures.

People told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training.

The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People were supported by staff who had the skills and knowledge to carry out their roles and responsibilities. People benefitted from caring relationships with staff who had a caring approach to their work.

Staff spoke positively about the support they received from the management team. Staff had access to effective supervision. Staff and the provider shared the visions and values of the service.

The service sought people's views and opinions. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

Where people needed support with eating and drinking they were supported effectively. People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The agency sent us a plan describing what actions they would take to improve the accuracy of the documentation.

We inspected the agency on 22 September to check they had implemented the required changes. We visited the registered office and met with the registered provider. We reviewed care records for six people and we spoke with two members of staff. We spoke with the registered manager the following day.

We found the registered manager had made significant improvements to the care records. Most of the care plans were detailed and provided comprehensive, accurate and up to date guidance. We spoke with staff who told us about the care needs of the people they provided care and support for.

We found that two of the care plans did not provide accurate guidance. We judged there was still a risk of people receiving care that was unsafe. We have asked the provider to tell us what they are going to do to meet the requirements of the law.

At this follow-up visit we saw that improvements had been made. Care plans were person centred and written in a way that reflected people's preferences when receiving care. The information also informed care workers how to deliver peoples care so as to develop and maintain their independence.

More detailed information was available to care workers in relation to the moving and handling support they were to deliver. We found care workers could describe how they would manage risks and meet people's needs appropriately. People's care records however did not always provide care workers with sufficient information to enable them to deliver care consistently and in line with professional guidance. People's care plans lacked sufficient information specifically in relation to the support they required, for example, to manage their risk of falling, taking medication, preventing pressure sores and managing their health needs.

People were assured that their care would be delivered. People and relatives told us that calls were never missed and care workers were seldom late.

We found that people had an assessment of their needs and risks to their health and welfare. We spoke with four staff members and found they were caring, respectful and committed. We saw that care plans did not always accurately reflect people's needs or include important information. Care workers did not always have accurate and sufficient information to know how to support people appropriately to ensure their safety and welfare.

The agency had effective staff selection arrangements in place. We found that all the recruitment checks, as required by the agency, had been undertaken prior to staff undertaking their duties.

The agency had arrangements in place to protect people from the risk of abuse. Staff understood the local safeguarding arrangements and knew how to respond to any concerns relating to abuse. We saw that investigations had been undertaken in line with the local safeguarding procedures.

We found that staff had received appropriate induction, training and supervision to ensure that they had the skills to undertake their care tasks competently.

The agency had systems in place to monitor the quality of care provided. A customer survey undertaken in June 2013 showed that most people and their relatives were satisfied with the care. Systems were in place to monitor risks and the agency ensured that they learned from investigations. People we spoke with told us they knew how to complain and we found that the agency took account of complaints to improve the service.