Acute Need CIC

About the service

Acute Need CIC is a domiciliary care agency providing personal care for people living in their own homes. At the time of our inspection there were 8 people using the service.

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

Right Support:

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. People had a choice in who supported them; staff knew people well and trusting relationships had been formed.

The support people received enabled them to maintain their employment and also to pursue leisure interests in their local area. The provider demonstrated a commitment to offering opportunities for people to reduce the risk of experiencing social isolation. Through the support offered there was also a real focus on supporting people to develop independence skills in all aspects of their life.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity, understanding and responding to their individual needs.

People received good quality care and support because appropriately trained staff could meet their needs and wishes. People could communicate with staff and understood information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the registered managers and staff employed. The provider had clear and effective governance systems in place which identified and managed risks through audits and regular reviews of people’s support. People receiving support, and those important to them, were fully involved in the development and review of their support.

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 26 July 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Acute Need CIC is a domiciliary care agency providing personal care for people living in their own homes. The service provides care and support to people who have an acquired brain injury and or a physical disability. At the time of our inspection there were 13 people using the service across the North West of England.

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

The provider was operating parts of this service outside of the regulatory framework. The provider had not applied to be registered with the CQC for all the regulated activities taking place. The CQC assesses the suitability of applicants to safely provide the relevant regulated activity upon application, this had not taken place. The legal responsibility to ensure the service is appropriately registered rests with the provider and the registered manager.

We were not assured the registered manager and provider had appropriate governance arrangements in place, to assess, monitor and ensure safe clinical practice. We raised two safeguarding alerts with one local authority regarding this.

The systems in place did not always ensure as much as possible that people were safeguard from the risk of abuse. Staff recruitment systems were not robust and the providers oversight of the safety of clinical tasks was not effective.

The service had pockets of differing approaches, style and cultures within the teams built around people. In some areas they were thoughtful, inclusive and empowering. However, there was also areas of disempowering and demeaning practices at times. The provider had not ensured there was a consistently positive and empowering culture across all aspects of people’s support.

The provider had not consistency followed the principles of the Mental Capacity Act. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the practices taking place at the service did not uphold people’s rights in accordance with the Mental capacity Act 2005.

On multiple occasions we had to ask for information in order to complete our inspection. At times information that was given to the CQC was not clear, straightforward or was presented in an ambiguous manner.

Feedback from people’s family members was mostly positive. Some people’s family members told us about person centred care that their relatives had received which had supported them to achieve good outcomes. One person’s relative told us, “The service is excellent, I can’t fault it.”

There were systems in place to help ensure people received their medication safely. People and their family members told us they were well supported by Acute Need CIC during the COVID-19 pandemic.

People were supported to access healthcare services and to be as healthy as possible. Staff had been proactive when supporting people to access healthcare services.

It was evident that care staff cared about and had warm and positive relationships with people. We also saw that the provider and registered manager had warm relationships with people.

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 outstanding (published 10 January 2019).

Why we inspected

The inspection was prompted in part due to safeguarding concerns shared by a local authority. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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.

At this inspection, we have identified breaches in relation to protecting people’s rights under the Mental Capacity Act 2005 and keeping records of decisions made on behalf of people; ensuring that safe recruitment practices were in place for new staff; ensuring the system for providing and monitoring staff training was effective; and failing to ensure there was an effective system in place to assess the safety, quality and regulatory compliance of the service.

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

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.

People’s experience of using this service:

People were supported to live enriched lives and did what they chose. Staff encouraged them to be as independent as possible whilst ensuring they remained safe. A proactive approach was taken to anticipating and managing risk to people to ensure they remained safe. People were encouraged and supported to take positive risks to allow for an unrestricted and meaningful life. Staff showed an excellent understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received medication at the right time. People told us they felt extremely safe whilst being supported by staff and felt able to live a safe, fulfilled life.

A holistic approach had been adopted in the assessing, planning and delivery of people’s care and support. Care plans were extremely detailed and identified intended outcomes for people. Staff provided excellent care and support that was met in a way people preferred and provided consistent and positive outcomes that exceeded expectations. Staff worked hard to provide a consistently better quality of life for people by supporting them to develop in areas such as communication, social interaction, education and independence. People spoke highly of the support provided and told us how they had achieved improvements in their own abilities, independence and confidence.

People and family members spoke enthusiastically about how consistently kind and caring staff and managers were. Staff were highly motivated to provided a person-centred culture and delivered care in a kind and compassionate way that was based on people’s preferences. The management team and staff had developed strong familiar relationships with people and family members and were described as ‘going above and beyond’ in order for them to live an excellent quality of life. People and family members told us staff had become more like friends and family and spoke highly of the support they provided not only to people but those close to them.

The leadership of the service demonstrated a high level of experience and capability to deliver excellent care; they were extremely knowledgeable and inspired confidence and passion in the staff team. They promoted a culture that was extremely person-centred and inclusive and which provided high-quality care with good outcomes for people. The management team placed strong emphasis on the importance of not only supporting people but their family members also. They were described as supportive and approachable and always putting the needs of people first. They showed a continued desire to improve on the service and worked closely with other agencies and healthcare professionals to do this. Effective systems were in place to check on the quality and safety of the service and improvements were made when required.

Rating at last inspection: Good (report published 17 March 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved on the quality of care provided and has been rated outstanding overall.

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

Acute Need CIC is a Domiciliary Care Agency located in St. Helens, Merseyside. The service is registered with the Care Quality Commission for the regulated activity of personal care .The agency currently employ staff to provide care and support to five people who live in their own homes across the Merseyside area. The amount of support people receive varies depending on the person’s individual needs.

There is a registered manager at Acute Need CIC. 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.

The registered manager has managed the service since it commenced in 2008. He was knowledgeable and inspired confidence in the staff team. Both he and the registered provider had a proactive approach to developing a positive culture in the service.

Staff were recruited in a safe way and full employment checks were completed before they started work in the service. Staff were well trained. They also had supervision and support systems in place to ensure their practice was monitored and they were able to develop skills and knowledge. We saw that staff had competed safeguarding training and knew what to do to keep people safe from abuse or harm. There were policies and procedures available for additional information and guidance.

We found people’s care was delivered safely and in a way of their choosing. They were supported in a manner that reflected their wishes and supported them to remain as independent as possible.

People praised the staff for their kindness and consideration and were happy with the care and support they received.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) legislation. Documentation on people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. We saw information to show that the service understood their responsibilities as a domiciliary care agency and would make an application to the court of protection if people were thought to be deprived of their liberty. They did this to make sure that people’s legal rights were protected. Staff worked with other health care professionals when ‘best interest’ decisions had to be made on behalf of people using the service.

We observed the culture of the service was one of openness and sound values based on putting the people who used the service at the centre of the services they provided. There was a quality monitoring system to enable checks of the services provided to people and to ensure people were able to express their views so that any improvements identified could be addressed.

The registered manager was seen as a good leader by both staff and people using the service. He was trusted and had created a strong sense of commitment to meeting people’s diverse needs and supporting staff.