Archived: AMG Nursing and Care Services

The service had 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 2008 and associated Regulations about how the service is run.

During the inspection, staff within the office were welcoming and friendly. All information we requested was supplied in a timely manner and records were comprehensive. People who use the service and staff all spoke very positively about the service. Comments included, “I rarely need to contact the office as I have regular staff and calls” and “[Name] is brilliant, they deserve an award. Completes all required tasks with a cheerful attitude”.

Staff had built up positive relationships with people and this was confirmed through conversations when people were visited in their homes. People said they felt well cared for and that they really mattered. One person said, “The staff are well trained and do all we need” and “The carers [staff] are all well trained and I look forward to and enjoy their visits”.

People told us they felt safe. All staff undertook annual training on safeguarding adults from abuse, and put their knowledge into practice. Where staff had raised alerts the service managed the concerns promptly and where required, conducted thorough investigations to protect people. The service had thorough recruitment practices which protected people. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People were supported by staff teams that received training that reflected people’s individual needs. Bespoke training was arranged for staff when working with any person that had specific care needs. Staff put their training into practice and delivered good care.

People were involved in the assessment process and were encouraged to say how they would like to be supported. People’s preferences were sought and respected. People told us staff provided consistent care and support. Staff responded quickly to people’s changing needs and these were communicated to those that needed to know.

People’s risk assessments were person centred and specific to their individual needs. Staff managed risks effectively and actively supported people’s decisions, so they had as much control and independence as possible. Risks were regularly reviewed and updated promptly following any change.

People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily. There had been one complaint received within the last twelve months and this had been appropriately investigated and responded to. People said they were confident any concerns or complaints would be listened to and addressed.

Staff described the management as approachable, always willing to listen and honest. Staff were motivated about their roles and talked positively about the service and people they supported. They said they were encouraged to undertake training to progress and strive for career development.

New quality assurance systems had recently been put in place following the introduction of the field supervisor. The field supervisor role is to support and monitor staff working in the community. They regularly visit people using the service to monitor the care and support they have received. Some evidence was seen that actions had been highlighted and addressed for areas requiring improvement and development. The new changes had been made to help ensure the service moved forward and continually improved.

As part of this inspection we spoke with five people using the service, three relatives, four members of staff and the registered manager. We visited the homes of some people and spoke to others by telephone. We reviewed records relating to staff training and supervision, complaints, care files, quality audits and retention of records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. Care had been planned for each person after risk assessments had been completed. These included environmental and health risks. People who used the service and their relatives had discussed their needs with a senior member of staff who planned their care in consultation with them. Carers knew what to do in emergency situations and were well supported by the senior team. The service co-operated with other providers such as social workers and health professionals. Records were managed safely in accordance with the policy of the service.

Is the service effective?

The service was effective. People told us that they were happy with the care they received and felt their needs were met. One person said, 'They look after me great.' Two people told us that care staff had helped them to regain some of their independence. During three visits that we made to people's homes, we observed the interaction between people who used the service and the care staff. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us, "The staff are very good, they think of the little things that make a difference.'

A person told us that the service was flexible and was able to change the times that they delivered care from time to time, to meet their needs. Carers had received all of the training they needed to meet the needs of people using the service.

Is the service caring?

The service was caring. One person said, 'They are nice to me because they all like me.' Other people and relatives told us that the care staff were very caring. We spoke with carers who knew people's needs and we observed them interact with people in a pleasant and caring way. We saw that staff were kind and used humour when appropriate when helping people. The manner in which carers talked about the people that they supported showed us that they cared about their wellbeing. One of the care staff told us that they enjoyed, 'making a difference' to people's lives.

Is the service responsive?

The service was responsive to comments and suggestions made by people and to people's changing needs. A relative told us that if they were ever less than happy, 'I phone straight away and they are very responsive.' The experience of people using the service, was reviewed regularly. Changes were made in response to this or to requests. We saw that telephone calls made to the service were answered promptly. Calls were logged and included details of the response made. The service provided people with information about how to make a complaint and followed a policy when dealing with any complaints they received. Staff told us that people were encouraged to tell their carer or call the office if they were unhappy with anything, or with any suggestions. People told us, 'All I have to do is ask.'

Is the service well led?

The service was well led by an enthusiastic and well organised registered manager who was supported by a care planner and care co-ordinators. Care staff said that the manager was supportive and, "a good leader." The service had a system in place to monitor and assess the quality of the service which had led to changes had been made to improve the training that care staff received. The service followed a detailed policy when managing complaints. Care plans were legible and detailed. All staff had received regular supervision, either in meetings with their manager or when they were giving care to people using the service.

All care records we looked at included detailed care plans including people's personal preferences, likes and dislikes. A summary care plan highlighting key tasks for staff was also included and had been signed by people who used the service or their relatives.

The staff were able to demonstrate a clear understanding of their roles and responsibility to safeguard people from abuse. All staff we spoke with were able to confidently explain to us the process of reporting and documenting concerns immediately to their line manager or safeguarding lead.

Staff were able to obtain further relevant qualifications from time to time.

People who used the service, their representatives and staff were asked for their views about their care and treatment. People were confident that any comments or concerns would be acted upon. The provider took account of complaints and comments to improve the service.

The purpose of this visit was to ascertain if these concerns had been addressed. We found that the Business Development Director of AMG had been brought into oversee the management of the Chester office. We saw a letter she had sent out to all of the people who used the service apologising for any lapses in the quality of care received and that these issues would be resolved.

We spoke with seven people who used the service. One person told us: 'I have no complaints, they are pretty good.' Another told us: 'The standards have improved and are acceptable.' People told us that usually staff turned up on time and if not, the office staff would contact them to explain what was happening. Six out of the seven people we spoke with would recommend the service to other people.

We found that recruitment checks were carried out prior to staff starting work. We found that there had been improvements in the training and support of staff and in the processes to assess and monitor the quality of service that people received.

We saw recruitment procedures were in place however, we identified there had been occasions when these had not been adhered to. We found that inexperienced staff received insufficient time shadowing more experienced staff to understand what was expected of them in order to look after people in their care. We also found that there were no regular supervision processes in place.

We spoke with three people who used the agency and one relative. We also looked at a sample of questionnaires. People told us the staff were always respectful and very helpful. One person told us 'They make a difference to my life' another told us 'I have never been so spoilt, the girls are so lovely and polite.' However, people also told us that they did not always have the same staff attending or sometimes they were late or did not turn up at all. Similar comments were seen on the sample of questionnaires we viewed. One comment was 'I would rather not see so many different people' and another person wrote 'Same carers would be better.' Although the agency sought people's views, there had been no action taken in response to these issues.