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Inspection carried out on 6 July 2017

During a routine inspection

We undertook this announced inspection on 6 July 2017.

During our last inspection in August 2016 we found the provider was not meeting all the required Regulations. The provider did not make reasonable adjustments to care plans to enable people who used the service to receive their care when needs had changed and did not monitor and improve the quality and risks in relation to the health and welfare of services users. We found during this inspection that the provider had taken appropriate actions to address the requirements made.

AK Care Services Limited is a small domiciliary care agency providing care and support to four people living in their own homes. The agency had five care workers employed. The agency refers to care workers as personal assistants.

The agency had a manager registered with the Care Quality Commission (CQC). 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.

Staff demonstrated good understanding in how to recognise and report abuse and told us that they were confident that the provider would deal appropriately with allegations of abuse in relation to people who used the service.

People’s risk was managed appropriately, risk assessments reflected people’s needs and had been reviewed if people’s risk had changed.

People who used the service praised the provider’s flexibility to accommodate their requests to change calls and ensure the same care workers were allocated. Robust recruitment procedures ensured that all staff had been vetted appropriately prior to working with vulnerable people.

At the time of our inspection none of the people who used the service required any support with taking their medicines.

Care workers were provided with regular supervisions and appraisals to discuss and plan their development and training. Training was provided to care workers to ensure they had the necessary skill and knowledge to support people who used the service.

On occasions care workers helped people to prepare meals, however, all people were able to eat their meals without assistance.

Care workers had contacted the office if people’s health care needs had changed and on the person’s request accompany people to health appointments.

People told us that they had good relationships with the care workers who listened to their requests and provided caring and understanding support.

Care plans were reviewed regularly and had been updated if people’s needs had changed. People who used the service or their relatives had been involved in this process.

People told us they knew how to raise a complaint, but had currently no concerns regards to the treatment or care provided.

Regular spot-checks and surveys ensured people were able to comment on the care provided and suggest changes if required to improve the quality of care provided.

Inspection carried out on 25 October 2016

During an inspection to make sure that the improvements required had been made

We carried out an announced comprehensive inspection of AK Care Services Limited on 4 August 2016. We found two breaches of legal requirements and sent the provider and registered manager two warning notices. We send warning notices to a registered person where the quality of the care they are responsible for falls below what is legally required. Legal requirements can include the Health and Social Care Act 2008 (‘the Act’) and the regulations made under it, but also other legislation that registered persons are legally obliged to comply with in delivering the service.

The registered provider and the registered manager did fail to review risk assessments and did not put robust risk management plans in place to mitigate such risks from happening in the future. This was a breach of regulation 12(1)(2)(a)(b) of the Health and Social Care (HSCA) 2008 (Regulated Activities) Regulations 2014. We asked the registered provider and registered manager to comply with this breach by 20 September 2016

The registered provider and the registered manager did not provide appropriate training, professional development, supervision and appraisal to enable persons employed to carry out their duties they are employed to perform. This was a breach of regulations 18(2)(a) of the HSCA 2008 (Regulated Activities) Regulations 2014. We asked the registered provider and registered manager to comply with this breach by 30 September 2016.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches by 30 September 2016.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for AK Care Services Limited on our website at www.cqc.org.uk.

AK Care Services Limited is a small domiciliary care agency providing personal care to six people living in their own homes. The agency also provides live-in support. The agency has currently six care workers employed. The agency refers to care workers as personal assistants.

The agency has a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the HSCA 2008 and associated Regulations about how the service is run.

We found that since our comprehensive inspection the registered provider had reviewed all risk assessments and put robust risk management plans in place to ensure risks to people who used the service were minimised.

Since our comprehensive inspection the registered provider ensured that personal assistants had received one supervision and annual appraisal and outstanding training was provided. This ensured that personal assistants received the support and had the necessary skill to support people in their home.

Inspection carried out on 4 August 2016

During a routine inspection

This announced inspection took place on 4 August 2016.

During our last inspection in August 2015 the provider was in breach of Regulation 12 Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 Safe care and treatment. The provider had not reviewed risk assessments when people’s needs changed and robust management plans were not in place to mitigate such risks. The provider was also in breach of Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2014 Safeguarding service users from abuse and improper treatment. Staff had not received regular updates in safeguarding adults training and were not able to recognise the different signs of abuse and how to report suspected abuse to ensure vulnerable people were safe. The provider was also in breach of Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2014 Staffing. The provider was unable to demonstrate that staff members had received appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to do.

An action plan of the breaches identified at the last inspection was sent to the CQC on 19 November 2015. The registered provider told us that risk assessments would be reviewed and updated by 30 April 2016 and all care workers will receive up to date professional development, supervision and appraisal by 31 May 2016.

AK Care Services Limited is a small domiciliary care agency providing care and support to six people living in their own homes. The agency also provides live-in support. The agency has currently six care workers employed. The agency refers to care workers as personal assistants.

The agency has a manager registered with the Care Quality Commission (CQC). 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 that care workers were able to demonstrate to us how to report abuse and were able to tell us the different forms of abuse. However, the provider continued to fail in providing safeguarding adults training to care workers.

People were put at harm and risk as no improvements had been made in providing robust risk management plans to mitigate such risks. Risk assessments had not been reviewed to respond to peoples changing needs.

Care workers were not receiving regular training updates, supervisions and appraisals. This meant that people using the service were at risk of care being not effective, due the care workers not having the appropriate skills.

Care plans were in place, which were based on peoples’ assessed needs and people who used the service or their relative were able to contribute in the care planning process. However, the provider failed to review these at regular intervals and respond to people’s changing needs. We did not find evidence that quality assurance monitoring was being carried out regularly, that would have helped identify the shortfalls we found during the inspection. For example regular spot checks had not been carried to monitor the quality of care.

People told us they felt safe. Care workers knew how to keep people safe from abuse. They knew how to recognise abuse and who to report to and understood how to whistleblow. Whistleblowing is when someone who works for an employer raises a concern which harms, or creates a risk of harm, to people who use the service.

Recruitment and selection procedures were in place. Checks had been undertaken to ensure care workers were suitable for the role.

Care workers demonstrated understanding of how to obtain consent form people who used the service. People and their relatives told us that they were involved and consulted about their care.

People to

Inspection carried out on 27 August 2015

During a routine inspection

This comprehensive inspection took place on 27 August 2015 and was announced.

This was the first inspection since registering with Care Quality Commission (CQC) on 21 August 2014. However the provider was previously registered in a different London Borough and has moved offices to a new location.

AK Care Ltd is a small domiciliary care agency who provides care and support to older people and people with learning disabilities living in their own home. During the day of our inspection the agency provided care to ten people in their home provided by nine care workers. The agency has a manager registered with the CQC. 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’s safety was compromised because there was limited evidence that actions were in place to ensure that they were safeguarded from risk or abuse. The staff training records that we saw indicated that a number of staff members had not received safeguarding training. We also found that the safeguarding procedure did not include all relevant information. Risk assessments did not always reflect risks that had been identified in other areas of people’s care documentation. People’s human rights were protected and the service was diligent with ensuring that the requirements of the Mental Capacity Act (2005) were complied with. However we noted that care workers had not received training in the Mental Capacity Act 2005.

We looked at the training records of care workers. We saw while staff had received training during their induction, there was no evidence that care workers had received refresher training to keep their skill and knowledge up to date. We found that staff appraisals were happening annually and staff had development objectives set, arising from the appraisal system.

From the discussions we had with people using the service and relatives we found that people were satisfied with the way the service worked with people. There was confidence about contacting staff at the service to discuss anything they wished to and care workers were thought to be knowledgeable and skilled. People felt that there was honesty in the way the service communicated with them.

We saw that medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately.

During our review of care plans we found that these were tailored to people’s unique and individual needs. Communication, methods of providing care and support with the appropriate guidance for each person’s needs were in place and regularly reviewed.

We found that staff respected people’s privacy and dignity and worked in ways that demonstrated this. From the conversations we had with people and records we looked at, we found that people’s preferences had been recorded and that staff worked well to ensure these preferences were respected.

Records which we viewed showed that people were able to complain and felt confident to do so if needed. People could therefore feel confident that any concerns they had would be listened to.

People who used the service, relatives and stakeholders had a range of opportunities to provide their views about the quality of the service. We found that the provider took this process seriously and worked hard to ensure that people were included and listened to.

We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.