Andersen Care Agency

Andersen Care Agency is a domiciliary care service providing personal care in people’s own homes. At the time of our inspection there were 17 people using the service. The service was supporting older people and adults with physical disabilities.

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

We found there were shortfalls with how risks which some people faced were assessed, managed and planned for. Certain high risks were not identified and fully explored. Staff did not have robust care plans to guide their practice and promote people’s safety. The provider did not effectively assess this aspect of the service they provided. Improvements were required with how they assessed and managed high risks.

The providers audits did not identify the issues we found in relation to the planning and management of people’s medicines, how incidents were responded to, and how staff and managers evidenced the quality checks they completed. Improvements were needed in how the provider assessed these aspects of their service.

The registered manager was open to all of this feedback and told us they would make these improvements.

Despite these findings, we found there was a positive culture at the service and people received a person-centred care experience. People’s relatives said their relatives were safe and well cared for. One person’s relative said “She [relative] is quite happy, their regular carer makes her laugh.” Another person’s relative said, “[Name of relative] is 100 per cent safe and happy. Their main carer is fantastic, [name of carer] is brilliant.”

People received care visits at times they were happy with and saw a regular group of care staff. New staff were introduced to them and spent time getting to know them with a more experienced member of staff before they visited alone.

Relatives reported how respectful, polite, and caring staff were to their loved ones. One person’s relative said, “They [care staff] are chatty and kind, [name of carer] dances with him, [name of another carer] shares the football news.”

Staff told us they spent time with people and were not under pressure to rush about to the next care visit. If they needed to stay longer, they did and reported this to the office. The managers celebrated people’s birthdays with a cake, card, and a visit from them and the person's main carer.

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; the policies and systems in the service supported this practice.

At the time of the inspection, Andersen Care Agency did not support anyone with a learning disability or an autistic person. We assessed the care provision under Right Support, Right Care, Right Culture, as the service is registered as a specialist service for this population group. The registered manager had arranged training for themselves to assist them to make plans to fulfil ‘Right Support, Right Care, Right Culture’ if they supported anyone with a learning disability or autism in the future.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published on 24 November 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding which had not been inspected for some time.

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 good to requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified 2 breaches in relation to how the provider assessed the quality of the service, with risk management, medicines support.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in May 2016 the service was rated ‘Good’. We did, however, have concerns about how risks were being managed at the service. We identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the service was now meeting the regulation and it remained rated as ‘Good’.

Andersen Care Agency provides support and personal care to people living in their own homes. There were approximately 40 people using the service at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they were well treated by the staff, felt safe with them and trusted them.

Staff knew how to recognise and report abuse and they understood their responsibilities in keeping people safe. Staff understood that people were at risk of discrimination and knew that people must be treated with respect. Staff understood that there were laws to protect people from discrimination.

Where any risks to people’s safety had been identified ways to mitigate these risks had been discussed with the person and recorded so staff knew how to support the person safely.

The provider followed appropriate recruitment procedures to make sure that only suitable staff were employed.

There were systems in place to ensure people were supported with their medicines safely and appropriately.

People who used the service and their relatives were positive about the staff and told us they had confidence in their abilities. Staff were provided with the training they required in order to support people effectively.

Staff offered choices to people as they were supporting them and people told us they felt involved in making decisions about their care.

People confirmed that they were involved as much as they wanted to be in the planning of their care and support. Care plans included the views of people using the service and their relatives. Relatives told us they were kept up to date about any changes by the management of the service.

The management and staff were quick to respond to any changes in people’s needs and care plans reflected people’s current needs and preferences.

People told us they had no complaints about the service but said they felt able to raise any concerns without worry.

The provider had a number of quality monitoring systems including regular surveys for people using the service and their relatives. People we spoke with confirmed that they were asked about the quality of the service and had made comments about this.

Staff were positive about the management and told us they appreciated the clear guidance and support they received.

Andersen Care Agency provides personal care and support to people living in their own homes or within supported living schemes. There were approximately 60 people using the service at the time of the inspection.

The service was last inspected on 3 December 2013 and was meeting all the standards that we looked at.

The service had a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Each person using the service had a care plan which included information about the person and how they wished to be supported. Health, safety and environmental risk assessments had been completed which highlighted potential risks and how those risks could be mitigated. As part of the pre-service assessment, personal and individual risks were identified but the service did not complete an assessment of those identified risks such as risks associated with choking or pressure sores.

Incident and accident records were kept as part of that person’s care plan. The registered manager did not have an overview of all accidents and incidents that had occurred across the service so as to be able to monitor any patterns or trends.

People and relatives that we spoke with were happy with the care that they received. They received regular and consistent staff who were caring and ensured that their privacy and dignity was maintained at all times.

People told us that they felt safe in the presence of the care staff that supported them. Care staff demonstrated a good understanding of safeguarding and what this meant in order to ensure people were protected from abuse. They knew who to report abuse to and were confident that management would take immediate action.

Care plans had been signed either by the person using the service or their relative. People and relatives told us that they were involved in the planning of their care and also confirmed that the service regularly reviewed their care package with them.

People and relatives told us that they were allocated a main carer who supported them on a regular basis with a bank of carers who would cover the calls when the main carer was off on leave or was unable to work due to sickness.

People and relatives told us that they felt staff were adequately trained and had the ability and skills to provide good and effective care. Staff also told us that they received training prior to starting work as well as on-going training as part of their personal development.

The service had recruitment process in place which ensured that only suitable staff were employed.

The service had policies and procedures in relation to the MCA. The registered manager, senior staff members and care staff had a good understanding of the MCA and that they should always presume that people have the capacity to make decisions.

People and relatives told us that they did not have any complaints about the service. They knew who the registered manager was and felt confident to report any concerns or issues they may have. People and relatives were also confident that their concerns and issues would be dealt with promptly.

The registered manager had systems in place to monitor and check the quality of care being provided. This included spot checks, care worker’s work place assessments and weekly monitoring of late and missed visits. However, where care worker work place assessments had been completed and staff had been rated poorly in a particular area, there was no record of what action had been taken in order to improve care practises.

People and relatives were asked to complete six monthly quality questionnaires to obtain their feedback on the service that they received and if there were any improvements to be made. People and relatives confirmed that they regularly completed these questionnaires but in addition the care co-ordinators also maintained regular contact with them through the telephone and home visits to ensure that they were happy with the care they were receiving.

The service kept records of people’s birthdays and organised parties where the office team and the regular carers would take a cake, balloons and gifts to celebrate the person’s birthday.

We have made one recommendation in relation to the registered manager creating an overview of incidents and accidents.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to assessing risks associated to people’s care and support needs. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three people who used the service and three relatives. The majority were very positive about staff members' approach and a social worker told us that staff were very good at 'engaging [with] and enabling [people who used the service]'. We saw that people's needs were assessed and care plans were drawn up based on those needs. Risk assessments needed further development.

All staff had undertaken safeguarding training as part of their induction. They described the agency's managers as 'supportive and 'helpful'. We saw that everyone who used the service or their relative was given the opportunity to complete a regular questionnaire about the quality of the care provided.

There was evidence people were provided with information on their care and their views and experiences were taken into account in the way the service was provided.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider had a safeguarding policy in place and staff were aware of their responsibilities.

We found that staff were able, from time to time, to obtain further relevant qualifications. In the staff files we looked at we saw evidence staff had received appropriate training.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.