Background to this inspection
Updated
14 April 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We visited the office on the 22 and 23 of June 2017 and the 11, 18 and 19 of July 2017. We visited people in their homes and made calls to staff, professionals and people throughout our inspection up to 27 July 2017. The provider was given notice of our inspection because the location provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be at the office to assist us to arrange home visits. The inspection was carried out by two inspectors and two specialist advisors. Both specialist advisors had expertise in safeguarding, the Mental Capacity Act 2005 and risk management in community settings.
Before the inspection we reviewed information we had about the service. This included notifications from the provider; a notification is the way providers tell us important information that affects the care people receive. Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed this information before we visited the service.
We spoke with four people in their own homes and observed interactions with four members of staff. We also spoke with people who used the service or their relatives by telephone. In total we spoke with 15 people and six relatives. We spoke with 14 care staff, 15 staff responsible for organising, setting up care and supporting people and care staff. We also spoke with the registered manager, operational director and the director of customer services. We also spoke with two social care professionals and two health professionals. We reviewed records relating to 33 people’s care and support. We also looked at records related to the management of the service. This included 10 staff files, training and supervision records, accident and incident records and audit documentation.
Updated
14 April 2018
This announced inspection took place between the 22 June 2017 and 27 July 2017. It was carried out by two inspectors and two specialist advisors. Agincare Live- In Care Service is registered to provide personal care to people living in their own homes. At the start of our inspection the service provided personal care and support for 236 people living all over the country.
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.
We carried out an announced comprehensive inspection of this service in November 2015. After that inspection we received concerns in relation to how people were being protected from abuse and neglect. As a result we undertook a focused inspection to look into those concerns. This was extended to a comprehensive inspection as additional risks were identified.
Staff skills were not appropriately checked and this meant the provider and people could not be assured that staff had the skills and knowledge to care for the safely.
People were supported by staff who had been trained in how to respond to abuse, but the staff in the office had not received this training and safeguarding concerns were not always identified and addressed appropriately. Notifications that the service was legally required to make to the CQC had not always been made when abuse had been alleged.
People told us they received their medicines safely, however the systems were not always operated effectively to support the safe administration of medicines and staff competency was not sufficiently assessed.
Care staff had received training in the Mental Capacity Act 2005 (MCA). However staff did not all understand and implement the principles of the MCA and this meant people were at risk of not having their human rights respected.
People mostly had their privacy and dignity maintained although systems to return records to the office did not protect people’s confidential information.
People had been involved in developing individual care plans which took into account their likes, dislikes and preferences. These care plans and records covered people’s social, emotional and health needs including access to health care. These were not always updated effectively and this put people at risk of receiving inappropriate care.
There was a clear management team and staff had defined roles and responsibilities that supported providing person centred care. There was not sufficient capacity in this team to ensure the efficacy of the oversight systems and issues identified during our inspection had not been picked up by internal quality assurance.
People knew how to make a complaint and where they had made complaints these had usually been responded to appropriately. We found examples of learning opportunities from complaints.
People were comfortable with most staff and, where they had regular care staff, had formed positive relationships. They told us they were usually cared for by staff who treated them kindly and with respect.
CQC has taken action to vary the provider’s conditions of registration. The provider is required to submit a report to CQC on a monthly basis, setting out the action take to address shortfalls in risk management, protecting people from abuse, staff competency and deployment and quality assurance.