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A1 Nursing & Homecare Agency Limited Good

Inspection Summary

Overall summary & rating


Updated 27 January 2016

This was an announced inspection carried out on 16 and 20 November 2015. 48 hours’ notice of the inspection was given so that the manager would be available at the office to facilitate our inspection. The registered manager was required to leave during the inspection due to unforeseen circumstances, but the care manager was available and facilitated the inspection during both site visits.

A1 Nursing & Homecare Agency Limited is a domiciliary care agency that provides support to adults in their own homes within Wigan and the surrounding areas. At the time of the inspection, 13 people were being supported by the agency. Seven of these people received daily visits by the agency and the remaining six people received intermittent support responsive to their needs. One of the people that was being supported frequently had complex care needs. The agency’s office is located near Wigan town centre.

At our previous inspection on 07 and 12 August 2014, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Suitable arrangements were not in place for the management of medicines. We found that appropriate arrangements were not in place to ensure medication was safely administered to people who used the service, which could have placed them at risk of harm. We also found that an effective system was not in place to regularly assess and monitor the quality of the service provided.

We asked the provider to take action to make improvements in regards to the medicine management and auditing of the service provision. We found at this inspection that this action has been completed. We found medicines and care plans had been written to reflect the medication policy to ensure medication was administered safely. Competency checks were being undertaken quarterly by the registered manger with staff administering medication so that areas of concern could be highlighted and addressed.

We had previously considered the quality assurance system to be ineffective as it didn’t highlight when appraisals or mandatory training was required. In addition, policies and procedures had not been reviewed or updated for some time. We saw that there was now a matrix for care workers to show when they had completed training, competency checks and appraisals. However, policies and procedures were not dated so we were unable to determine whether they had been reviewed or updated to reflect current best practice.

Incidents and accidents were documented and we saw that families were informed and actions had been documented to mitigate risks. A system had been implemented to review the quality of care provided which was achieved through the care manager and registered manager conducting audits.

People had a full assessment of their needs prior to the commencement of the service and the care plans devised following the assessment process were person centred and comprehensive. Care workers demonstrated a commitment to providing person-centred care and demonstrated an excellent understanding of people’s individual needs.

Staff received an induction, basic training and additional specialist training to meet the needs of the person they supported.

Should people lack mental capacity to make specific decisions, the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People’s nutritional needs were identified and being met. Information about health and social care professionals involved with people’s care and treatment was recorded so care workers could access their help if required.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. We reviewed a sample of recruitment records, which demonstrated that staff had been safely and effectively recruited.

Care workers demonstrated a good knowledge of people they supported and provided examples of how they promoted people’s independence and maintained their privacy and dignity when providing support.

Care workers told us that they felt the service was well managed and that the care manager and registered manager were available and approachable. We received positive feedback from people we spoke with about the care provided and this was substantiated further through the feedback seen that had been obtained through satisfaction surveys.

Inspection areas



Updated 27 January 2016

The service was safe.

Risk assessments were in place to ensure people were safe within their home and when they received care and support.

Medication assessments had been undertaken and care plans were in line with service policy. Care workers ensured that people received their medicines as prescribed.

The service had clear policies in place to protect people from abuse, and care workers demonstrated a clear understanding of what to do if safeguarding concerns were identified.

There were enough staff to deliver care safely, and ensure that people’s care calls were covered when staff were absent. When the service employed new staff they followed safe recruitment practices.



Updated 27 January 2016

The service was effective.

Care workers felt supported and were offered regular supervision and appraisals.

People received care from staff that were skilled and trained to deliver care.

People’s social, health and nutritional needs were met.



Updated 27 January 2016

The service was caring.

Care was provided in a caring and respectful way.

People’s rights to privacy, dignity and independence were encouraged and valued by staff.

We observed that staff had a good understanding of people’s care and support needs and their individual preferences.



Updated 27 January 2016

The service was responsive.

Care was personalised and delivered in accordance with people’s preferences and regularly reviewed.

People were aware of the complaints procedure and felt confident that their complaint would be dealt with thoroughly.



Updated 27 January 2016

The service was well led.

There was a new care manager in post who had plans in place to improve the service.

Systems were in place to monitor the quality of the service and action had been taken to make the required improvements.

Staff felt supported and positive about the leadership and management.