Archived: Annette's Care Limited Domiciliary

The service is also registered with the commission to provide care to people housed under supported living arrangements. However, at the time of the inspection, the agency was not supporting anyone under this arrangement.

Rating at last inspection: Requires improvement (6 March 2018)

At the last inspection we found the provider had not always acted to keep people safe. People’s medicines were not always managed safely. The provider had not always assured themselves new staff were suitable to work with vulnerable people. The provider had not ensured systems and processes were in place to monitor the quality of the service and staff practice. Concerns raised or identified had not always been used to improve the service. The provider had failed to notify us of all significant events in line with their legal obligations.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of ‘safe’ and ‘well led’ to at least good. The provider assured us they had already put processes in place to ensure improvements were made.

Why we inspected: Concerns about the service had been raised with us by whistle-blowers, people and relatives, so we decided to inspect the service earlier than required. The concerns included staff providing care to people before checks had been completed to ensure they were safe to work with vulnerable adults; staff providing care who had not received appropriate training; people not receiving their calls at the correct time or for the correct amount of time, or calls being missed without notice; records being falsified; people who need the support of two staff members to move safely, receiving support from only one member of staff; and staff not ensuring people’s medicines and health needs were met.

People’s experience of using this service:

• People did not receive a service they could be assured was safe.

• People received care from staff who had not all been trained appropriately.

• People’s needs were not assessed promptly when they started to use the service. People did not all have records in place that described how they wanted and needed to receive their care.

• The providers were not always open and honest. They had assured us all staff providing care had been recruited safely and trained appropriately. This was not always the case.

• The providers were not up to date with best practice and were not aware of all regulations and legal requirements.

• The providers had not checked the quality of the service effectively.

• New people continued to be accepted to the service even though the providers were having to cover care visits and some people did not have care plans in place.

• Staff did not always feel supported in the role.

• Staff cared for people. People felt staff kept them safe and were responsive to their needs.

More information is in the full report.

We asked the provider to ensure that no staff who had not been recruited safely were enabled to support people. We also reported our concerns to the local safeguarding authority.

Enforcement: We found breaches of regulation. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

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

The service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger adults who may have a physical or learning disability or a mental health need.

The service is also registered with the commission to provide care to people housed under supported living arrangements. However at the time of the inspection, the agency was not supporting anyone under this arrangement.

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. At the time of this inspection, all people supported by the service were being provided with personal care.

The service is newly registered with the commission and this was its first inspection. However, the provider had operated the same service from a different office location previously. New services are required to be inspected within 12 months of their registration. However, concerns had been raised with the commission regarding the service so we decided to inspect the service earlier than required. The concerns included staff understanding and recording of medication, one staff attending a call when two were required, missed calls, length and time of calls, infection control, unsafe manual handling and not informing relevant agencies safeguarding concerns promptly.

During this inspection we found that, as a result of the concerns raised, some improvements had been made regarding medicines management and updated staff’s manual handling training. People told us they were happy with call times and the right number of staff attended. They also reported staff followed used correct protective equipment to protect them from infection. However, we found improvements were still required regarding alerting relevant agencies to safeguarding concerns and medicines management.

A registered manager, who was also the owner, ran the service. 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 told us they received their medicines as prescribed, however when people were prescribed creams, there were no records to show where they were to be applied or to show whether they had been applied.

The registered manager had not taken action to ensure they had an overview of the quality of the service and made improvements where required. They had not kept up to date with relevant regulations and best practice. They had delegated responsibilities for the day to day running of the service to other staff members; however, they did not monitor the work done by these staff members to ensure it was of a satisfactory standard. They had not completed any audits of the service to assure themselves of the quality of the service. When they had completed spot checks of staff care work, they had not recorded any reasons for negative outcomes or actions taken as a result. The provider had not always notified the Commission of significant events in line with their legal obligations.

Recruitment procedures had recently been updated but new staff had been able to support vulnerable adults before the provider had assured themselves they were safe to do so. There were risk assessments in place to help reduce any risks related to people’s care and support needs. However, when people received support with their shopping, there was no risk assessment in place detailing staff responsibility regarding people’s finances.

Staff induction and training were in the process of being updated to ensure they met the needs of the service. However, there was no evidence the registered manager had assessed new staff members as competent to provide care and support or administer medicines, before they supported people alone.

Action was taken following incidents or safeguarding concerns being raised, however, professionals told us they felt these concerns could have been avoided if the service was more proactive in identifying and acting on gaps in quality or potential problems more swiftly.

People told us they felt safe using the service. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. People told us the correct number of staff attended their calls, on time and for the right amount of time.

Staff had received mental capacity act training and were aware of the need to act in people’s best interests. However, the registered manager needed to ensure people’s mental capacity was assessed, when appropriate. People confirmed staff requested their consent before providing care.

People received support from staff who knew them well and people’s care plans reflected their wishes, need and preferences. However, people had not always been asked about their preferences for care at the end of their life.

We have made recommendations about complying with the requirements of the Mental Capacity Act 2005 (MCA) and about requesting and recording people’s wishes for the end of their life.

People and their relatives spoke highly of the staff and the support provided. Comments included, “They are so kind and caring. My wife looks forward to seeing them” People were supported by staff who talked about them with fondness and were aware of the importance of supporting people’s wellbeing. People’s diverse needs were respected and met.

Staff told us they felt supported by the management team and people confirmed they had good communication with the registered manager and the office. People and staff felt any concerns they raised were dealt with. Feedback was sought informally and via annual questionnaires from people who used the service.

Further information is in the detailed findings below.

We found three breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.