Annies Homecare Services Ltd

Annies Homecare Services is a domiciliary care agency providing personal care to people living in their own houses and flats. At the time of the inspection 59 people were using the service.

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 the service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The provider had failed to make all of the required improvements since the last inspection. The provider did not have robust oversight of the quality and safety of the care people received. Risks to people’s safety were not assessed or managed appropriately. People did not always receive personalised care which reflected their individual needs and preferences. People’s care plan and risk assessment documentation was poorly completed and people’s end of life care needs and wishes had not always been considered.

The provider did not have effective processes in place to analyse and learn from complaints, accidents, and incidents in order to drive improvement. The provider had not always submitted appropriate notifications to CQC in line with their regulatory responsibilities. Employment checks were completed for all new staff; however, documentation was not always checked robustly to ensure all details were recorded.

Staff told us they did not always feel supported or listened to and we received mixed feedback about how well the provider communicated and the effectiveness of the leadership. Staff did not always feel there was an open and positive culture in the service.

The provider had made improvements to their monitoring of people’s care visits. People and relatives told us there were now enough staff available to provide support. People had not experienced missed calls, although punctuality remained an issue. The provider had implemented a new system to monitor the administration of people’s medicines. We found people’s medicines were now managed safely.

The provider worked in partnership with other health professionals in order to support people’s needs. People were not always supported to have maximum choice and control of their lives; however, staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People and relatives told us they were able to give feedback and felt comfortable discussing any concerns with the management team.

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 11 November 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

When we last inspected Annies Homecare Services on 12 October 2022, breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements. The inspection was also prompted in part by concerns received about the management of safeguarding concerns and oversight at the service. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Annies Homecare Services on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Please see the action we have told the provider to take at the end of this report. 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.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Annies Homecare Services is a domiciliary care agency providing care to people living in their own houses and flats. 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. At the time of the inspection there were 39 people receiving personal care.

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

The provider had not always ensured there were enough staff available to support people appropriately. People experienced missed and late care visits and staff did not always stay for the agreed length of time. The provider had not always kept people updated about delays and changes to their care.

People’s medicines were not always managed safely and the provider’s processes for checking the accuracy of people’s medicines records were not robust. Risks to people’s safety were assessed. However, the documentation in place about how people should be supported to manage these risks was not up to date or accurate.

The provider did not have effective systems in place to monitor the quality and safety of the service. The processes in place had not highlighted the concerns we found during the inspection and we could not be assured the provider had clear oversight of the service.

The employment checks for new staff were not always completed robustly. We have made a recommendation about the provider’s recruitment processes. We received mixed feedback about staff’s use of personal protective equipment [PPE]. We have made a recommendation about the provider’s oversight of infection prevention and control processes.

People’s relatives told us they did not always feel involved in the service and were not always confident their concerns would be responded to promptly. We received mixed feedback about the effectiveness of the culture and leadership of the service.

Staff were aware of how to keep people safe from harm and had received training in safeguarding. However, the provider did not have robust processes in place to analyse incidents and share any learning with staff in order to minimise the risk of a reoccurrence.

The provider worked in partnership with other health professionals in order to support people’s needs. Staff told us they generally felt comfortable raising concerns with the management team and were supported in their roles.

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.

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

Rating at last inspection

The last rating for this service was good (published 30 July 2018)

Why we inspected

We received concerns in relation to people’s safety, staffing, the management of medicines and the provider’s oversight of people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Annies Homecare Services on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety, the management of medicines, staffing and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report. 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.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection on 16 November 2017, we found that the provider was in breach of Regulation 9 (Person centred care), Regulation 10 (Dignity and respect), Regulation 11 (Consent), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance), Regulation 18 (staffing) and Regulation 19 (Fit and proper persons). We rated the service as ‘Requires improvement’ in safe, effective, caring, responsive and ‘Inadequate’ in well led with an overall rating of ‘Requires improvement’.

Following the last inspection, we met with the provider on 15 December 2017 to discuss our findings and asked them to complete an action plan to show what they would do and by when to improve all the key questions to at least ‘Good’.

We found significant improvements had been made to the service when we returned on 12 June 2018 and the service was no longer in breach of the Regulations. We have judged their rating to be 'Good'.

Annies Homecare Services is a domiciliary care service and is registered to provide personal care to people in their own homes. At the time of the inspection, there were 43 people using the service and 21 care staff supporting them.

There was 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.

Systems to protect and keep people safe had been improved through the review and implementation of risk assessments, medicine administration and quality assurance processes. Staff knew how to protect people from the risk of harm.

The service had improved the way in which they recruited staff and they had sufficient staff to meet people’s needs. People received their medicines safely as prescribed and the records had been improved to make the management and administration more effective. Staff had an understanding of how to minimise the risk of infection, they had been trained, and had access to personal protective equipment such as gloves and aprons.

People’s care needs had been assessed and their care plans reviewed as their needs changed. Staff had received all necessary training and supervision and they knew how to support people effectively. People were supported with a healthy diet and sufficient fluids. Staff ensured people’s healthcare needs were met. The service worked well in partnership with other professionals to ensure that people received the health care support they needed.

The service worked in line with other legislation such as the Mental Capacity Act 2005 (MCA) to ensure that people had as much choice and control over their lives as possible. The service had carried out appropriate assessments in line with legislation.

People were supported by kind and caring staff. Their independence was encouraged as much as possible while minimising any risks to help keep them safe. People felt staff gave them the time they needed and respected their dignity and privacy.

People and their relatives were very complimentary about the service. They told us they were kept involved in decision-making and had good contact with the management through visits and calls.

People received care that was responsive to their needs. Care plans had been improved as they were now written in a personalised, detailed and respectful way. There was a good complaints procedure and people had confidence that any complaints would be dealt with quickly.

Action had been taken to manage the oversight of the service and the improvements made meant it was well led and managed. People knew who the registered manager was, and had confidence in them. Staff told us that improvements had been made as a result of the inspection and they were more involved, respected and rewarded.

The quality assurance systems were working more effectively and the registered manager learnt from audits and investigations and made the necessary improvements. Confidential information was stored safely in line with data protection requirements.

Further information is in the detailed findings below.

We undertook an announced focused inspection of Annies Homecare Services on 10 November. This inspection was done to check that improvements to meet the legal requirements after our September 2016 inspection had been made. We saw that whilst some actions had been taken, there had been minimal improvements made. We therefore returned on 16 November 2017 to undertake a comprehensive inspection. We found that the service was still in breach of Regulation 17 as the required improvements had not been made. In addition, we identified breaches of Regulation 9 (Person centred care), Regulation 10 (Dignity and respect), Regulation 11 (Consent), Regulation 12 (Safe care and treatment), Regulation 18, (staffing) and Regulation 19 (Fit and proper persons). You can see what action we told the provider to take at the back of the full version of the report.

Annie's Homecare service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger adults. On the day of our inspection, 52 people were using the service.

A registered manager was 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.

People were at risk because the provider did not have robust processes in place for keeping people safe. Risks to people’s safety were not assessed or sufficiently detailed to understand their needs and to minimise risks to their health and wellbeing.

Staff were not recruited safely with the necessary checks in place and in line with the legal requirements to ensure they were safe to work with people in the community.

Medicines were not being administered or managed correctly and people were at risk of not having their medicines as prescribed and at the correct time. Investigations and lessons learnt were not always undertaken when incidents and accidents occurred. Infection control procedures were not sufficient to support staff in carrying out their role safely.

People’s needs were not holistically assessed to achieve effective outcomes for them. A system for the training and supervision of staff was in place but this was not sufficiently robust to ensure staff had the necessary information, skills and knowledge to carry out their role effectively. Staff had not received sufficient training to support people at the end of their life.

People’s capacity to make day to day decisions was not assessed or recorded and their consent about their care and support arrangements was not obtained to ensure their wishes were carried out.

People were not always treated with dignity and respect or their privacy maintained. The involvement of people and their families in the planning and decisions about their care were minimal as care plans were not person centred and did not identify people’s communication needs, wishes or views.

The management of the service was not well led. The leadership did not promote an open and positive culture. There was not a robust system in place to monitor measure and review the quality and delivery of the service or involve and engage with staff in its development.

We have made a recommendation that the provider make themselves aware of and implement the requirements of the Accessible Information Standard.

Staff had knowledge of the safeguarding procedures and were clear about the actions they would take if they saw, heard or suspected any abuse or harm to people they supported.

There were sufficient staff to care for people safely as the registered manager and other managers provided hands on care as required. The scheduling of the rotas meant that people had consistent and familiar staff.

People’s health needs were met as staff liaised well with health and social care professional. People were supported to be able to have their meals as and when they wanted them which met their nutritional needs.

Staff understood people’s day to day needs and caring relationships had developed as staff engaged with people in a kind and compassionate way. People were satisfied with the staff who provided their care and support.

People knew how to make a complaint and who to at the service and complaints were recorded and dealt with appropriately. A process was in place to seek people's views about the service either through reviews or annual surveys.

Annies Homecare Services is a domiciliary care service and is registered to provide personal care to people in their own homes. On the day of our inspection, there were 74 people using the service and 37 staff supporting them.

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.

Quality assurance arrangements were in place but there were improvements needed in relation to the review of care records and communication and involvement of staff.

The visible leadership of the service showed that person centred care was being delivered to people who used the service.

The service had appropriate systems in place to protect people from harm and uphold their rights. Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported.

People’s medicines were given to them safely and in a timely way and risks to people’s health and wellbeing were appropriately assessed and managed.

There were sufficient numbers of staff available to meet people’s needs. A recruitment process was in place to protect people and staff had been employed safely. Staff had the right skills and knowledge to provide care and support to people. Staff were supported in their role and received supervision.

People were supported to have meals of their choosing which met their nutritional needs. They were treated with kindness and respect by staff and their dignity was maintained.

Staff understood people’s needs and provided care and support accordingly. Caring relationships had been developed and people were fully involved in their care arrangements.There was a system for responding to complaints and concerns.