9, 10, 11, 14 July 2014
During a routine inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
The inspection was announced 48 hours before we visited.
Agincare Live In Care Services provides care to people in their own homes. They provide live in care staff to support people with personal care needs throughout England. At the time of our inspection there were 170 packages of care being provided to people in their own homes. This number changes weekly. The provider is registered to provide personal care.
At the time of our inspection there had been no registered manager in post since July 2013. The current manager had been managing the service since January 2014. They had submitted an application to become the registered manager in April 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
People’s experience of their care was mixed. While most people and their relatives were very happy, others were not. Most people’s concerns related to times when their regular, or permanent, staff member was on a break.
People’s safety was being compromised in a number of areas. This included how they were protected from the risks of abuse and how possible abuses were identified and responded to. The provider had not notified the Commission about some allegations of abuse in a timely fashion.
Medicines were also not managed in an appropriate way. There were gaps in records and some records did not accurately reflect the medicines that staff were giving people.
Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make a decision. The staff responsible for assessing people’s ability to consent had not received training in the Mental Capacity Act 2005 and were not able to describe how capacity should be assessed.
We found that people’s care needs were assessed, but their care was not always delivered consistently. In some cases, this either put people at risk or meant they were not having their individual care needs met. For example one person wasn’t able to go out for three weeks because the staff weren’t confident to support them with their mobility. Sometimes risks to people’s welfare were not identified as part of their care plan.
Staff were not always trained and supported to provide the care people needed. We found that staff had received induction training but staff did not always get the specialised training they needed around people’s particular needs. This meant they were not always able to provide appropriate care. We found examples of this when people had specialist health care needs and also in end of life care.
Systems in place to monitor the quality of the service were not effective. Staff who undertook assessments, quality monitoring and staff support in the community did not have adequate training to undertake this role effectively and safely.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.