Archived: A&R Guardian Services Limited

A&R Guardian Services Limited is a domiciliary care service. The service provides care and support to people living in their own homes. At the time of the inspection there were 40 people using the service

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 considers any wider social care provided.

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

People and relatives told us they would recommend the service to others. People were supported by sufficient numbers of reliable staff to meet their needs. This contributed towards them feeling safe.

Risks to people had been assessed including the environment in which they were cared for. People’s care plans had been personalised, provided clear guidance for staff to promote their safety and were kept under review. People were supported with their medicines safely whilst promoting maximum choice and control of their lives.

Staff recruitment processes had been strengthened. Staff training had been updated in relation to promoting people’s safety and wellbeing and the infection prevention and control procedures.

The provider’s business continuity plan had been updated in response to the COVID-19 pandemic and had adopted the government guidance to operate a safe service. Staff were trained in the correct use of personal protective equipment (PPE). People were informed about the actions being taken and their individual needs had been considered and kept under review.

The provider had made improvements to the quality assurance systems and processes. The changes to the managerial structure provided clearer responsibilities to monitor the quality of service and to drive improvements. People’s views about their care and the service were sought in a variety of ways. Systems were in place to monitor people’s care, staff performance and safety including incidents, accidents and complaints so action could be taken. The provider had invested in electronic call monitoring system and care planning, accessible to staff using their hand held devices and provided real-time monitoring.

People spoke positively about the registered manager who they found to be responsive, supportive and approachable. The registered manager and provider were aware of their responsibilities in meeting their legal obligations. They worked in partnership with health care professionals and local authorities responsible for monitoring people’s packages of care.

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 (published 26 March 2020).

We carried out an announced comprehensive inspection of this service on 17 February 2020. A breach of legal requirement was found. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check improvements had been made and that they now met the legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contained the requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A&R Guardian Services Limited on our website at www.cqc.org.uk.

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.

A&R Guardian Services Ltd is a domiciliary care agency providing personal care to people living in their own homes. At the time of inspection 39 people were receiving personal care services.

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

Although audit checks took place these did not cover all key aspects of the service and did not always identify and follow up on issues, for example, inconsistent recording on medicine charts. Quality assurance checks did not cover care and staff files, which meant some gaps had not been picked up prior to inspection. Systems needed strengthening to ensure effective oversight of staff supervision/appraisal and training timescales as these were overdue for some staff. MCA assessments had been completed but did not cover all areas required.

Recruitment processes were in place to ensure staff were suitable for their roles but there were some information missing from recruitment files. All staff had up to date checks from the disclosure and barring service (DBS). Some staff were overdue refresher training and supervision. Spot checks took place and staff felt trained to carry out their roles.

Aspects of medicines recording required strengthening, along with additional information needed about the medicines people took on an 'as and when required' basis. Where people needed support with medicines this was provided by trained staff.

Mixed feedback was received about the punctuality of call times, although visits always took place and lasted the right length of time.

People had a range of care and risk support plans in place, which were comprehensive and up to date. However, reviews of people’s care were not fully recorded Staff had a good understanding of people’s wishes and individual routines. People’s personal preferences, likes and dislikes, communication needs and links with family were all considered within the care plans.

Where required, people were supported with their eating and drinking to ensure their dietary requirements were met. People were supported to use health care services when needed.

People received support from reliable, compassionate staff. Staff enjoyed working at the service and there was good communication and team work. Staff were caring in their approach and had good relationships with people and their relatives. People were treated with respect. Staff maintained people’s dignity and promoted their independence. Consent was sought before care was delivered.

Feedback was sought from people and their relatives informally and through annual surveys.

The service worked in collaborative and proactive partnership with other agencies and professionals, positive feedback confirmed this.

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.

Rating at last inspection

The last rating for this service was good (published 9 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to good governance of the service. Although a range of quality assurance processes were in place, these did not cover all key aspects of the service and at times were not fully effective in identifying issues and following up where necessary. We could not be assured the registered manager had effective oversight of all aspects of the running of the service.

Follow up

We will request an action plan from the provider to understand their plans for implementing effective quality assurance processes. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A&R Guardian Services Limited is registered to provide personal care and support to older people living in their own homes. The office is based in the city of Leicester. At the time of our inspection there were 15 people using the service and six care staff employed. People’s packages of care varied dependent upon their needs.

This was our first inspection of the service since they registered with us on January 2016.

A registered manager was 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 found further action was needed to ensure that people received the support they needed to make decisions about their care. Records did not demonstrate that appropriate Mental Capacity Assessment (MCA) and best interest decisions made had been documented. Although staff recognised the importance of gaining people’s consent their knowledge on the MCA varied. The registered provider was working with the local authority commissioner for support and to confirm the training dates.

Risks associated to people’s health and safety and risks within their own home had been assessed. Measures to protect people from avoidable harm were not always accurately reflected. However, when raised with the registered provider they amended the care plans to ensure staff had clear guidance for follow in order to support people to stay safe.

Staff were provided with appropriate uniforms. Some adjustments had been made to staff uniform to ensure people’s safety was not compromised whilst respecting staff’s diversity. To further assure people’s safety, the registered provider told us they would carry out unannounced spot checks and take action as required.

People said they felt safe. Staff knew how to report any concerns of abuse or harm they identified when they visited people. People were supported with their medicines in a safe way.

People’s safety was promoted by the provider’s recruitment processes. There were sufficient numbers of staff employed to meet people’s needs. Staff received induction and ongoing training for their role. Staff felt supported and had their work was appraised through regular meetings and their practice checked. This helped to ensure people’s needs were met effectively.

People’s rights were protected and respected. People were supported, where required to meet their dietary needs and had access to healthcare support. People were supported by a regular individual or group of staff who they knew. This helped people to develop positive relationships with staff and promote continuity of care.

People told us their privacy and dignity was respected. Staff’s approach was caring and they were knowledgeable about people's preferences and the support required to promote their wellbeing and independence.

People were involved in the development of their care plan to ensure care provided was personalised and responsive. People’s needs were monitored and reviewed. This helped ensure staff responds to people’s changing needs.

People knew how to complain and were confident that their complaint would be addressed. A complaint process was in place and staff knew how to respond to complaints.

The provider was meeting their regulatory responsibilities. There was clear leadership and communication between management, staff and people who used the service. People had a range of opportunities to be involved in the development of the service. The provider’s quality monitoring system in place was mostly effective. Following our discussion with the registered provider about our findings, they identified areas which they could improve to ensure the system would help identify and drive improvements to provide quality a service.