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A24 Group Ltd - Sutton Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 October 2018

This inspection took place on 23 August 2018 and was announced. We gave the provider 24 hours’ notice to ensure they were available to facilitate our inspection. We last inspected the service on 9 February 2016 we found the service was meeting the fundamental standards and we rated the service Good.

A24 Group - Sutton is a domiciliary care agency that provides personal care and nursing care to adults and children living in their own homes across the UK. The agency has been in operation for around 22 years and provided personal and nursing care to people in healthcare settings as well as in people’s own homes. We only regulate personal care and nursing people receive in their own homes so did not look at the other part of the business. The agency provides domiciliary care as several distinct brands: Ambition 24 Nurses, British Nursing Association, Grosvenor Nursing and Mayfair Nurses. People had a wide range of complex nursing needs. The registered manager told us there were five people receiving care at the time of our inspection . However, our inspection findings showed this number was inaccurate. We again asked the registered manager to clarify the number of people and they gave us a list of seven people using the service. This list did not include everyone staff told us they provided personal care to. This meant the registered manager lacked robust oversight of the service.

There was 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.

At this inspection we found standards had deteriorated and the service was rated requires improvement overall. The registered manager and provider lacked good oversight of the service which meant they had not identified and resolved the issues we found. For example, the provider had not established systems to regularly and consistently audit medicines records to check people received medicines safely. The provider’s record keeping could also be improved, such as records of the care people received.

The provider did not always assess risks relating to people’s care and did not always ensure comprehensive, reliable care plans were in place for staff to follow. Instead for some people the provider relied on documentation from other services which was several years out of date.

The provider did not always supervise staff in a way which supported them to do their jobs and some staff had not had any supervision for several years. The provider had not established systems to assess the competency of staff to check they provided care in the best ways.

People may not have received care in line with the Mental Capacity Act 2005 (MCA) as the provider had not established systems to assess people’s capacity in relation to their care when they suspected people lacked this.

People were safeguarded from abuse by the provider as staff understood their responsibilities in relation to this. Staff received training in safeguarding adults to help keep their knowledge current.

People were supported by sufficient numbers of staff to meet their needs. The provider followed suitable recruitment processes so that only suitable staff worked with people.

Staff received a programme of training to help them understand their roles, including clinical training for nurses which helped them maintain their registration with their regulatory body.

People received the support they needed in relation to eating and drinking. People also received support in relation to their day to day health.

People and relatives were positive about the staff who supported them and developed good relationships. Staff treated people with kindness, dignity and respect. Staff understood the people they were working with and the

Inspection areas

Safe

Requires improvement

Updated 17 October 2018

The service was not always safe. People’s medicines and risks relating to people’s care were not always managed safely.

People were safeguarded from abuse as staff understood their responsibilities in relation to this.

There were enough staff deployed to support people and staff were recruited through recruitment procedures to check they were safe to work with people.

Effective

Requires improvement

Updated 17 October 2018

The service was not always effective. Staff did not always receive regular supervision to support them in their roles. The provider had not established systems to assess staff competencies.

The service did not ensure people always received care in line with the Mental Capacity Act 2005.

People received the support they needed in relation to their healthcare needs and eating and drinking.

Caring

Good

Updated 17 October 2018

The service was caring. Staff knew the people they were supporting and understood their needs and preferences.

Staff treated people with dignity and respect, gave them the privacy they needed. People were supported to be as independent as they wanted to be.

People received information at the right times.

Responsive

Requires improvement

Updated 17 October 2018

The service was not always responsive. People were not always involved in developing their care plans and care plans did not always reflect their preferences or guide staff appropriately in caring for them.

Care plans were not regularly reviewed to ensure they remained current.

People were offered activities they were interested in when this was part of their care package.

There was a complaints system in place and the provider responded to concerns raised.

Well-led

Requires improvement

Updated 17 October 2018

The service was not always well-led. The registered manager and provider lacked good oversight of the service and had not audited the service sufficiently to identify the issues we found.

A clear organisational structure was in place with visible leadership.

The registered manager encouraged open communication with people, relatives, staff and professionals.