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A1 Nursing & Homecare Agency Limited Good

Reports


Inspection carried out on 16 & 20 November 2015

During a routine inspection

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 carried out on 7 & 12 August 2014

During a routine inspection

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 carried out on 30 January 2014

During a routine inspection

During this inspection we reviewed the remaining two outcomes that the provider had not been compliant with at the inspection conducted in May 2013. We found that the service was now compliant in the regulations as detailed in the body of this report

The manager had now completed their application to be registered for the service and this had been confirmed for the personal care element of care provided and there was now a nominated individual in post.

Inspection carried out on 26 September 2013

During a routine inspection

During this inspection we reviewed two of the outcomes that the provider had not been compliant with at the last inspection. We will inspect again to check compliance with the remaining two outcomes after the target date for their compliance has been reached.

We found that the manager for the service has not yet fully completed their application to be registered for the service but we were informed that it is still their intention to do so.

Inspection carried out on 2, 21 May 2013

During an inspection to make sure that the improvements required had been made

We spoke with two relatives' of service users, three service users and two members of staff who provided a variety of comments.

One person told us that '' the carers are o.k. they turn up on time and they look after me. I have no concerns.'' Another person said that they were well looked after and they had no problems, although sometimes the carers were late due to traffic. If they had a problem they would phone the office but did not know who else they could contact.

One staff member told us that the care plans were good documents to use. We noted that staff were now receiving regular supervision of their work. However, this practice should also be available to senior members of staff. Regular supervision provides a good way to support staff in their job role.

The monthly meetings between the provider and the office staff had continued.

We noted that the service does not currently have a Nominated Individual and the provider told us that they will address this issue. The manager in post is making an application to be registered.

Inspection carried out on 1, 16 November 2012

During a routine inspection

We spoke with four relatives' of service users, one service user and four members of staff.

Overall, their comments were positive. They used words to describe the service such as ''The staff are polite and the care seems good'' and '' The staff turn up on time''. We asked people if they felt that there was anything they would change about the service. We were told that ''The support from the office could be better''.

One staff member told us that they had sufficient time to meet the needs of the service users that they supported. We noted that staff were not receiving regular supervision of their work. Regular supervision provides a good way to support staff in their job role. The provider acknowledged that some areas of supervision and monitoring had lapsed, however they were already taking action to address these shortfalls.

Another member of staff told us that there were monthly meetings between the provider and the office staff. The provider told us that they acknowledged the fact that some areas of monitoring and reviewing had lapsed due to staff shortages. For example, the three monthly 'spot checks' of observing staff at work providing care, but they were taking actions to address this such as the current review of the service users assessed needs.

The service had vacancies for staff necessary for the management of this service including a manager and a care co ordinator.

Inspection carried out on 4 August 2011

During a routine inspection

“They look after my mother very well, always very caring and respectful”.

“I can trust them when I am not there; I know my son is in safe hands”.

“The carers are brilliant, I have every confidence in leaving my son in their care, and they have been a god send”.

“They have been wonderful, the information the agency gave me was very detailed and explained everything “.