Agincare UK Newcastle under Lyme

Agincare UK Newcastle-under-Lyme is a domiciliary care agency. It is registered to provide personal care to people living in their own homes in and around Newcastle-under-Lyme. CQC only inspects where people receive personal care. This is related to help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, 65 people were receiving personal care.

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

We made a recommendation about the safe recording and management of some medicines.

People’s risks were assessed, however, people’s records needed to ensure staff had effective guidance to support people’s wider health needs, such as diabetes.

The systems in place to monitor the quality of the service did not always highlight areas of improvement. The manager and provider were continuously working to implement new and effective systems.

People were supported by safely recruited staff, who had the skills to provide effective care. People received support from regular staff who knew them well and were protected from risk of infection. People felt safe and were protected from the risk of harm by staff who understood their responsibilities to identify and report signs of potential abuse.

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 and their relatives were involved in planning and reviewing their care. The manager had commenced obtaining people’s verbal feedback which demonstrated people were happy with the care provided.

There was an open culture within the service, and complaints were acted upon and improvements were being made. People and staff could approach the manager who acted on concerns raised to ensure the service developed.

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 (04 September 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the changes need to be fully embedded in order to ensure the improvements will continue. Therefore, we require the provider to continue to submit their monthly action plan.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

About the service

Agincare UK Newcastle under Lyme is a domiciliary care agency. It is registered to provide personal care to people living in their own homes in and around Newcastle under Lyme. 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 consider any wider social care provided. At the time of our inspection, approximately 95 people were receiving personal care.

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

The provider had failed to act on past concerns to ensure there was a systematic approach to quality assurance to identify shortfalls and drive improvements. Staff were not effectively deployed and people did not always receive their care at the planned time. When concerns were raised by commissioners, the provider responded to this but did not recognise the need to improve their systems and monitor calls across the service. People told us the staff treated them with kindness and respect, but when people had short call times, there was a risk that staff would rush to finish people’s care and may not always have time to provide emotional support.

The provider had not made improvements to assure us people always received their medicines as prescribed. Staff did not always have effective guidance on the safe administration of medicines and suitable systems were not in place to monitor their competence and practice.

The provider had recruitment procedures in place but had not consistently carried out checks to ensure staff were suitable to work with people. Staff were not always effectively trained and supervised to fulfil their role. Staff felt able to raise concerns with the registered manager.

There was a system to manage complaints and people felt able to raise any concerns with staff. However, improvements were needed to ensure engagement with people using the service was effective in driving improvements.

People felt safe and were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. Risks associated with people’s care and support were managed safely. However, improvements were needed to ensure staff had effective guidance to ensure people’s wider health needs, such as diabetes, were managed safely.

People had good relationships with staff and were happy with how their care was provided. However, improvements were needed to ensure care plans were personalised and considered people’s diverse needs, to ensure they were met. People were involved in planning and agreeing their care. However, we could not be sure 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 did not support this practice.

People were supported to access other health care services when they needed to and staff ensured people had choice when they supported them with meals.

Following changes at the service, the registered manager was developing a new management team, which supported an open, positive culture.

Rating at last inspection

At the last inspection the rating for this service was Requires Improvement (published 15 August 2018). This was because improvements were needed with the deployment of staff, the management of medicines, and the overall governance of the service, including learning lessons when things go wrong.

At this inspection, the service remains rated Requires Improvement and has been rated Requires Improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the recruitment and deployment of staff, the management of medicines and governance of the service at this inspection.

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

There was a manager in post at the time of the inspection; they had made an application to register with us (Care Quality Commission). 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 our last inspection on 28 and 29 September 2016 we found the service was rated Requires Improvement. This was because there were not robust systems in place to ensure staff were suitable to work with people that used the service, there was not clear guidance for staff for administering some medicines and the systems to monitor the quality of the service were not effective. We issued the service with a requirement notice for breach of Regulation 17, governance arrangements. At this inspection we found improvements had been made and the provider was meeting the regulations. Improvements to the systems for checking staff were suitable to work with people had been made and the guidance was available for staff on administering medicines and overall governance arrangements had improved, but further work was needed.

This is the third consecutive time the service has been rated Requires Improvement.

People did not always receive support from staff at their preferred time. Medicine stocks were not always available where staff were responsible for ordering peoples medicine. Governance arrangements needed further improvement and peoples feedback needed to be considered to drive improvement within the service. The manager had systems in place to implement learning from incidents and when things went wrong, however these were not always used as they should be by staff.

Risk assessments and management plans were in place to keep people safe. People were safeguarded from abuse. People were protected from the risk of infection.

People’s needs were assessed and their care plans were used to deliver effective care. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were trained to deliver effective support to people and had their competency checked. People were supported to maintain a healthy diet. People were supported to access health professionals when required.

People were supported by caring staff that protected their privacy and dignity. People had support to make decisions and choices about their care and maintain their independence. People’s communication needs were assessed and they received support to communicate effectively.

People’s preferences were understood by staff and were used to provide person centred care. People understood how to make a complaint. People received support with care at the end of their life, which allowed them to have a dignified and pain free death.

Agincare UK Newcastle under Lyme is a domiciliary care provider providing personal care and support to people in their own homes. At the time of this inspection 120 people used the service.

The service did not have a registered manager. A person had been recruited into this position and was undergoing their registration with us. 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.

Robust systems were not in place to ensure care workers were suitable to work with people who used the service.

People's medicines were not always managed safely; guidance for the administration of some medicines was not available for staff.

The provider had some systems in place to monitor the quality of the service, however improvements were required to ensure that all areas of the service delivery were audited and checked to ensure a safe and quality service was provided.

Care being delivered generally met people's personal preferences and was regularly reviewed to ensure it met people's needs.

People felt safe, carers and managers knew what to do if they suspected someone may have been abused.

The provider followed the principles of the Mental Capacity Act 2005 (MCA 2005) and ensured that people consented to or were supported to consent to their care and support.

People received care from carers who were supported and trained to fulfil their role well.

People were supported with their nutritional needs and if they became unwell carers responded and gained the appropriate healthcare support.

People were treated with dignity and their privacy was respected.

There was a complaints procedure and people knew how to use it. The provider took the necessary action when complaints were raised.

The manager was well liked and respected and demonstrated a commitment to improving the service being delivered to people. The manager was currently undergoing the registration process with us.

People were happy with the care and support provided to them. They liked the consistency of care and they told us that care and support was delivered to them at a time and in a way they preferred. They told us that staff were caring, polite and respectful. One person said, "The staff are very good and they know how I like things done."

The staff we spoke with felt well supported and told us that they received the training and supervision they needed to do their jobs properly. New staff had received appropriate induction training. One staff member said, "This is the best induction I have ever had."

The service was well managed and quality monitoring audits showed how the service had improved over the last few months.

People who used the service felt able to raise concerns and their views about the way they were cared for were taken into account by the provider.