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A & K Home Care Services Ltd Requires improvement

Reports


Inspection carried out on 15 December 2020

During an inspection looking at part of the service

About the service

A & K Home Care Services Ltd is a domiciliary care agency that provides personal care to older people who are living in their own homes. At the time of our inspection visit, 46 people were being supported by 19 members of care staff.

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

Safeguarding systems and processes had improved and were in place to protect people from avoidable harm. Risks management required improvement to ensure people always received safe care. The recruitment process to check staff were of a suitable character to work with vulnerable people needed improvement. Staffing and resources were not always sufficient to ensure people received their scheduled call times at agreed times, and for the length of time agreed. Infection control procedures were not consistently followed to ensure people were protected from the risks of infection and cross contamination.

People who required support to take their medicines told us they received their medicines as prescribed.

The registered manager was able to demonstrate staff had received training to fulfil their role, although manual handling training techniques needed to be improved. People's needs, wishes and preferences had been assessed before they received support from the service.

People were not supported to have maximum choice and control of their lives, as the provider did not always follow the requirements of the Mental Capacity Act (2005). The provider did not have systems and processes to ensure people were supported in their best interests.

People, relatives and staff told us communication and the management of the service could be improved. Checks were not always effective in ensuring people had up to date care records.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection and update

The last rating for this service was requires improvement (published 24 September 2019) and there were multiple breaches of regulation. We found there was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safeguarding service users from abuse and improper treatment and a breach of Regulation 17 Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found the provider had completed actions on their action plan, and there was no longer a breach in Regulation 13. However, we found there continued to be a breach of Regulation 17 Good Governance.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those 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 remained as Requires Improvement.

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

Enforcement

We have identified two breaches in relation to safe care and treatment and good governance. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 23 July 2019

During a routine inspection

About the service

A & K Home Care Services Ltd is a domiciliary care agency that provides personal care to older people who are living in their own homes. At the time of our inspection visit, all thirty-five people being supported by the service received personal care.

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

Safeguarding systems and processes were not robust to protect people from avoidable harm. Despite this, people told us they were safe.

Risks to people’s health and well-being were not always identified or managed .

The recruitment process checked employees were suitable for working with vulnerable people.

People and relatives told us care calls had been later than agreed which had caused them concern. However, most people told us staff arriving on time to scheduled calls had recently improved.

People who required support to take their medicines told us they received their medicines as prescribed. However, systems and processes did not always demonstrate this.

The registered manager was unable to demonstrate staff had received enough training to fulfil their role. People and relatives confirmed staff followed good infection control practices.

People's needs, wishes and preferences had been assessed before they received support from the service.

Staff ensured people had enough to eat and drink.

People told us they made daily decisions about their care. 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 told us staff were caring and kind and treated them with dignity and respect.

Some people and relatives told us the service had been flexible and responsive to their needs.

People and relatives confirmed any concerns raised had been resolved, but no records of complaints had been maintained to ensure lessons were learned.

Checks had not always been completed to ensure people using the service received high quality, compassionate care. Significant changes in office and supervising staff over the past 12 months had impacted on the effectiveness of the provider’s oversight and governance.

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 good (published 07 March 2017).

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed now from good to requires improvement. 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 & K Home Care Services Ltd on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Enforcement

We have identified two breaches in relation to safeguarding service users from abuse and improper treatment and governance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 26 January 2017

During a routine inspection

We inspected A & K Home Care Services on 26 January 2017. The inspection visit was announced two days before we visited so we could be sure the manager was available to speak with us. This was the first time the service had been inspected.

A & K Home Care is registered to provide personal care and support to people living in their own homes. There were 29 people using the service at the time of our inspection visit. The service offered support to people dependant on their specific needs, some people received one call a day; other people received four calls each day.

A requirement of the provider’s registration is that they have a registered manager. 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection visit who was also the provider. We refer to the registered manager as the manager in the body of this report.

Staff received training in safeguarding adults and understood the correct procedure to follow if they had any concerns about people’s safety. All necessary checks had been completed before new staff started work to make sure, as far as possible, they were safe to work with people. The manager and staff identified risks to people who used the service and took action to manage identified risks and keep people safe.

There were enough staff employed at the service to care for people safely and effectively. People were supported by a staff team that knew them well. New staff completed an induction programme when they were employed to ensure they had the skills they needed to support people effectively. Staff received refresher training and had their practice observed to ensure they had the necessary skills to support people. Staff had regular meetings with their manager in which their performance and development was discussed and development plans were agreed.

People’s care was planned with them, and with the support of their relatives and staff at A & K Home Care. This helped to ensure care matched people’s individual needs, abilities and wishes.

The manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their choices and freedom.

Staff were described as being caring and kind. Staff respected people’s decisions to make their own choices and supported people to maintain their independence.

People were supported with their health needs and had access to a range of healthcare professionals where a need had been identified. There were systems in place to administer medicines safely. People were supported to prepare food that took account of their preferences and nutritional needs.

People who used the service and their relatives, were encouraged to share their views about how the service was run. People knew how to make a complaint if they needed to. Feedback gathered by the provider from people and their relatives was used to drive forward improvements.

Quality assurance procedures were in place to ensure the quality of the service was maintained. These included regular checks of people’s care plans, medicines administration and staff’s practice. However, some audit checks had not been completed recently, due to a vacancy for a deputy manager. The vacancy was being recruited to at the time of our inspection visit.

Accidents and incidents were monitored and investigated, and actions were taken to minimise the risks of a re-occurrence.