Background to this inspection
Updated
16 January 2020
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
The inspection was carried one inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
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 had a manager registered with the Care Quality Commission. This means that they and 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 we needed to be sure that the registered manager would be in the office to support the inspection. Inspection activity started on 27 November 2019 and ended on 3 December 2019. We visited the office location on 3 December 2019.
What we did before inspection
We reviewed information we had received about the service since the last inspection. 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 and seven relatives about their experience of the care provided. We spoke with six members of staff including the registered manager and care workers.
We reviewed a range of records. This included four people’s care records, and multiple medication records. We looked at three 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.
Updated
16 January 2020
About the service
Abbey Nursing and Care agency is a domiciliary care agency providing care to people living in their own homes, so they can live as independently as possible. At the time of our inspection the service was supporting 36 people with personal care.
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
People’s medicines were not always managed safely. One person had not always received their medicine as prescribed, and medication administration records were not always completed accurately in line with national guidelines. Medication audits had not identified concerns with people’s medicines.
The provider could not demonstrate that all care workers had completed training which enabled them to meet people's care needs in a safe manner.
Audits and checks were in pace; however, these were not always effective at identifying concerns. There was a lack of robust oversight with aspects of the service. The provider has been in breach of regulation 17 (good governance) three consecutive occasions, which demonstrates a lack of continuous improvement and effective leadership.
People were involved in the development of their care plans and relatives were involved where this was appropriate. The plans generally contained person-centred information. However, some staff told us they did not always have time to read people’s care plans. Staff told us they got to know people during visits to their home and delivered care in line with their preferences. People and relatives told us staff generally knew people well, but there were concerns raised about newer members of staff not knowing people as well. People told us this did not impact on their level of care as newer staff were generally accompanied by more experienced staff on care calls.
Risks to people were assessed, and appropriate plans were in place to keep people safe. One person did not have a plan in place regarding a specific medical condition, but the registered manager made arrangements to complete this immediately. However, there were no systems in place to effectively analyse incidents to ensure learning could be implemented to prevent reoccurrence.
There was some mixed feedback from staff about the management of the service. Some staff felt the management team were not supportive and communication needed to improve.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
There were enough staff to meet people's needs. There were some concerns raised by staff and relatives regarding staffing levels, but the registered manager told us they had halted new packages of care until recruitment had been completed. People told us they had good relationships with the staff that supported them. People were treated with dignity and respect. Staff supported people to be as independent as possible and express their views about the service and their care.
People told us they felt safe with the care provided by Abbey Nursing and Care Agency.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 5 December 2018).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
At this inspection we have identified breaches in relation to the management of medicines, staff training and good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet 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. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.