Background to this inspection
Updated
4 July 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was completed by 2 inspectors and an Expert by Experience. Two inspectors visited the location's office, and the Expert by Experience made telephone calls to people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was announced. We gave 24 hours’ notice of our visit. This was so the provider would be available to support this inspection and to tell us about the improvements they had made, since our last visit.
Inspection activity started on 03 May 2023 and ended on 10 May 2023. We visited the location’s office on 03 May 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We used all this information to plan our inspection.
During the inspection
We spoke with 2 people and 6 relatives about their experience of care provided. We spoke with 4 members of care staff, a field care supervisor, an administrator, a deputy accounts support officer, a finance director and the registered manager.
We reviewed a range of records. This included 5 people's care records, samples of medicine records and associated records of their care. We looked at records that related to the management and quality assurance of the service and risk management. We reviewed 4 staff recruitment files.
Updated
4 July 2023
About the service
A&K Home Care Services Ltd is a community-based care provider that provides personal care to people living in their own homes. At the time of inspection there were 34 people in receipt of the regulated activity of personal care. Everyone who received support at the time of our inspection 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.
People’s experience of using this service and what we found
The service has not been able to achieve a good rating since our inspection in 2017. Good care is the minimum standard of care that people receiving services should expect and deserve to receive. Since this time, the service has been inspected 5 times where it has been rated either requires improvement or inadequate. On 4 of these inspections, the provider has been in breach of the regulations, with some regulations being continually breached.
At this inspection we continued to find a lack of robust systems and processes in place to continually monitor and review the quality of care and support people received.
The registered manager and staff responsible for completing audits and checks, had limited records to show us what they had checked, what they had found, and what they had done to improve the service. Where checks had been completed, such as medicines audits, they had not identified some of the shortfalls found during our inspection.
Some people and relatives continued to raise concerns to us about the timeliness of their care calls. There were not enough suitably trained staff to ensure people received a consistently reliable service which met their individual care and support needs. Care call times continued to be significantly shorter than they should have been, with limited or no overview by the registered manager.
Staff received training to support them to undertake their role. However, this training did not always ensure staff provided safe, effective care and support. For example, some staff had not received sufficient moving and handling training.
Staff were recruited safely. Pre-employment checks were now completed in line with the providers expectations.
Overall, people received their prescribed medicines. Medicine Administration Records (MAR) showed staff had administered medication in line with people’s individual prescriptions. However, medication checks had not always identified poor medicines practices.
People felt protected from the risk of abuse and overall, felt confident in the staff who supported them in their home. Most people did not require support with eating and drinking. Where this was a need, information was provided in care plans.
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.
The registered manager told us they worked with other healthcare professionals to ensure people had access to healthcare services. Staff told us they would not hesitate in contacting a doctor if a person was unwell.
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 inadequate (published 10 February 2023). Breaches of the regulations were found. The provider continues to send us monthly action plans as per the imposed conditions on their registration which were imposed on 29 March 2021.
At this inspection we found insufficient improvements had been embedded into everyday practice. We found the provider remained in breach of the regulations.
Why we inspected
We carried out an announced focused inspection of this service on 14 December 2022. Breaches of legal requirements were found and following this visit, we took enforcement action.
We undertook this announced focused inspection to check the provider had improved sufficiently and the systems they told us they had improved, now met the legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same based on the findings from this inspection. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A&K Home Care Services Ltd on our website at www.cqc.org.uk.
Enforcement
We have identified continued breaches in relation to Regulation 17 (Good governance) and Regulation 18 (Staffing).
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.
Follow up
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 next inspect, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.