Access Dignity Care Limited Also known as Access Dignity

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked at all quality statements for Caring at this assessment. The service was not always caring. This showed a decline since the last inspection. People’s individual needs and preferences were not consistently well understood, and this was reflected in their care, treatment, and support. Staff did not have sufficient guidance to respond to people’s immediate care needs, to reduce the risk of avoidable distress, pain, or discomfort and instead responded intuitively. Staff could explain how they would support people’s privacy and dignity, and people told us staff were polite, caring and kind. However, people told us their preference for the gender of staff supporting them was not always respected by the provider when organising their care, impacting on their sense of receiving dignified care. People’s aims and ambitions were not recorded by the provider to empower independence, choice, and control. Staff told us they feel well supported by the management team. During our assessment of this key question, we found concerns about person-centred care, which resulted in a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from partners about the consistency of support provided to people, which could impact on people feeling cared for. A professional who works with the service told us, "I have received good contact from the team leaders which has resulted in positive outcomes for the individuals involved, and they appear committed to their roles in providing the best care for the adults they work with and act quickly when things are raised. However, I would like to note, and the care agency is aware, that there have been issues with some of the care workers in relation to communication with the people the work with, also not knowing how to cook meals, spending long times on their phones to write notes in front of the adults."

Staff spoke about people with kindness and respect. However, although the provider and staff came over as motivated to provide a quality caring service, not everyone using the service was receiving this level of care. This meant people received an inconsistent experience. The management team did not always demonstrate an understanding as to how shortfalls such as safeguarding concerns, timing of visits and people not receiving their preferred staff gender did not reflect kindness, empathy and a compassionate approach. This was reflected in areas such as the Christmas newsletter sent out to people, which focused on staff celebrations and bonuses, rather than demonstrating compassion for those who would be alone or find Christmas a difficult time. It also set out at length why people could not have their preferred visit times, showing the provider was unable to meet people’s expectation as stated on its own website: ‘Bespoke care tailored to you.’ The registered manager told us they would review communications going forwards to ensure they were accessible and involved people using the service.

Some people gave positive feedback that staff were caring and kind. One person’s relative said, “[Care staff] don’t rush and they always ask if there is anything else they can do. We are happy with them.” Another person told us, “My carers are lovely and friendly, some of them have become sort of friends.” However, other feedback was not as positive, where people told us their preference for the gender of staff supporting them was not always respected, impacting on their sense of receiving dignified care. A person told us, "When we moved to 1 care worker I never felt properly [supported with personal care] and I had to ask my husband to help [with my personal care] when the care worker had gone. They would send a male care worker and he wasn’t very comfortable, so I think he just used to rush it.”

Staff and leaders did not always know people’s specific care and support needs, including people's aspirations, interests and hobbies. Staff could not always fully explain how to advocate or support people as individuals, for example what specific approach should be taken to help and reassure someone who refused personal care. Whilst the registered manager shared a positive story about staff accompanying a person to attend a country fair in line with their interests and life history, this did not reflect other people's experiences more widely and was inconsistent in approach.

Processes did not support person-centred care. The provider failed to consistently respond to people sharing their individual preferences or requests, including through complaints. Assessments did not take account of people’s individual strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics, and care records reviewed did not evidence people planning or meeting any of their own goals. This demonstrated a task-based approach.

People’s individual needs and preferences were not always considered and reflected in their care, treatment, and support. People reported their clear preferences for a particular staff gender were not respected, which meant care was sometimes provided directly against people's express wishes. A person told us, “I don’t feel comfortable, I don’t want male care workers. I have 1 girl called [staff member] who I really want more of. I feel very vulnerable with the males.” Another person said, “[Access Dignity Care] sent 2 males (care workers) and when we complained they said they would change it, but it happened again.” Another person’s relative told us, “Some of the care workers they send are young boys, the same age as [person’s] grandsons and on one shower day 2 males turned up. That is not acceptable.” However, other people were satisfied with their care team and felt their individual needs were met.

People told us their individual choices and preferences were not always respected. Complaints showed people were not always responded to by office staff when asking for a change to their care workers, even though this was contrary to the provider's own Statement of Purpose. Support for independence and choice was not consistently managed safely, and people were not always supported with informed decision making, placing their wellbeing at risk. We saw a theme of some people refusing care ('self-neglect') rather than accept care in a way contrary to their choice and preferences. A person told us, “I don’t think [Access Dignity Care] are very helpful. I phoned 3 times because the night visit was 10pm at night and it’s too late for us. The office just said they would tell the coordinator, but it didn’t change, and no one ever phoned us back so I would just cancel the evening calls on the day.”

Care plans did not always provide detailed information on how staff were supporting people’s choices or how to seek people's views on their own care. A person's communication care plan stated their family member would advocate for them, but then also stated the person could verbally communicate: 'I do not speak too much due to my current condition; however, I can express how I am feeling if asked closed ended questions.’ This meant staff might not be aware they should seek the person's views before that of their family member.

The management team did not always promote people’s independence, so they knew their rights and had choice and control over their own care, treatment and wellbeing. Feedback from the management team showed focus was on making their own staffing model work, rather than identifying and assessing whether this met the needs of people being supported. However, steps had been taken to try and ensure visit times were better aligned to people’s choices, and this work was ongoing. There was limited awareness or proactive discussion from care workers about supporting independence and achieving goals, as they did not have access to this key information in care plans.

Staff could not always fully explain how they would support people in emergency situations. A care worker we spoke with during the assessment told us they had to seek permission from the office before providing any basic first aid, and we received incorrect information from staff on what they would do in the event of a choking incident. There was limited information to guide staff on how to support people experiencing distress, for example in relation to palliative care, or for a person who experienced 'extreme pain' when moving. This meant staff provided intuitive care rather than following best practice guidance, which led to inconsistency of approach. We raised this with the provider to address and make improvements in this area.

People’s feedback was mixed, but did not show how staff consistently listened to and understood people’s needs, views and wishes. Staff did not always respond to these in the moment to minimise any discomfort, concern or distress. This was further impacted by language barriers. A person told us, “They [Access Dignity Care Limited] sent a man in (care worker); he didn’t speak English and I couldn’t understand him, and he couldn’t understand me.”

Processes were in place to support with staff wellbeing, such as supervisions, bonuses, and care worker awards. Team meetings were held with a view to support care workers and to deliver supportive guidance in areas such as culture, and understanding religious holidays such as Christmas. However, processes for organising care did not put staff in the best position to meet the quality statement, for example in relation to continuity of care. This also included failure by the provider to supply adequate care plans to guide staff, and training lacking in specific areas relating to people’s health care needs.

Feedback showed leaders cared about the well-being of their staff, and were constantly looking at ways to support them, such as having a setup of a person’s home within the office space so they could complete mock care visits, with support and supervision. However, at the time of assessment, where staff were unaware of people’s health conditions and not given clear guidance in providing individualised support, they were not being fully supported to deliver person-centred care. The registered manager told us they were committed to continuous improvement and support for the workforce, and planned to work with the local authority quality team to deliver this.