Archived: Ace Community Care Ltd

Ace Community Care Limited is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults and people living with dementia or a physical disability.

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 this inspection 29 people used the service.

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

People were safe because staff could recognise when people were at risk of harm and knew how report any concerns appropriately. Risks to people's health, safety and well-being were assessed, and measures introduced to remove or reduce the risks. People were supported by safely recruited staff. People’s medicines were managed safely, staff had received training and competency assessments to help ensure they were skilled in this area. Staff had received training in infection control and gloves and aprons were provided for them. The management team took appropriate actions following incidents and learning was shared with staff.

Before care delivery started assessments were undertaken to make sure the service could meet people's needs. Care plans were developed from these assessments for each person’s identified needs. Staff received training and support to enable them to carry out their roles effectively. Staff prepared simple meals for people as needed and encouraged them to take fluids to maintain their health and wellbeing. Staff and management knew people well and could promptly identify when people's needs changed and sought professional advice appropriately. Mental capacity assessments were carried out where needed to establish if people making decisions affecting their lives had the capacity to do so.

People praised the kind and caring nature of staff. People received consistent care from a small team of staff. People told us they knew about their care plans and they could decide what care and support they needed. People’s records were held securely in a locked cabinet within a locked office to help promote confidentiality. People received care and support as they wished. People told us they would be confident to raise any concerns with the management team. However, everyone we spoke with during this inspection was satisfied with the care and support they received.

The registered manager was committed to providing a high standard of care to the people they supported and understood their responsibilities under the Duty of Candour. People and staff members spoke highly of the registered manager and told us that they were always available and supportive. People told us that they were asked for their views about the quality of the service.

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 requires improvement. (Last report published 28 June 2018) 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 improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was carried out on 29 May 2018 and was announced.

The service had a registered manager. 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 the previous inspection in November 2017 the service was rated as ‘Requires Improvement’ because the provider was found not to be meeting the required standards. We had found that people had not consistently received person centred care that took account of their health and social care needs and were not involved in planning or reviewing their care. We also found that people had not always received safe care and treatment and that the provider’s governance systems were not effective because they had not identified the shortfalls we had found.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-led to at least good.

The registered manager and provider had made some improvements to how the service operated since the previous inspection in November 2017. However there were some areas that still needed further development and embedding into daily practice.

Staff members had not always received the basic core training, refresher training and meaningful supervision to support them to meet people's needs safely. People and their relatives told us that the care and support provided by staff of Ace Community Services was appropriate to meet people's needs. The service worked to the principles of the Mental Capacity Act (2005) which provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. People were provided with prompting where needed to have a healthy diet and fluid intake. People’s health care appointments and health care needs were managed by themselves or their relatives.

At the previous inspection in November 2017 we had found that people's care plans contained limited guidance for staff to be able to support people with person centred care. At this inspection we found further development was necessary to help ensure that staff had all the information they needed to provide people with safe care and support. People told us that they, or their relatives where appropriate, had been involved in planning and reviewing their care needs. All people and relatives that we spoke with during the course of this inspection were confident that the registered manager would take the necessary actions to manage any complaints raised with them.

At this inspection we found that some improvements had been made but further work was necessary to implement a robust system of meaningful audits and provide a comprehensive training programme and system of competency assessment so that the provider and registered manager could satisfy themselves that people received safe care and support. Increase in staffing meant that the registered manager had dedicated time to undertake routine spot checks, audits and monitoring as part of their managerial responsibilities. People who used the service and their relatives provided positive feedback about the service and how it was managed. The management team took action to address concerns raised by people who used the service or staff members. The registered manager had a system to collect data on missed or late calls which meant they had a clear overview of how the service was performing. Quality assurance surveys were distributed to service users, their relatives and staff to gather their views on the service provided.

A recent recruitment campaign had been successful in attracting more staff to work for the provider and this had resulted in no missed or late calls since the previous inspection. People’s medicines were managed safely. Staff confirmed they had received safeguarding training and were clear that they would report any concerns however, they did not demonstrate an awareness of who the lead agency was for safeguarding matters. Risk assessments were undertaken to help staff provide safe and effective care. People were protected from the spread of infection. Safe and effective recruitment practices were followed to help make sure that all staff were of good character and suitable for the roles they performed at the service.

People’s relatives praised the staff team for the care and support they provided for people. People, or their relatives where appropriate, had been involved with developing people’s care plans. People who used the service were positive about the relationships they had formed with staff and the care they received. People and their relatives told us staff were respectful and protected and maintained people`s privacy and dignity when offering care and support. Staff members respected and maintained confidentiality by not discussing people's care outside of work or with anyone not directly involved in their care. People's care records were kept securely in the provider's office to help ensure that they could only be accessed by people authorised to do so.

This announced inspection took place between 4 October 2017 and 6 November 2017.

Prior to the inspection we received information of concern that the service did not have enough staff and subsequently, some people had experienced missed care visits. However, the provider told us of their on-going staff recruitment programme. Some of the staff in West Hertfordshire had told us that some of the people using the service did not always receive good quality care, and they were concerned that the registered manager did not take appropriate action to ensure that improvements were made. We looked into the issues during the inspection and we found the provider was not meeting five regulations. This was because they did not always have sufficient staff to provide safe care, and people's care records lacked detailed information to enable staff to provide person centred care. Additionally, potential safeguarding incidents had not been reported to relevant organisations, and the registered manager did not always complete audits to assess and monitor the quality of the service.

You can see what action we told the provider to take at the back of the full version of this report.

The service had a registered manager. 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. However, the registered manager required more support to understand her role and responsibilities in relation to her registration with the Care Quality Commission.

People told us they were safe because they were supported well by care staff. Staff told us that they had been trained on how to protect people from abuse, but the training records were not organised in a way that enabled us to check that all staff had been trained. People had risk assessments in place, but records had not always been updated in a timely way to evidence that these remained relevant to people’s needs. Staff’s recruitment records were not always up to date and for one member of staff, there was no evidence in their file to show that concerns recorded in their Disclosure and Barring Service report had been assessed. Although people told us their medicines were managed safely, medicines administration records had not been formally audited to identify any potential errors.

People told us they were supported effectively by their regular staff, who knew their needs well. However, we could not be certain that staff had been supported to acquire skills and knowledge necessary to support people well because the staff training records were not up to date. Staff also told us that the training provided was not of good quality. We have made a recommendation that the service finds out more about training for staff, based on current best practice guidance.

The requirements of the Mental Capacity Act 2005 were being met and people told us that staff asked for their consent before providing care. People were happy with how they were supported with food and drinks. Where required, the service ensured that people had been supported to access healthcare services and equipment they needed to maintain their health and wellbeing.

People told us that staff were kind and caring. They also said that staff treated them with respect, and supported them to maintain their independence as much as possible. People made choices about how their care was provided and they valued staff’s support. People had been given information about the service and they knew how to contact the registered manager if they needed to.

Care plans were not always up to date and reviewed in a timely way. We discussed this with the provider and they said they would resolve this issue.

Although most people were complimentary about the caring nature of the registered manager and staff, they said that concerns about inadequate staffing and poor performance by some of the staff were not always dealt with quickly. We found the provider did not always provide opportunities for people to provide formal feedback about the quality of care.