Archived: Absolute Dignity Care ltd

Absolute Dignity Care Ltd is a domiciliary care agency providing personal care. At the time of our inspection, the agency was supporting 11 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People were at risk of harm as risks were not consistently assessed or mitigated. Systems to protect people from abuse and improper treatment were not effective. Opportunities to learn from adverse incidents had been missed which meant action was not taken to prevent reoccurrence and keep people safe. There was a risk medicines may not be managed safely. People were exposed to the risk of infection. There were not enough staff employed to ensure people’s safety and meet their needs and safe recruitment practices were not always followed.

Staff did not have adequate training to provide safe and effective care and support. Issues with staff performance were not always addressed. Care was not always provided in line with national good practice guidelines and there was a risk people may not receive support to maintain their health.

The service was not well led. Governance systems were limited. Issues found during our inspection had not been identified or addressed. Systems to ensure the safety and quality of the service were not used effectively. The registered manager had not addressed known issues and there had been a failure to make improvements in relation to issues found at our previous inspection. People, their relatives and staff had opportunities to provide feedback and shape the development of the service and the provider understood their responsibilities to be open and honest when things went wrong.

Systems did not ensure people’s right to privacy was upheld, as steps had not been taken to protect their personal information. There was a risk people may not receive consistent, personalised support. People coming towards the end of their lives had not been given opportunity to think about and plan for their final weeks and days.

People were supported by staff who were kind and caring and they were involved in decisions about their care and support. People were supported to be as independent as possible. 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. People had enough to eat and drink.

Where possible, staff supported people to connect with people who were important to them and their local community. People’s complaints and concerns were addressed, however, record keeping in this area was poor.

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 requires improvement (published 5 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safeguarding, safe care and treatment, staffing levels and staff training, person centred care and governance.

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

Follow up

We will continue to monitor information we receive about the service and 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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. Aand it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Absolute Dignity Care ltd is a domiciliary care agency. It provides personal care to older people, including people living with dementia, people with sensory needs, physical disabilities, learning disabilities and mental health living in their own homes. Not everyone using the service received the regulated activity of personal care. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection eight people were receiving personal care as part of their care package.

People’s experience of using this service:

Risks associated with people’s needs had either not been assessed and planned for or the guidance available to staff, was not sufficiently detailed. However, people were positive how staff managed any known risks and staff were found to be knowledgeable of the action required to keep people safe. This therefore indicated this was a recording issue.

Where people received support with their medicines staff did not have guidance of the administration of medicines prescribed to be taken ‘as required’. Whilst staff had received training in the administration and management of medicines, the registered manager had not assessed their competency.

People described staff as being experienced and competent. Staff had received training the provider had identified as required. We made a recommendation in the training of staff in manual handling. Staff had not received opportunities to review their work, training and development needs with the registered manager.

People were cared for by staff who had completed safe recruitment checks on their suitability to work with people. The registered manager was in the process of recruiting additional staff that would enable them to concentrate on the management and development of the service. Staff had not been provided with an identification badge to protect people from unauthorised staff.

Guidance for staff in people’s care plans were inconsistent in the level of detail provided. The Accessible Information Standard was not fully complied with because people’s sensory and communication needs had not consistently been assessed and planned for. Assessment of people’s needs, did not fully include the protected characteristics under the Equality Act 2010.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, best interest decisions had not been recorded following an assessment that identified a person lacked mental capacity to consent to their care. The registered manager was not aware of the action required should a person be restricted of their freedom and liberty.

We made a recommendation about the application process to the court of protection.

People were very positive about the care they received and the approach of staff. Staff were unrushed and stayed for the duration of the call and if they were running late, they were informed of this. People received care from regular staff they had developed positive relationships with and no person had experienced a late or missed call.

Communication with people and their relatives were good and the electronic system used to monitor calls and care provided worked well. However, reviews and opportunities for people to feedback about their experience of the service was informal.

Rating at last inspection:

This is the provider’s first rated inspection since registration.

Why we inspected:

This is a scheduled inspection based on the provider’s registration date.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. If any concerning information is received we may inspect sooner.