Archived: ASK Home Care Limited

Updated 31 May 2019

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.

This inspection took place on 13, 14 and 15 November 2018. The first day of the inspection was unannounced, and the second and third days were announced. Two inspectors carried out the inspection.

The inspection was partly prompted by information received from other agencies which indicated potential concerns about the management of risk in the service. Incidents have been brought to the attention of the police and the local safeguarding authority, and CQC is dealing with some areas of concern, separate to the inspection process, which may be subject to criminal investigation.

We sometimes ask providers to send us some key information about the service, what the service does well and improvements they plan to make. On this occasion we did not ask the provider to send us the information and took this into account when we inspected the service and made the judgements in this report.

During the visit we spoke with two people who used the service, one person who had ceased using the service the week before the inspection, a relative, three members of staff and two registered managers. We looked at documents and records that related to people’s care and the management of the service.

Updated 31 May 2019

This inspection took place on 13, 14 and 15 November 2018. The first day of the inspection was unannounced, and day two and three were announced. At the last inspection in July 2017 the service was rated as requires improvement; one domain was inadequate; three domains were requires improvement and the caring domain was good. We found the provider was breaching four regulations which related to safe care and treatment, supporting staff, recruitment of workers and governance. At this inspection we found the provider was still in breach of the same four regulations and an additional five regulations, which related to safeguarding people from abuse, person centred care, requirements relating to registered managers, notifying CQC about changes and notifying CQC about other incidents.

ASK Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to people with physical disability and older adults. At the time of the inspection two people were using the service. The provider was operating from a different location to the registered location. Therefore, the inspection did not take place at the registered location. CQC is dealing with this separate to the inspection process.

Two registered managers were 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.

At this inspection we identified people were not safe. Risk was not well managed and concerns around people’s safety were not identified. People told us staff usually arrived on time and the same staff usually visited but the provider did not carry out robust pre-employment checks so could not be sure staff were suitable. Medicines were not managed safely.

Staff and the management team understood they had a responsibility to report safeguarding concerns to the local authority, however, they did not follow this in practice when safeguarding concerns were raised. Sometimes people paid for their care in cash but were not given receipts. There was no record of the payments. This meant people’s money was not protected.

Some staff had received training but not all. There was a lack of staff support and supervision which meant staff might not be equipped with the relevant knowledge and skills.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not support this practice because there was a lack of information to show people were enabled and supported to make decisions about their care. People did not have care plans and staff were not recording the care that was being delivered which meant people’s well-being could not be monitored.

The provider did not have overall responsibility for meeting people’s health and nutritional needs but where they had offered support, people felt this had been appropriate. People were complimentary about the staff who looked after them. Their views varied about how effectively the provider dealt with concerns.

There were widespread and significant shortfalls in the way the service was led. The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement. The provider did not have guidance to follow which ensured the met certain standards.

The service did not show honesty and transparency from all levels of staff and management. During the inspection we found the provider was operating in such a way that made it difficult for others to see what service was being provided. Both registered managers did not act with integrity and blamed each other for things going wrong. They were dishonest when responding to questions about the service.

We found nine breaches of the Health and Social Care Act 2008 (Registration) Regulations 2009 and (Regulated Activities) regulations 2014. 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.

The overall rating for this service is ‘Inadequate’ and the service therefore is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.