J.C Michael Groups Ltd Bexley

People’s experience of using this service

There were safeguarding adults’ procedures in place and the registered manager and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work and there were enough staff to meet people’s care and support needs. Where required people received safe support from staff to take their medicines. The provider and staff were following government guidance in relation to infection prevention and control. Staff had received training on COVID 19 and the use of personal protective equipment (PPE). The service had COVID 19 contingency plans in place that made provisions for safe care in the event of an emergency.

People’s care and support needs were assessed before they started using the service and care plans were in place to ensure staff could support them safely. Staff received training relevant to people’s care needs. Where required people received support from staff to maintain a balanced diet. 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 support this practice.

People and their relatives told us they were treated respectfully, and they had been consulted about their care needs. People and their relatives knew how to make a complaint if they were unhappy with the service. People had access to end of life care and support if it was required.

Effective systems were in place to monitor the quality of service that people received. Staff said teamwork was good and they received good support from the registered manager. The registered manager took people and their relatives views into account through satisfaction surveys and telephone monitoring calls and feedback was used to improve the service. The registered manager and staff worked with health care providers to plan and deliver an effective service.

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

Rating at last inspection: Requires improvement (report published on 18 May 2020). The service had been rated requires improvement on three previous inspections. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection to assess if the provider was complying with our regulations.

Follow-up

We will continue to monitor information we receive about the service in line with our monitoring activity, which will inform when we next inspect the service.

People’s experience of using this service:

There was poor planning for care visits with staff not following care plans and working to meet people's needs. Staff rostering records showed staff were not always given enough time to travel between the calls, which impacted on their ability to arrive promptly or stay the full length of time with people as planned for. Some people were not always treated with dignity and respect. People’s care was not delivered in line with their care plans. Complaints were not managed effectively. The provider’s quality assurance systems were not effective, and their internal monitoring and audit process had not identified the above issues we found at this inspection.

People were protected from the risk of abuse, and risks to people had been identified, assessed and had appropriate risk management plans in place. There was a system to manage accidents and incidents and to reduce them happening again. Staff administered prescribed medicines to people safely. People were protected from the risk of infection. The provider trained staff to support people and meet their needs. The provider worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent to their care. 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’s needs were assessed to ensure these could be met by the service. Where appropriate, staff involved relatives in these assessments. Staff supported people to eat and drink enough to meet their needs and staff supported people to maintain good health. Staff supported people and they showed an understanding of equality and diversity and people’s privacy was respected.

Care plans were person centred and contained information about people’s personal life and social history, their health and social care needs, allergies, family and friends, and contact details of health and social care professionals. The provider had a policy and procedure for managing complaints and to provide end-of-life support to people.

The provider completed checks and audits on accidents and incidents, medicines management, staff training, and safeguarding. However, their audits about staff care visits, recruitment and complaints was not effective. The registered manager and the provider remained committed to working in partnership with other agencies and services to promote the service and to achieve positive outcomes for people.

Rating at last inspection: Requires improvement (report published on 13 February 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected: This was a planned inspection based on the last inspection rating.

Enforcement

We have identified breaches in relation to staff deployment, rostering and call monitoring, complaints management, dignity and respect, and effective quality assurance system and process at this inspection.

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 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.

At our inspection of the service on 5 October 2017, we found the service did not meet Regulations 9, 12 ,13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans were not kept up to date, there was no clear guidance on how people’s care needs should be met, risks to people were not identified and managed, procedures for reporting safeguarding concerns were not always being followed appropriately and there was a lack of effective quality assurance systems in place. We served a warning notice on the provider relating to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out a focussed inspection on 4 January 2018 to follow up on the issues referred to in the warning notice. We found the service had acted and had made improvements to the issues referred to in the notice.

At our last comprehensive inspection of the service on 31 May 2018, we found the service took sufficient action to meet Regulation 13. However, the provider had not sustained improvements they had made in relation to regulation 17. We also found continued breaches of regulations 9 and 12 and new breaches of regulations 10 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans were not kept up to date, there was no clear guidance on how people’s care needs should be met, risks to people were not identified and managed, staff were not always caring and people’s privacy and dignity had not always been respected and the service did not ensure the appropriate levels of staff were deployed to keep people safe and meet their needs in a timely manner. We took enforcement action against the registered provider and we placed the service into Special Measures.

Following that inspection, the registered provider sent us an action plan telling us how they planned to make improvements. They appointed a manager in August 2018 to run the service and to implement the improvement action/plan. We found that improvements had been made. The provider had quality assurance systems in place that were operating effectively at the time of this inspection. People’s care plans were up to date and there was guidance on how their care needs should be met, risks to people were being identified and managed, the provider had taken steps to make sure that staff treated people with respect and dignity and we found there were appropriate levels of staff were deployed to keep people safe and meet their needs in a timely manner.

We also found there were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks were being carried out before staff started working at the service. There were system’s in place for monitoring, investigating and learning from incidents and accidents. Staff had received training in infection control and food hygiene, and they were aware of the steps to take to reduce the risk of the spread of infections.

Staff completed an induction when they started work and received appropriate training, supervisions and appraisals. 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. People were supported to meet their nutritional needs where appropriate and people were supported to access health and social care professionals when required.

People told us staff were caring and respectful. People were consulted about their care and were provided with information about the service in a format that met their needs. People received personalised care that met their diverse needs. People knew about the provider’s complaints procedure and how to raise concerns. No one using the service required support with end of life care, however the service had access to health care professionals for this type of support if it was required.

The provider considered the views of people using the service and there was an out of hours on call system in operation that ensured support and advice was always available. The provider and staff worked closely with health and social care professionals to ensure people received good quality care. The service did not have 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. The manager told us they were due to leave the service the day after we inspected. The business manager told us that a new manager was due to start working at the service on the 21 January 2019 and they planned to register them as a manager with the CQC.

The service is no longer in special measures. We will continue working with the local authority to monitor this provider to ensure the improvement we observed continues. We will carry out a further comprehensive inspection within 12 months. We will return before this time if we think this improvement has not been sustained.

JC Michael Groups Ltd Bexley is registered to provide the regulated activity personal care and provides personal care, housework and assistance with medicines in people’s homes.

At the time of the inspection, the service was providing care and supporting 83 people and had 34 care workers working for them.

There was no 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. The business manager told us an application had been submitted to the CQC and this was still in progress.

At our last inspection on 5 October 2017, the service did not meet Regulations 9, 12 ,13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care plans were not kept up to date and there was no clear guidance on how people’s care needs should be met, risks to people were not identified and managed, procedures for reporting safeguarding concerns were not always being followed appropriately and there were no effective quality assurance systems in place to monitor the service.

The service was rated Inadequate in well led and a warning notice was issued against the service. A focused inspection took place on the 4 January 2018 and we found the service had addressed the issues and met the warning notice we served. The rating for well led was improved to requires improvement. However, the provider had not sustained improvements in terms of the quality monitoring that were observed at our last inspection.

During this inspection, we found the service took sufficient action to meet Regulation 13. There were safeguarding and whistleblowing procedures in place. Training records confirmed that staff had received safeguarding training and were aware of how they would recognise abuse and what to do if the service did not act upon concerns. Accidents and incidents were recorded. Records showed any necessary action had been taken by management staff in response to the incidents. Records showed statutory notifications were completed and sent to CQC when required.

However, the service failed to take action to address the concerns identified in relation to Regulations 9 and 12. In addition to this, additional breaches of regulations were also identified.

People experienced a lack of consistency in the care they received. Care workers turned up late and people were not aware of which care worker was coming to support them.

Risks assessments were in place however risks to people were not identified and managed appropriately.

Arrangements in place to manage people’s medicines were not sufficient to ensure people received their medicines safely and as prescribed.

Staff told us they received regular training and were supported in their roles. Appropriate checks were carried out when staff were recruited. However, people using the service and relatives told us they felt the care workers were not sufficiently trained to provide the care and support people needed.

Some people spoke positively about the care workers, however we found instances where people experienced a lack of consistency in the care demonstrated by staff and there were instances where people were not treated with dignity and respect.

Procedures were in place for receiving and responding to complaints. Formal complaints received had been responded to and resolved, however, people and relatives did not always feel listened to when they contacted the office to raise concerns.

Some action has been taken by the provider to assess and monitor the quality of service being provided. A business manager had been appointed to ensure the office was managed effectively. An action plan was in place and some measures had been taken to make improvements.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act 2005 (MCA). Care plans contained information about the person’s mental state and cognition. People were supported with their nutritional and hydration needs.

Staff told us that they received up to date information about the service and had an opportunity to share good practice and any concerns they had at team meetings. Staff spoke positively about working for the service.

We have made one recommendation about reviewing the effectiveness of current systems in relation to measuring staff performance.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment.

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.

We undertook this unannounced focused inspection of Aquaflo Bexley on 04 January 2018. This inspection was carried out to check that the provider had met the requirements of the warning notice. This report only covers our findings in relation to the key question ‘Is the service well-led?’ You can read the report from our last comprehensive inspection, by selecting the link for Aquaflo Bexley on our website at www.cqc.org.uk.

Aquaflo Bexley is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service mainly to older adults.

At this inspection we found that the provider had addressed the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and had met the warning notice we served. We found that people's medicines were now being monitored in line with the provider’s medication policy and procedure. Accidents and incidents were now recorded and monitored. The provider’s out-of-hours on-call system was now used by staff appropriately. Records relating to complaints, safeguarding, and missed and late calls were now in place in the office, and these were now being audited on a regular basis.

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. The provider was in the process of recruiting a new registered manager to run the service. A registered manager from another of the provider's locations had been supporting staff as an acting manager at Aquaflo Bexley since the last inspection. They demonstrated a good understanding of the role and their responsibilities under the Health and Social Care Act 2008. They were aware of the events which they were required to notify CQC about and we found appropriate notifications had been made to the Commission when required.

Following this inspection, the rating for the key question ‘Is the service well-led?’ has improved from ‘Inadequate’ to ‘Requires Improvement’ because the provider's systems for assessing and monitoring the quality and safety of the services provided have improved, but have not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice.

The inspection was prompted in part by a notification of an incident relating to a person using the service. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management and reporting of safeguarding concerns.

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. The registered manager had been supporting the acting manager the week prior to our inspection and was available during this inspection. However the registered manager had not managed the service on a day to day basis since April 2017.

At this inspection we found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, safeguarding people from abuse, person centred care and good governance.

We found that action had not always been taken to support people where risks to them had been identified. Staff did not assess risks to people using the service in a timely way following falls. The provider’s procedures for reporting safeguarding concerns to the local authority were not always being followed appropriately.

The provider was failing to operate effective systems to assess, monitor and improve the quality and safety of care to people using the service. Not all staff used the out of hours on call system to report incidents and the system in place to monitor missed and late calls was not working effectively. Monthly medicines audits were not being carried out which meant that the provider could not be assured people received their medicines.

There were sufficient staff employed to safely meet people’s needs. Appropriate recruitment checks took place before staff started work. Staff received mandatory training to help meet peoples care and support needs which included training in dementia awareness. Staff had completed an induction when they started work and received regular supervision to ensure they were competent to fulfil the role. Staff said they enjoyed working for the agency and the received good support from the manager and office staff.

People who used the service had capacity to consent to their care and treatment. The registered manager demonstrated a clear understanding of the Mental Capacity Act 2005 and acted according to this legislation. People’s care files included assessments relating to their dietary needs and preferences. People had access to a GP and other healthcare professionals when they needed them.

People said their privacy and dignity was respected by staff when they visited. People were provided with appropriate information about the service when they first started to use the service. This ensured they were aware of the standard of care they should expect. People and their relatives, where appropriate, had been involved in planning for their care needs. The provider took into account the views of people using the service and their relatives about the quality of care provided through spot checks, surveys and telephone monitoring calls.

At our last inspection of the service on 5 and 7 January 2016 we found a breach of legal requirements because the arrangements for administering people’s medicines did not always comply with recommended guidance or the provider’s own policy. At this inspection we found that the provider had made improvements relating to the management of peoples medicines.

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 and associated Regulations about how the service is run.

The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Procedures were in place to support people where risks to their health and welfare had been identified. Appropriate recruitment checks took place before staff started work.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they had received training relevant to the needs of people using the service. People’s care files included assessments relating to their dietary support needs. People had access to health care professionals when they needed them.

People were provided with appropriate information about the service. People and their relatives said staff were kind and caring and their privacy and dignity was respected. People were consulted about their care and support needs and care plans were in place that provided information for staff on how to support people to meet their needs. There was a matching process in place that ensured people were supported by staff that had the experience, skills and training to meet their needs. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through satisfaction surveys and telephone monitoring calls. They carried out unannounced spot checks to make sure people were being supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the registered manager and office staff. There was an out of hours on call system in operation that ensured management support and advice was always available for staff when they needed it.

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 and associated Regulations about how the service is run.

People told us they received their medicines when they needed them however we found arrangements for administering people’s medicines did not always comply with recommended guidance or the provider’s own policy. The provider was working on this at the time of the inspection but we were not fully assured that robust arrangements were in place. You can see the action we have asked the provider to take at the back of the full version of the report.

People said they felt safe and staff treated them well. The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they were up to date with their training. People had access to health care professionals when they needed them.

People had been consulted about their care and support needs. Care plans and risk assessments provided information for staff on how to support people to meet their needs. People’s care files included assessments relating to their dietary support needs. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through telephone monitoring calls and satisfaction surveys. The provider carried out unannounced spot checks to make sure people were supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the manager. They said there was an out of hours on call system in operation that ensured management support and advice was always available when they needed it.