Archived: Access Homecare Ltd

Updated 16 November 2019

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

This inspection was carried out by one inspector.

Service and service type

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

The service did not have a manager registered with the Care Quality Commission. This means that 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 manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. However, we did not receive any responses. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service about their experience of the care provided. We also visited two people in their own home. We spoke with the acting manager and five other members of staff. The provider was not available to speak to at the time of the inspection.

We reviewed a range of records. This included six people’s care records and one person’s medication record. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification to validate evidence found. We looked at training data and communication records. The provider was out of the country at the time of the inspection. However, after the inspection we spoke with them on the telephone.

Updated 16 November 2019

About the service

Access Homecare is a domiciliary care agency. At the time of the inspection, the service was providing personal care to 24 people. This included older, younger adults, people living with dementia and people with a physical or learning disability. 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 feedback we received about the service was mixed. People told us about times when calls were missed, staff left calls early and their home had not been left clean and tidy after staff had visited them. However, other people were positive about the service they received. One person said, “There is nothing I think they need to improve on, it’s all okay and all works fine.”

Whilst there was enough staff to cover care calls, staff were stretched and the office staff were undertaking a considerable number of care calls. This included the acting manager and had an impact on the time they had to improve the service. Staff told us that they did not always have the time they needed between calls and were in a rush to get to the next call at times. Some people told us that they were unhappy about this.

Medicines were not well managed. There was a lack of information about people’s medicines such as what they took and what the medicines were for. Medicine records had not been checked to make sure medicines had been given as prescribed.

Risks to people’s health and wellbeing had not always been fully assessed. People were at risk of harm because staff did not always have the information they needed to support people safely. There was a lack of personalised information about people’s health conditions and how to identify if they were becoming unwell.

Incidents and accidents were recorded. However, these records were not easily identifiable as they were logged on a computer system alongside other communication records. Where incidents had happened, actions had not always been recorded. Incidents had not been analysed for trends and lessons had not always been learned when things went wrong. Systems to check the quality of the service were not robust. Audits were not completed or had not been acted upon and used to improve the quality of care.

The provider had not always treated people with respect as they had failed to maintain the quality of the service. The provider was not able to demonstrate that people were supported to have maximum choice and control of their lives. There was a lack of evidence that staff supported people in the least restrictive way possible and in their best interests. There were no records of decisions being made in people’s best interests. There was a lack of information relating to people’s capacity to make a decision or that they had given the legal authority for other people to make decisions for them.

Care plans did not always include detailed information about how people wanted to be supported including at the end of their life. There was a lack of information about people’s preferences, life history and background. Staff had not considered people’s communication needs to ensure that information was provided in an accessible format.

People told us that they knew how to complain if they needed to do so. However, complaints were not recorded in an accessible way. We made a recommendation about this. People did not always feel listened to by the staff and management and their feedback through surveys had not been acted upon.

Staff had not always received appropriate training. Some staff had not completed up to date training on safeguarding and the mental capacity act and were not knowledgeable of confident when talking about these subjects. However, the acting manager and provider had started to address this at the time of the inspection.

Staff had access to the equipment they needed to prevent the spread of infection, such as gloves and aprons. People told us that staff used these when providing care.

People received access to healthcare professionals when they needed this support.

People were receiving adequate support with eating and drinking.

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

Rating at last inspection

This service was registered with us on 27/06/2018 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

Enforcement:

We have identified breaches of the Regulations in relation to safe care and treatment, the safe recruitment of staff, the management and oversight of the service, personalised care and consent to care and treatment.

We planned to take action against the provider to impose conditions on the service. However, the provider took the decision to close the service and the service is no longer registered with CQC..

Follow up

We met with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. The provider took the decision to close the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.