Anco Care Limited

Updated 9 August 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 26 June 2023 when we made phone calls to people and relatives of people who used the service. We visited the location’s office on 27 June 2023 and reviewed documents remotely afterwards.

What we did before the 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 (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 1 person and 2 relatives of people who received support for feedback on their experience of the care provided. We spoke with the registered manager, manager and 4 staff. We also received email feedback from 8 care staff. We reviewed a range of records. This included 4 people’s care records and medicine records. We looked at 2 files in relation to staff recruitment and support. We looked at a variety of records relating to the management of the service.

Updated 9 August 2023

About the service

Anco Care Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 4 people using the service.

People’s experience of using this service and what we found

This service has been rated inadequate in well-led on 5 occasions since 2019. The provider has not been able to implement, embed and sustain effective governance and oversight of the service. We found continued concerns about the quality of systems and records. The provider could not assure themselves people received safe care due to the lack of effective processes in place.

Quality assurance audits remained ineffective at identifying and driving improvement. This included in areas such as medicines, accident and incident recording and safeguarding processes, all of which potentially impacted upon people's safe care and treatment.

Not enough improvement in people's care records including risk assessments, care plans and mental capacity assessments had been made. There remained gaps, inconsistencies and unassessed areas of known risk. There was no overall service improvement plan to set out the actions identified and underway to make, embed and sustain improvements.

Medicines processes remained unsafe. Recording of medicines administration was inaccurate. There was no guidance to support staff safely administer some 'as needed' medicines. Medicines audits did not identify any concerns.

Not all known risks were identified or assessed. Concerns with risk assessments were found in the last 5 inspections and remained ongoing.

Accidents and incidents were not always recorded. Due to this the provider could not assure themselves appropriate actions were always taken, including learning lessons to reduce the risk of recurrence. Safeguarding referrals were not always made when required.

People's eating and drinking needs were not always assessed or accurately recorded. This included when people were at heightened risk of choking and required physical assistance with eating and drinking.

When people's capacity fluctuated, processes to assess their capacity and make decisions in their best interests were not effective. Issues identified at the last inspection had not been fully rectified in this area. People remained at risk of having decisions made which were not in their best interests or in line with their wishes.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

There was no easy reference system to check whether staff training was in date, and the chart showing staff training contained gaps. People were potentially receiving care from staff who did not have all required training.

Care plans did not contain sufficient detail to guide staff in people's routines, needs and preferences.

People and relatives felt safe care was provided. Safe recruitment processes were followed. Staff were reliable. Staff used personal protective equipment (PPE) to reduce the risk of any infection spread.

Staff told us they received an induction and feedback confirmed people and relatives felt staff were competent in their roles.

People and relatives told us they were involved in making decisions about their care. People received support from staff who were caring, kind and attentive. People's privacy and dignity was respected, and their independence was promoted.

The provider and staff worked with health and social care professionals to ensure people received timely health care and support.

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 and there were breaches of regulation in the areas of people’s safe care and management oversight. We issued a Warning Notice to give the provider a short timescale to make improvements. Due to repeated ratings of requires improvement, the service was placed in Special Measures.

At this inspection we found the provider remained in breach of regulations in relation to people receiving safe care and treatment. We also found a continued breach in provider oversight of the service.

Why we inspected

We undertook this focused inspection to check whether they had met the Warning Notice in relation to management oversight and the Requirement Notice about people’s safe care.

We inspected and found there was a continued concern with mental capacity assessments and staff having access to sufficient information to ensure people were fully involved in decision making. We widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective, caring and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anco Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to people receiving safe care and management oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Following the inspection the provider submitted an action plan outlining planned improvements.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.