Agincare UK Christchurch

The service is registered to provide personal care to people living in their own homes. At the time of our inspection the service was providing personal care to 125 people.

This 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 people with dementia. Not everyone using Agincare Christchurch receives a regulated activity; 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.

Agincare Christchurch office is situated on the outskirts of Christchurch. It provides support to people living in the Bournemouth and Christchurch areas.

There was no registered manager in post at the time of inspection. However the acting manager was in the process of applying to CQC to become the 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

People were protected from the risks of abuse because staff understood how to report any potential concerns. People were supported by familiar, consistent staff where possible and staff knew people well and understood the risks they faced and how to manage these. Accidents and incidents were reported, recorded and learning shared with staff. People received their medication safely and this was recorded accurately to reduce likelihood of errors.

People were involved in pre-admission assessments which identified their physical, religious, emotional and mental health needs to ensure that these could be effectively met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink. Staff received regular support through supervision and had access to relevant training opportunities to provide them with the correct skills and knowledge for their role.

People were supported by staff who were kind and caring. Staff were able to communicate with people in ways which were meaningful for them. Some staff did not speak English as a first language. The acting manager told us that they would speak with their manager about sourcing English courses or training for staff struggling with communication to ensure that this did not impact on people. People were offered choices about their care and treatment. They were supported with respect by staff who protected people’s dignity and promoted their independence.

People’s care records showed their support was reviewed regularly and was responsive to changing needs. People and relatives were aware about how to raise concerns if needed and felt that these would be listened and responded to. Any advance medical decisions were recorded and discussions around people’s end of life preferences and wishes were recorded.

Feedback from people, relatives and staff was sought through surveys and monitoring phone calls. Quality assurance measures were used to identify any gaps or trends to continually improve the service people received. Staff understood their roles and responsibilities and felt supported in their roles.

Further information is in the detailed findings below.

We inspected this service on the 4 and 10 August 2016 and the inspection was announced. When we last inspected in February 2014 we found that the service did not have appropriate arrangements always in place in relation to the recording and handling of medicines. Planning of people’s visit schedules did not always take account of their views and preferences with regards to continuity and visit times. People were not being kept informed of changes to their visits. Records relating to contact with people who used the service and their representatives by telephone were not appropriately maintained. We asked the provider to take actions and at this inspection we found that improvements had been made.

The service provides personal care to older people living in their own homes. At the time of our inspection there were 153 people receiving a service from the agency. The service has 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 felt safe and were supported by staff who had undertaken safeguarding training and understood how to recognise potential signs of abuse and the actions they needed to take. Staff were not aware of external agencies they could report concerns to in addition their own managers. We discussed this with the registered manager who told us they would ensure that all staff were given contact information for the local authority and CQC.

Potential risks to people had been identified and actions put in place to minimise the risk. People were involved in decisions about how risks they lived with were managed, ensuring their rights to freedom and choices. Risks had been assessed for home safety, moving and handling, skin integrity, health conditions and eating and drinking. Some people had been assessed as requiring bed rails. A risk assessment to determine a person’s suitability for bed rails had not been completed. During the inspection these were being completed.

People were supported by enough staff to meet their agreed needs. Most people we spoke with told us that staff were punctual, attentive and conscientious. They told us that if a carer was likely to be late they normally received a call from the office. Staff. had been recruited safely which included obtaining an employment history, references and a criminal record check. Policies and procedures were in place to manage any unsafe practice. .

People had their medicines administered by staff who had been trained and had their competencies regularly checked by senior staff. However, some people had topical creams administered by care workers. We found that occasionally care workers had not signed to confirm whether this had been administered. Auditing and staff supervisions had improved the recording but the registered manager recognised further improvements were required. All other medicines had been recorded appropriately.

Staff received an induction and on-going training that enabled them to effectively carry out their roles. This included safeguarding, dementia awareness, infection control and moving and handling as well as training specific to the people care staff were supporting. Opportunities were available for staff to take further training such as diplomas in health and social care and leadership training. Staff felt supported and received regular supervision which included unannounced spot checks when supporting people in their own homes.

Staff understood how to support people to make their own decisions. When people lacked mental capacity to take particular decisions any made on their behalf included people who knew them and were made in the person’s best interest.

People were supported with their eating and drinking requirements by care workers who understood their needs and any associated risks. People were supported with accessing healthcare. We saw that this included GP’s, district nurses and occupational therapists.

People were mainly supported by staff who knew them. Staff had a good understanding of people’s interests, likes and dislikes. This meant that staff could have conversations with people about things that were important and of interest to them. Some people had health conditions that affected their communication and cognitive skills and care workers had found ways for effectively communicate with them ensuring they were involved in decisions about their care. Staff understood actions they needed to take to ensure a person’s dignity and privacy was respected.

People were supported by staff who understood and were responsive to people’s individual and changing care needs. Care plans provided clear information about the care a person had agreed and reviews were held at least six monthly and included the person and often family members.

A complaints process was in place and people felt it was effective. This meant that people were being listened to and actions were being taken to ensure positive outcomes for people.

People, their relatives and staff described the service as well led. Staff spoke positively about the management of the service and the teamwork and were supported in their roles. They felt able to share their views and that they would be listened too. They had a good knowledge of their roles and responsibilities and the level of decision making appropriate to their job.

The Manager had a good understanding of her responsibilities for sharing information with CQC and other regulatory agencies. Audits had been completed by the management team and had been effective in providing data about practice and service quality and driving positive change and improvements to the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service were not always protected against the risks associated with medicines. Although procedures were in place to support the safe handling of medicines, we found that these were not always followed. Information about people's needs in relation to their medicines was also not always accurate or up to date. Staff had not always been assessed as competent before giving people their medicines in line with the agency's policy. This put people at risk of not receiving their medicines in a safe way.

The agency had not always responded appropriately to incidents that had occurred within the service. Improvements were needed to ensure that there was a robust response to incidents and people's safety was promoted.

We have set compliance actions in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

Most people told us they were very satisfied with the care they received and felt their needs were met, especially where they received support from regular care workers. For example, one person told us, "They've always done what I've needed", while another person said, "They are always there when we need them."

We found that people had care plans which contained information about their needs and how they should be met. Most people we spoke with told us that staff followed their care plans and carried out their personal care in a way that suited them. This helped ensure that people's independence and rights were promoted.

People were not always informed about changes to their care visits. Some people told us that their care workers arrived later than planned or a different care worker would come to the one they were expecting. They told us they were not always consulted or informed about these changes which made them feel frustrated and anxious.

Although some people received visits from regular care workers at regular times, other people told us they did not receive the continuity of care they wanted. For example, one relative whose family member had dementia, told us that they received visits from a number of different care workers at variable times. This did not help establish a routine for the person concerned and did not promote continuity of care.

We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People were treated with respect and dignity by their care workers. Most people told us that care workers were kind, cheerful and respectful towards them. For example, one person told us, "The carers are very respectful and helpful. They do bend over backwards for me if they can. I'm a satisfied customer." Another person said, "Every single one of them is good. They are cheerful and friendly. It's like having an extra friend. I enjoy their company."

We spoke with four care workers who were responsible for providing people's care, all of whom showed a genuine commitment to giving people the best support they could. They told us they enjoyed their work and enjoyed supporting people in the community.

Is the service responsive?

People told us that their care workers responded to their needs each day and offered them choices about their care. They also told us that staff worked in a flexible way, giving them help with additional tasks where they could. This helped ensure that people's support was tailored to their individual needs.

People told us that their care workers noted any changes to their health and responded appropriately, for example, by getting in touch with health care professionals on their behalf when required. We found there were systems in place to ensure that staff were able to report concerns about people's welfare and take action where necessary.

The agency did not always respond effectively to comments and concerns from people who used the service. We found that complaints and concerns were not always recorded, or followed up, appropriately in line with the agency's complaints procedure. This meant that people did not always feel the agency was listening to them or taking action to resolve their concerns. For example, one person told us, "If you have to 'phone about a problem'they never sort it out. It just falls on deaf ears. It feels like the office don't give us priority and we are not important enough to them.' Another person told us, 'I have complained many a time. It doesn't make a difference." Improvements were needed to ensure that people's comments and concerns were managed appropriately and the agency's complaints procedure was followed consistently.

We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The agency had a manager who was registered with the Care Quality Commission which helped provide clear lines of accountability within the service.

We found there were systems in place to promote communication between the registered manager and care staff. This helped ensure that staff received the information they needed to carry out their work. It also ensured that staff were able to express their views and influence the service. Staff knew who to go to if they needed support or advice and told us that their managers were approachable and accessible. They also told us that the manager and office staff listened to their suggestions and worked with them to make improvements for the benefit of people who used the service.

There were some systems in place to monitor the quality of the service. For example, the agency carried out an annual survey of people who used the service. This enabled them to obtain people's views and assess where they were performing well and where improvements were needed. We also saw that the agency monitored staff performance by carrying out observations of their practice and checks on their records.

During our inspection, however, we found examples of the agency's policies not being followed appropriately. This resulted in complaints and incidents not always being managed effectively to reduce risks and improve the service. Improvements were needed to ensure that the organisation's policies and procedures were implemented in a consistent and robust way.

We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Our inspection visit took place over two days. On the first day we looked at documentation such as care plans, visit schedules, policies and procedures, training records, staff records,surveys and audit material. We also met with care workers to obtain their views about their work.

On the second day we accompanied the manager to the homes of five people we had randomly selected to visit. This was to see if care workers arrived on time, observe the support people received where this was appropriate, talk with people or their relatives about their experiences of the service and talk with care workers.

We sent out 58 questionnaires to people who used the service and 15 were returned by individuals and/or their relatives.

All but one of the people using the service or their relatives told us they received all the help and support they wanted. They said care workers treated them with respect, were prompt and had the competence to meet their needs.

There were arrangements in place that ensured people were helped to manage their medication safely.

The provider had taken steps to ensure that there were sufficient numbers of staff and that they were appropriately supported to care for people safely.

People were not always protected against the risk of unsafe or inappropriate care because records were not always accurate and up to date.