Archived: Abbey Nursing & Care Agency

Abbey Nursing and Care agency is a domiciliary care agency providing care to people living in their own homes, so they can live as independently as possible. At the time of our inspection the service was supporting 36 people with personal care.

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’s medicines were not always managed safely. One person had not always received their medicine as prescribed, and medication administration records were not always completed accurately in line with national guidelines. Medication audits had not identified concerns with people’s medicines.

The provider could not demonstrate that all care workers had completed training which enabled them to meet people's care needs in a safe manner.

Audits and checks were in pace; however, these were not always effective at identifying concerns. There was a lack of robust oversight with aspects of the service. The provider has been in breach of regulation 17 (good governance) three consecutive occasions, which demonstrates a lack of continuous improvement and effective leadership.

People were involved in the development of their care plans and relatives were involved where this was appropriate. The plans generally contained person-centred information. However, some staff told us they did not always have time to read people’s care plans. Staff told us they got to know people during visits to their home and delivered care in line with their preferences. People and relatives told us staff generally knew people well, but there were concerns raised about newer members of staff not knowing people as well. People told us this did not impact on their level of care as newer staff were generally accompanied by more experienced staff on care calls.

Risks to people were assessed, and appropriate plans were in place to keep people safe. One person did not have a plan in place regarding a specific medical condition, but the registered manager made arrangements to complete this immediately. However, there were no systems in place to effectively analyse incidents to ensure learning could be implemented to prevent reoccurrence.

There was some mixed feedback from staff about the management of the service. Some staff felt the management team were not supportive and communication needed to improve.

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.

There were enough staff to meet people's needs. There were some concerns raised by staff and relatives regarding staffing levels, but the registered manager told us they had halted new packages of care until recruitment had been completed. People told us they had good relationships with the staff that supported them. People were treated with dignity and respect. Staff supported people to be as independent as possible and express their views about the service and their care.

People told us they felt safe with the care provided by Abbey Nursing and Care Agency.

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 (published 5 December 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection we have identified breaches in relation to the management of medicines, staff training and good governance.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, younger adults with a disability and children. At the time of this inspection the service was supporting 44 people.

Not everyone using Abbey Nursing and Care receives regulated activity; the Care Quality Commission (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.

There was a manager in post who had been registered with CQC since October 2010. 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.

People and their relatives told us they received care and support that was safe.

Recruitment processes had improved. All relevant documentation was collected prior to staff commencing employment. Where required risk assessments were completed to ensure staff were suitable to work with vulnerable people. But control measures in place to reduce risk had not been carried out as stipulated.

Most people were supported safely because the provider had assessed the risks involved and staff had sufficient details and guidance to carry out their duties safely. We found one example where no guidance had been developed and the registered manager addressed this issue during the inspection.

People using the service were protected from harm due to the agency’s reporting systems and staff knowledge. Staff were well-informed about the types of abuse and the action they would take if they suspected that abuse was taking place.

People were supported by staff who knew and understood their needs. People and their relatives told us they had consistent staff supporting them. People told us staff most times arrived punctually for their visits and they were informed if staff were running late.

People told us staff had good hygiene practices and wore personal protective equipment (PPE) when carrying out their duties. This should help to ensure that people were protected from the risk of infection.

Where required, people were supported to take their medicines safely. Staff had the relevant training and competencies to administer medication safely and recorded these appropriately.

Staff had the right knowledge and skills and received continuous support to function in their caring role. People and their relatives told us staff did their jobs effectively. Staff received an induction and mandatory training prior to working with people. There was evidence that all staff were supported with ongoing training including refresher training as required. However, we found two examples where staff should have completed refresher training in one topic area but there was no record of this. Staff received regular supervisions and appraisals to help ensure they received the necessary support to carry out their roles.

People’s rights were protected because the service worked within the principles of the Mental Capacity Act (MCA). Staff sought people’s consent before undertaking tasks. Care records we looked at contained evidence that people had consented to the care they received.

Where assessed as a need, people were supported to maintain good nutrition and hydration. Everyone we spoke who required this support told us they were satisfied with the way staff consulted them prior to carrying out the task.

People told us the service supported their access to health care professionals and medical attention, if required.

People and relatives told us staff were kind and compassionate and that they considered them to be part of their family. People told us they were treated with dignity and respect and that staff carried out their duties in a professional and friendly manner.

People gave us examples of how staff encouraged them to be independent according to their abilities. Staff we spoke with confirmed this. This helped to promote people’s general good health and wellbeing.

People and relatives told us care and support was responsive to their needs. They gave us examples of how the service provided person-centred care that met their individual needs. Initial assessments were carried out to help ensure people could be supported. Care plans contained detailed and person-centred information about the care and support people required and were regularly reviewed.

There was a complaints process in place and there was evidence in care records indicating people had information about making a complaint. But for one complaint, it was not clearly recorded that the provider had communicated the outcome of their investigation to the complainant.

The service dealt with complaints effectively and satisfactorily resolved the concerns people and their relatives raised. However, there were gaps in how the registered manager recorded the actions taken in response. For example, in one person’s care records, we found no evidence that they had received a satisfactory response to the concerns they raised. We discussed this with the registered manager who said the matter had been dealt with immediately and the person had received verbal resolution. We spoke with the person who confirmed this was the case.

People and relatives said the management and staff at Abbey Nursing & Care were approachable and helpful. They found communication amongst the staff team was good and helped to ensure a seamless service of good quality was provided.

Quality assurance systems provided the registered manager and the provider with an overview of the service provided; however, these could be more robust as they had not identified areas of concern, for example, recording the outcomes of safeguarding and complaints investigations.

There were policies and procedures in place to provide staff with the appropriate guidance and support to carry out their roles.

Regular staff and management meetings were held which gave the staff and management teams the opportunity to discuss their work with peers.

The registered manager attended various forums within the care sector. This involvement helped them to share best practice and keep up to date with issues affecting the sector.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, younger disabled adults and children. At the time of this inspection the service was supporting 52 people.

Not everyone using Abbey Nursing and Care receives regulated activity; the Care Quality Commission (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.

There was a manager in post who had been registered with CQC since October 2010. 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.

We found six breaches of the Health and Social Care Act (HSCA) regulations in relation to recruitment processes, safe care and treatment, effective safeguarding systems, staffing training, managing complaints and good governance. We found one breach of the Care Quality Commission (Registration) Regulation 2009 in relation to notifications of incidents. In light of the concerns we found at this inspection, we asked the registered provider to enter into a voluntary agreement with the CQC, to which they agreed, to suspend new packages of care until the service was compliant with all regulations.

We made a recommendation that the registered provider review current good practice such as National Institute for Health and Care Excellence (NICE) guidelines in relation to the safe disposal of medicines in the care at home sector.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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. You can see what other action we have told the provider to take at the back of the full version of the report.

We found the service was not safe. People we spoke with raised concerns that care visits were not on time and especially at the weekend. Some people had experienced missed visits which had resulted in missed medication. This meant people were not receiving care and support at times which suited their needs. Following these missed visits, a system for managing these had been implemented. However the registered manager was unable to demonstrate that the current system was effective. This meant people were still at risk of experiencing missed visits as there was no effective means of preventing these.

Recruitment processes were not robust. This was a breach of the regulations and meant people were not protected from risk of unsuitable staff being employed.

Risk assessments were not always up to date and risks to some people had not been assessed and recorded. This meant staff did not have sufficient information to ensure people were supported people safely.

Staff we spoke with were able to describe the types of abuse and what action they would take if they suspected abuse was taking place. Recent safeguarding incidents had been reported to the local authority. The registered manager had not always notified CQC about these incidents as required by law. This was a breach of the regulation regarding notifiable incidents which registered providers must follow.

The registered provider did not have adequate oversight of staff training and development since we found the current induction and training systems did not provide suitable assurances that all staff had the required skills and competencies to carry out their roles effectively. This was a breach of the regulation relating to staffing and meant people were at risk of harm.

Care records contained initial assessments, person centred information about how people were to be supported and risk assessments. Records included appropriate equality and diversity information. We saw that reviews were currently being carried out. But no action plan had been devised to address concerns raised during these reviews.

People said staff’s approach was caring and that staff carried out their duties in a respectful manner. Staff supported people with dignity and encouraged them to maintain their independence according to their abilities. We found however the registered provider did not demonstrate the hallmarks of a caring organisation as they had not ensured staff had received the right training and support to care for people in a safe and person centred way.

The registered provider did not demonstrate there was an effective system of managing complaints and concerns raised about the standard of care provided. Some people told us they would contact the office to raise a concern but not everyone was aware of the registered provider’s complaints procedure.

We found the quality assurance framework was not sufficiently robust and did not give the registered manager and registered provider effective oversight of the quality and safety of service. This meant people’s care and support was not adequately monitored to ensure their safety and wellbeing.

Abbey Nursing and Care Agency is a domiciliary care agency which provides personal care and support to adults and children living in their own homes who have a variety of needs. The service is managed from an office located in Sale. At the time of this inspection 32 adults and one child were receiving assistance with their personal care.

The service had a registered manager. 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.

People told us they were happy with the care they received. Comments we received from people who used the service included, "extremely satisfied," "very satisfied" and "can't fault them at all." People and relatives felt there were enough staff to carry out visits and said the service was safe.

Staff completed safeguarding adults training as part of their induction, and this was updated regularly. Staff knew how to report concerns and were able to describe various types of abuse. Staff were confident any concerns they had would be taken seriously.

There were thorough recruitment and selection procedures to check new staff were suitable to care for and support vulnerable adults.

Risks to people’s health and safety were assessed, managed and reviewed regularly. There were clear risk assessments relating to a person’s medicines, mobility, nutrition and other areas of need in care plans. Medicine records were completed accurately.

People and relatives we spoke with said they were happy with the service and felt staff had the right skills to provide the care they needed. One person told us, "They know what they are doing.”

Staff told us they received appropriate training and opportunities to shadow established staff before providing care on their own. Staff received regular spot checks, supervisions and appraisals.

People told us care staff were caring, friendly, helpful and respectful. People’s comments included, “Staff are excellent and very friendly” and "They're so kind, they've got time for me." Staff had a good understanding of the importance of treating people with dignity and respect.

Staff spoke fondly about people who used the service and how thy enjoyed their role. One staff member told us, “I absolutely love the job as I know I’ve made a difference to someone’s life. Staff have a bond and a relationship with a client that is overwhelming.”

Staff had access to detailed information to help them better understand the needs of people they cared for. This information included a person’s life history, hobbies, preferences and daily routine. Care plans and risk assessments were specific to the needs of the individual and were reviewed regularly and whenever a person’s needs changed.

People knew how to complain if they had a concern. People were frequently asked for their views about the service and these were acted upon.

The provider ensured the quality of the service was assessed and monitored by carrying out regular audits of all aspects of the care provided.

Staff told us they felt supported by the management team and felt able to voice any concerns they may have. Staff told us there was a positive culture at the service.

We saw evidence that the provider had effective working partnerships with other stakeholders and other health and social care providers including the NHS Trafford Clinical Community Group and safeguarding team.

We found medicines were safely administered and that people who used the service received their medicines in the way that had been prescribed for them.

One person who used the service told us; 'They treat me with respect. They give me my medication from the blister packs and record it all in my care file. They are very efficient'.

One member of staff told us; 'They are really supportive. I've been given a chance to do a national vocational qualification (NVQ) which I'm waiting to here about. I have also just recently done a dementia course. I feel very supported by the team'.

Regular unannounced spot checks were undertaken by senior staff which involved direct observation of care staff. One person who used the service told us; 'They come in and do spot checks on what the girls are doing. They are all very good. We have had meetings to review my care needs which is good. I have no concerns at all'.

A person using the service told us that staff provided support in a manner that suited their preferences. They said that staff always took time to have a laugh and a chat with them before they left. They described staff as 'smashing' and 'really great'.

Further improvements had been made by ensuring that a robust system was in place to monitor the performance of staff following their appointments, based on the assessment of risk. The person using the service and two relatives that we spoke with told us that the service was provided in a safe way. They also said that staff had been trained well.

We found two concerns during our visit. Staff had been administering medication to a person who did not have a care plan or risk assessment confirming that it was safe to do so. We also found that although the service had quality assurance system in place, it had failed to identify concerns relating to care plan reviews and the issue with administering medication.