Archived: ASK Home Care Limited

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.

ASK Home Care Limited is registered to provide personal care to people in their own home. Twenty one people were receiving personal care at the time of the inspection. The service had two registered managers. 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 provider did not always take appropriate action to keep people safe because they did not carry out appropriate checks before employing workers. Medicines were not managed consistently and safely. Staff did not receive medicine related training and their competency was not assessed.

Staffing arrangements were planned and this ensured people received the same care workers and had regular visit times. However, staff did not receive appropriate training and support and were therefore not equipped with the knowledge and skills to carry out their role and responsibilities.

Staff were confident people were safe and said they would report any concerns to a member of the management team. Some staff had not received safeguarding training and were unsure where they would report safeguarding concerns outside of the organisation but said they would be able to find out. The registered managers said they would arrange for staff to attend safeguarding training and would ensure all staff clearly understood the safeguarding process outside of ASK Home Care Limited.

People who used the service and their relatives told us they were very happy with the service. They told us they felt safe and staff were very caring. No one raised any concerns. Staff’s caring and committed approach was a key strength of the service.

Risks to people were generally well managed through an assessment process. We have made a recommendation about the care planning process. When required people received appropriate support to make sure their nutritional and health needs were met.

Everyone we spoke with told us the service was well led and they would recommend the service to others. People were very complimentary about the management team and said they visited on a regular basis; they said they would feel comfortable raising concerns.

Quality management systems and processes were not established, which meant the lack of checks and audits did not ensure the quality and safety of services provided.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These related to management of medicines, employment of staff, supporting and training staff, and governance arrangements. You can see the action we have told the provider to take at the end of this report.