Archived: Agincare UK Southampton

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

People consistently raised concerns about calls being later than planned. They also told us that continuity of care needed to improve. Risk assessments did not always fully reflect people's needs or take account of all risks to their health and wellbeing. Medicines administration records did not always provide assurances that people were receiving their medicines as prescribed or in line with best practice frameworks. Systems and processes were in place to safeguard people from the risk of abuse. Good practice guidance was followed to ensure infection prevention and control processes were implemented. When things went wrong such as late calls or missed visits, reviews and investigations were not always undertaken to support lessons being learnt.

The systems in place had not been fully effective at improving the quality and safety of the service. The previous registered manager, deputy manager and all members of the office team had recently left their roles. A new manager had been appointed but had only been in post two weeks when we inspected. Staff were positive about the new manager and felt she had already had a positive impact on the service. They were hopeful the new manager would drive the required improvements.

Overall people were supported in the least restrictive way possible and there was evidence that capacity to consent to their care and support was considered as part of the care planning process, however, this had not always been well documented. Some people felt that their care workers needed to be better trained. The records provided to us relating to staff training were incomplete and so we could not be assured about this. People were supported with their health and nutritional needs.

People were also not kept adequately informed about any changes to their support. This limited their ability to have choice and control over their care. People told us the confidentiality of information was not maintained. Staff were kind and caring and some people had been able to develop positive relationships with their care workers which they valued.

Care plans contained personalised information about people’s preferences, likes and dislikes and life histories. Where people had regular care workers, staff were knowledgeable about their needs and this helped to ensure that they received personalised care. A complaints policy was in place and information about how to complain was in the Care Services Guide. People were generally confident that their complaints had been listened to and acted upon.

Rating at last inspection

The last rating for this service was requires improvement (published 8 November 2018) and there were two breaches of the Regulations. At this inspection we found improvements had not been made /or sustained and the provider remained in breach of one Regulation and two new breaches were found.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about whether there were enough staff to ensure people received a reliable and consistent service. A decision was made for us to inspect and examine those risks.

Follow up

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 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.

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

Agincare UK Southampton is a domiciliary care agency that provides personal care, respite and domestic services to people in their own homes, some of whom will be living with dementia or have complex health needs. The service operates mainly in the Hythe and Totton areas of Southampton. Not everyone using the service received a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care', that is, help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, there were 61 people receiving a personal care service.

The service was last inspected in June 2017 when we found it to be in breach of Regulation 19, Fit and proper persons employed. The overall rating of the service was ‘requires improvement’. Following our last inspection, the manager sent us an action plan with details of the improvements

they planned to make to meet the requirements of this Regulation.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Recruitment practices continued to require improvement. All the required checks had not been completed before new staff members started work.

Some risk assessments needed to be more robust and include more detailed guidance about how the identified risks were to be managed.

There were systems in place to monitor the quality and safety of the service provided, however these were not always effective.

People's care records lacked information relating to their support needs, although people told us, and we observed, that staff knew people well and knew how they liked to be supported.

People told us that their care workers were well trained and records confirmed staff had received training relevant to their role. However, some staff were not confident about how they would respond to an incident of choking. We have asked the registered manager to review the skills and knowledge of staff with regards to this.

Further improvements were needed to ensure that staff were following relevant policies and best practice guidance on medicines management.

Staffing levels were sufficient to meet people's needs and overall people were satisfied with the reliability of the service.

Staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect.

Incidents and accidents were appropriately recorded and used as an opportunity for learning.

The registered manager told us, no one using the service lacked capacity to consent to their care. We saw evidence of staff seeking people’s consent before provided support and offering them appropriate choices.

People were supported with their health and nutritional needs.

People were treated with kindness and felt that their privacy and dignity was respected.

Complaints had been managed appropriately.

People and staff spoke highly of the registered manager, who they said was approachable and supportive.

During this inspection we found one repeated breach and one new breach of the regulations. This is the third consecutive time the service has been rated as 'Requires Improvement' and we are currently considering our response to this and will report on any further actions when all representations are concluded.

Agincare UK Southampton is a domiciliary care agency that provides personal care, respite and domestic services to people in their own homes, some of whom will be living with dementia or have complex health needs. The service operates mainly in the Hythe and Totton areas of Southampton. There were 57 people using the service at the time of this inspection.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been appointed in February 2017 and was currently applying to the CQC to become registered. Prior to this, the service had an extended period during which there had been a number of changes in management which people and staff felt had impacted upon the consistency of leadership and the support provided.

Recruitment practices continued to be unsafe. We could not be assured that all of the required checks had been completed before new staff members started work.

Improvements were needed to ensure that medicines were managed appropriately.

More needed to be done to improve the consistency and reliability of the service and to prevent the risk of missed or late calls.

Audits were not being fully effective at ensuring the quality and safety of the service.

Improvements had been made which helped to ensure that people had a care plan which provided adequate information about their needs and supported staff to deliver responsive care.

The new manager had taken action to ensure that staff had all of the training relevant to their role and to ensure that staff felt supported and understood their role and responsibilities.

Staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect.

Staff acted in accordance with the key principles of the Mental Capacity Act 2005 (MCA) and people’s choices were respected.

People were supported with their health and nutritional needs.

People were treated with kindness. They felt involved in how their care was planned and provided and felt that their privacy and dignity was respected.

The manager was strengthening the systems in place to ensure that complaints were effectively managed and used to drive improvements.

Staff told us the manager was effective, approachable and had an understanding of the challenges faced by the service. They expressed a growing confidence that the new manager would continue to make improvements.

We found one breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see the action we have asked the provider to take in the main report.

Agincare UK Southampton is a domiciliary care agency that provides personal care, respite and domestic services to people in their own homes, some of whom will be living with dementia or have complex health needs. The service operates mainly in the Hythe and Totton areas of Southampton. There were 149 people using the service at the time of this inspection. Approximately half of these people were receiving care under the REACT scheme. The REACT service is a reablement service offering time limited support, usually for up to six weeks, that is designed specifically to maximise the person’s independence and abilities which have been lost through deterioration in their health or following hospital admission. This care is provided under a contract with the local authority.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been appointed in January 2016 and was currently applying to the CQC to become registered. Prior to this, the service had experienced an extended period during which there had been a number of changes in management which people and staff felt had impacted upon the consistency of leadership and the support provided to the staff team.

Recruitment of care workers remained a significant challenge and this meant that some people did not always receive consistent care in line with their individual needs and preferences.

Further improvements were needed to ensure that each person had a care plan which provided detailed information about their needs and supported staff to deliver responsive care.

Recruitment practices were not always safe as we could not be assured that all of the required checks had been completed before new staff members started work.

Staff did not have all of the training relevant to their role and they had not been receiving regular supervision. This is important as it helps to ensure staff receive the guidance required to develop their skills and understand their role and responsibilities. The new manager was taking action to address this.

Staff had received training in safeguarding adults and had a good understanding of the signs of abuse and neglect. They understood their responsibility to report abuse. However it was not clear that following two safeguarding concerns, that remedial actions were taken which prevented the risk of further harm or which were in line with the provider’s policy and procedures.

Some risk assessments needed to be more robust and include more detailed guidance about how the identified risks were to be managed. Incidents were not always being effectively used as an opportunity for learning or to change practice.

People were happy with the support they received with their medicines. Medicines administration charts had been completed accurately and did not contain any gaps or omissions. However, staff were not confident about the provider’s policy for administering PRN or ‘as required’ medicines or about how they should act upon verbal instructions from people’s relatives about changes to medicines. We have made a recommendation about this.

People were supported to make their own decisions and where they lacked capacity to do so, care staff ensured the legal requirements of the Mental Capacity Act (MCA) 2005 were met.

People were asked about what assistance they needed with food and drinks when the service assessed their needs. Care workers were aware of people’s dietary needs and were able to tell us how they would identify whether a person might not be eating and drinking in sufficient quantities to maintain their wellbeing.

People were treated with kindness. They felt involved in how their care was planned and provided and felt that their privacy and dignity was respected. People felt at ease with their care workers who had developed positive caring relationships with them.

The manager had an ethos of honesty and transparency. They demonstrated a passion for delivering a more personalised service to people and for supporting and developing the staff team. Staff told us moral was improving and that the new manager was approachable and supportive. They expressed a growing confidence that the new manager would continue to make improvements.

We found three breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see the action we have asked the provider to take in the main report.

Our inspection took place over two days. On the first day we visited the agency's office and looked at documentation such as care plans, visit schedules, policies and procedures, training records, staff records, surveys and audit material. We spoke with the agency's manager and also met and spoke with a care worker and care-co-ordinator.

On our second day we met with four people and or their relatives in their homes. They told us about the service they received. We also spoke with four more care workers.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service caring?

People we spoke with told us they received the help and support they wanted. Their care and support plans were person centred. Instructions in the plans referred to choices to be offered to people such as meals and drinks and personal comfort.

Is the service responsive?

People's support needs were regularly reviewed and plans to meet them were updated and amended as necessary.

Is the service safe?

People's needs were identified before they were provided with a service by the agency as well as risks to their welfare so measures could be put in place to manage them.

The provider had business continuity plans in place for events such as lack of staff due to a pandemic or severe weather conditions.

Effective staff recruitment and selection processes were in place that ensured only staff suitable to work with vulnerable people were employed by the agency.

The agency employed enough trained and competent staff to meet people's needs.

Is the service effective?

People were asked for their consent before they received help and support and where people were unable to make decisions for themselves the provider acted in accordance with the requirements of the Mental Capacity Act 2005 and promoted people's best interests.

All the people we spoke with who used the service or their representatives told us they generally received the care and support they wanted and care workers were usually prompt when they carried out their visits.

Is the service well led?

The provider had systems in place to regularly check and monitor the quality of the service they provided and to identify, assess and manage risks to the health, safety and welfare of people using and providing it.

Appropriate arrangements were in place in relation to the support the agency provided to people with regards to their medicines. The agency had a clear medication policy. We spoke with four members of the care staff and the field care supervisor. They all told us they had received training in medication as part of their induction training, which was refreshed annually. The provider had an effective quality assurance system and they sought the views of people who used the service and their families through regular surveys.

We found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We saw that there were appropriate secure storage facilities, which enable the records to be kept confidential. Records were kept for the appropriate period of time and then destroyed securely.