Archived: A & K Home Care Services Ltd

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.

A&K Home Care Services is a community-based care provider that provides personal care to people living in their own homes. At the time of inspection there were 42 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

At our last inspection, we found some improvements were required. At this inspection we found failure to improve the overall quality of service people received. We found the providers systems and processes to monitor the quality of the whole service people received continued to require improvements and better recording to embed systems into everyday practice.

At this inspection, we found that although the provider had made some improvements to the service, there continued to be areas of potentially unsafe or ineffective care and support. Some areas identified as improved, had not been improved consistently to minimise people from the risk of harm. We found the provider was now in breach of the regulations because effective oversight of recruitment, medicines management and quality assurance did not meet expected standards.

At this inspection, we found the provider’s ongoing action plan described some improvements, but these improvements lacked detail to ensure their sustainability. For example, risks were not always managed safely through appropriate and accurate records or evidenced that the provider had followed their own policies and procedures.

We could not be confident; some people received their prescribed medicines safely. The systems to support safe medicines practices were ineffective. Medicine Administration Records (MAR) did not always correlate with people’s care plans. It was not always clear what medicines a person had been prescribed or if staff administered them. People who required ‘as and when’ medicines did not have a protocol in place to tell staff, when, how and at what dosage these medicines should be given safely.

People were not protected from ineffective staff recruitment checks. The provider had policies to ensure staff were recruited safely and were suitable for their roles by conducting relevant pre-employment checks. However, those policies and checks were not always followed or completed before staff began supporting people. Where staff needed to have a risk assessment to support safe recruitment practices, this was not completed.

We were not confident the provider deployed sufficient numbers of suitably qualified and experienced staff to meet and support people’s assessed needs. Most people and relatives told us staff arrived later than planned and, in some cases, their care calls were cut short. Staff told us they did not always follow planned routes, and this was known by the management and office staff. Additional staff had not been allocated to ensure all calls went ahead as planned. People’s feedback to us was of a service that they could not always rely on. In some cases, people were fine with this, others felt rushed during care calls, not valued and told us it disrupted their daily plans. Overall, the majority of people and relatives were dissatisfied.

Systems of audits had not identified some of the areas for improvement we found at this visit. There were limited audits and actions to show people received their medicines safely and as prescribed. Systems and processes to ensure safe recruitment were not always followed.

Risks for some people were updated and these reflected the support people needed. The provider told us they had spent time since the last inspection, updating people’s care plans. However, we checked examples of updated care plans and found these were not always accurate or held conflicting information. Some risk assessments although completed, needed additional information to ensure the overall risks were fully documented. Speaking with staff showed us that despite gaps in records, they knew how to manage those risks.

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.

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 requires improvement (published 26 May 2022). The provider continues to send us monthly action plans as per the imposed conditions on their registration which we imposed on 29 March 2021. At this inspection we found insufficient improvements had been embedded into everyday practice. The provider was now in breach of regulation 12, regulation 17, regulation 18 and regulation 19. The service is now rated inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about people not receiving care at the required time and for the right amount of time. We also received some information that people were not always transferred safely, or that some people did not receive their medicines safely. A decision was made for us to inspect and examine those risks.

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.

This report only covers our findings in relation to the Key Questions Safe 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 changed to inadequate. 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 Homecare Services on our website at www.cqc.org.uk.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 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.

A&K Home Care is a is a community-based care provider that provides personal care to people living in their own homes. At the time of inspection there were 38 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

More improvements were required in allocating and monitoring care calls, to ensure people always received their care calls on time, and for the agreed length of time. Staff did not always stay for the full length of people’s scheduled calls. Staff told us they felt more staff would improve the service. Recruitment processes were in place and recruitment checks were carried out before staff were appointed. This helped to ensure suitable staff were appointed to support people.

Staff had received training in safeguarding and knew the actions to take to keep people safe. Overall, people’s medicines were managed safely. The provider had infection control policies and procedures in place to guide staff on how to reduce the risk of infections.

Staff received induction and training in their role. 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 provider had made a number of improvements since our previous inspection. Governance systems had been put in place, care records had been developed, and improvements had been made in service delivery. The provider carried out regular audits of the service to oversee the quality of the care provided. The provider carried out competency checks to assess whether staff were working in line with best practice. However, we found more improvements were required to ensure people received a good quality service that met their needs.

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 March 2021) and there were two breaches of the regulations in regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to risk management under safe care and treatment, and the governance and leadership of the service under good governance. After the last inspection we imposed conditions on the provider’s registration, requiring them to send us an action plan each month, showing how they were meeting the requirements of regulation 12 and 17. At this inspection we found the provider had completed actions on their action plan, and there was no longer a breach of Regulation 12 and Regulation 17. We found improvements were still required in Safe and Well Led and have rated these key questions as requires improvement.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will continue to receive a monthly report on how the provider is continuing to meet the conditions on their registration, 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.

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.

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.

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.