Archived: AMG Nursing and Care Services - Crewe

About the service:

AMG Nursing and Care Services - Crewe is a domiciliary care agency that was providing personal care to around 180 children and adults at the time of the inspection. The number of people using the service varied daily due to nature of the service provided.

People’s experience of using this service:

We found a breaches in Regulation as the registered provider needed to better utilise the checks and audits that were in place to determine and manage the quality of the care. These checks had not highlighted or addressed some of the issues found during this inspection. People were supported with their medicines, but improvements were needed to record keeping to ensure that this was safe.

We made a recommendation that the registered provider review planning and delivery of care to ensure that it consistently meets people’s preferences and needs. People reported that staff met their needs but that they did not always have a consistent and punctual staff group. Care plans varied greatly in their personalisation, content, accuracy and detail.

We made a recommendation the registered provider seek guidance to ensure that they meet the requirements of the MCA in the assessment and recording of mental capacity and best interest decisions. Records did not demonstrate how the mental capacity act was applied and followed.

People who used the service and their relatives were positive about the impact it had on their lives: enabling them to remain safe, healthy and as independent as possible within their own homes. They said that staff were kind, patient, knowledgeable, considerate and competent.

The registered manager worked in partnership with health and care professionals and the local community to ensure people received the support they needed and it was well support was coordinated. The management team were open and approachable in the way they managed the service.

People received safe care delivered by staff who understood their role in safeguarding the people in their care. Risks to people's safety were assessed and a management plan put in place to keep them safe.

People commented that they were treated with dignity and respect and their privacy was maintained. When staff supported people at the end of their life, they ensured their wishes were acted upon and supported their relatives during this time. People were aware of how to raise concerns and complaints.

Processes were in place to ensure that staff recruited was of suitable character and skill. Staff received robust induction, on-going training and support so that they could be effective in their roles.

Rating at last inspection:

The service was rated Good overall at the last inspection with a Requires Improvement judgment in Effective. The report was published on 26 November 2016.

Why we inspected:

This was a planned inspection to check whether the service remained Good.

Enforcement:

Please refer to the action we told provider to take towards the end of the full report.

Follow up:

We will review the action plan we have requested from the registered provider. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

AMG Nursing and Care Services (Crewe) is a domiciliary care agency that provides personal care for people in their own homes. The office is based in Crewe and is part of a larger organisation, AMG Nursing and Care Services that provides care in other areas of the UK.

The service did not have a registered manager in place. 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. There was a manager in post who had applied to register with the Commission.

We found that people were positive about the service that they received. They told us that they felt safe and well supported. We found that staff understood their responsibilities to report safeguarding concerns and to protect people from abuse or harm. Staff had received appropriate training and knew how to report concerns appropriately. However, not all staff knew where they could report concerns to outside of their organisation.

There were sufficient staff to meet the needs of people receiving a service. The service was recruiting new staff. People told us that staff always arrived on time and calls were not missed. The service had introduced a call monitoring system to support the monitoring of calls. However some people reported issues with the consistency of staff and said that many different staff provided their care. Other people told us that they had a regular small team of staff. The manager had taken steps to address people’s concerns about the consistency of staff.

We found that there were robust recruitment procedures in place. Medicines were administered safely. People were supported to take their medicines by staff as prescribed. However, the auditing of medication administration records needed to be more robust.

We found that staff were appropriately skilled and trained to meet people’s needs effectively. The manager told us that one of the service’s strengths was the training available to staff by qualified nurses, employed within the organisation. We found that staff completed a robust induction prior to starting work in the service. Staff received regular and on going training. However the service needed to ensure that all staff had completed specific training required to meet individual needs.

The provider had a policy on The Mental Capacity Act (MCA) that followed the relevant principles, however the management team had not ensured that this was fully implemented within its service, regarding appropriate mental capacity assessments. We recommend that the service finds out more about training for registered managers, based on current best practice, in relation to The Mental Capacity Act (2005) and adjust their practice accordingly.

People told us that staff were caring and treated them with kindness. We found that people and their relatives were very happy with the support that they received and told us that staff treated them with dignity and respect. Staff demonstrated a good understanding of the importance of treating people with compassion and dignity.

We found that people received care that was personalised to their needs. The majority of people we spoke with felt that the staff knew them well and knew how to support them. Care plans were thorough and person centred. They were reviewed on a regular basis and any changes to people’s needed were responded to appropriately.

People knew how to raise concerns and were confident action would be taken. We saw that complaints had been dealt with thoroughly and appropriate investigations had been carried out, with actions taken to learn from and address any concerns.

The management team were friendly and approachable. We found that information was organised and readily available. There were systems in place to monitor the care provided and people's views and opinions were sought regularly about the quality of the service. There was a quality assurance team who helped to monitor the quality of the service and regular audits were carried out. Staff told us that they felt supported by the management team, but also told us that communication could be better and said that staff meetings would be helpful. There were plans in place to develop and improve further the quality of the service.

We looked at consent issues and found that the service was working with the people and their relatives to ensure that the care was provided in the way they wanted and was consistently meeting people's needs.

We looked at the medication procedures in place and saw that people who used the service were supported with their medication by staff who were trained and followed the correct procedures.

We looked at the support that staff received. We looked at the systems in place and found that staff received various types of support which included regular supervision, a six monthly appraisal and all mandatory training as well as specific training to meet particular people's needs.

We looked at the quality assurance systems in place and saw that the service was carrying out sufficient checks to ensure that they were providing a good service.

We reviewed three care plans and risk assessment documentation and found the care plans were drawn up with the people who used the service and their relatives and contained signatures to demonstrate this further. However, in one person's daily communication log we saw that some information about their care had not prompted a care plan review.

We spoke with four staff members and saw that staff received safeguarding vulnerable adults training as part of their induction process and that there was a thorough staff recruitment process and policy in place.

The people we spoke with told us they had no complaints or concerns they wished to raise and had an awareness of the complaints procedure. We found that some historic complaints from 2012 within the complaints log were not auditable on the day of the visit and requested that this information to be forwarded to Care Quality Commission following the inspection. We found that recent complaint documentation was auditable and contained the information expected.