Background to this inspection
Updated
1 October 2019
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 completed by one inspector, one assistant 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 gather information about people who used the service in order to consult them for feedback.
Inspection activity started on 13 August and ended on 15 August 2019. We visited the office location on 13 and 14 August 2019.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. 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 16 people who used the service and four relatives about their experience of the care provided. We spoke with ten members of staff including the provider, operations manager, care coordinators and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at five 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.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one health and social care professional who worked with the service.
Updated
1 October 2019
About the service
Ana nursing and care services is a domiciliary care agency providing personal care to 110 younger and older adults in their own homes at the time of the inspection. The service is registered to support people with a range of different support needs, these included people who may be living with dementia and those who have physical health needs.
People’s experience of using this service and what we found
Risks were not always suitably assessed and planned for. For example, where people had diabetes and specific dietary requirements there was no guidance in place for staff to follow. There was no guidance in place for staff to follow when people had ‘as and when required medication’ and medication administration records were not always fully completed. This is a breach regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Despite what we found people told us they felt safe. There were enough safely recruited staff to meet people’s needs and people were protected from the risk of cross infection as staff wore personal protective equipment.
Governance systems were not operated effectively to assess, monitor and mitigate people’s risks and the provider did not have suitable oversight of systems in place to monitor assess and improve the quality and safety of the service. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not always provide good outcomes for people due to the inconsistency of staff, however staff told us management were approachable. The nominated individual was aware of their duty of candour and the service engaged people using the service and staff and worked in partnership with others.
People had their needs assessed, however care plans lacked detailed on how to effectively support the person in line with their support needs. Staff received training which they felt enabled them to do their job well. People told us they were supported to eat and drink enough and received access to health care when necessary.
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; however, the policies and systems in the service did not always support this practice.
People did not always receive personalised care that was responsive to their needs this was due to most people not receiving regular carers, so people had to explain to care staff how they liked their care to be delivered on different occasions. People had their communication needs meet and felt able to complain. When a complaint or concern was raised it was investigated. We have made a recommendation about end of life wishes.
People were supported by caring staff who respected their privacy and promoted their independence. People were supported to express their views and be involved in making decisions about their care.
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 28 August 2018) and there were two breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
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 with the 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.