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Advanced Community Healthcare Limited Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 21 February 2019

The inspection took place on 17 January 2019 and was announced. The service had previously been inspected in 2016 and had not met the regulation on good governance or supporting staff to develop. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of effective and well-led to at least good. We checked for improvements at this inspection.

Advanced Community Healthcare provides a domiciliary care service in the Kirklees area of West Yorkshire for people over the age of 18. It provides personal care to people living in their own houses and flats in the community. Not everyone using Advanced Community Healthcare Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection they supported 45 people.

There were two registered managers’ in post who had owned the company until December 2018. The business had been sold and the two registered managers had applied to deregister. The new owners were in the process of recruiting a new manager who would apply to register with CQC. 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.

Risk assessments were in place in relation to the environment and for people using the service and the registered managers sought advice when required to ensure people were safe. Staff ensured the risk of harm was minimised and people were supported to stay safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; Staff were able to describe how they would support people to make decisions if they lacked capacity and how they would act in their best interests when providing care. Decision specific capacity assessments and records of best interest decision records was an area the new provider highlighted to improve.

Supervision, training and appraisals had not all been completed in line with recommended evidenced-based best practice guidance.

People who used the service and their relatives were positive about the staff providing care and told us they were caring and compassionate. They said staff were respectful always and ensured their privacy was maintained and their independence promoted.

Care plans were recorded in a person-centred way to enable an understanding of the person’s personal history, individual preferences, interests and aspirations. They detailed information about the person’s strengths, their levels of independence and what they could do maintain this.

There was a lack of systems and processes including regular audits which meant the registered managers had been unable to identify where quality needed to improve. Up to date nationally recognised guidance had not been implemented in the service.

The new provider had undertaken their own audits and had identified where improvements were needed. They had an action plan which detailed what improvements they intended to make over the next few months and had identified the issues we also found on inspection.

The culture of the organisation was positive, and staff told us they wanted to provide the best service possible. Staff told us how much they enjoyed their role and how supportive their colleagues were. They were positive about proposed changes and were keen to engage with the new provider.

This is the second consecutive time the service has been rated Requires Improvement. We found a continuing breach of the Health and Social Care Act 2008 (Regulated Activities)

Inspection areas

Safe

Requires improvement

Updated 21 February 2019

The service was not always safe

Staff understood their responsibilities around protecting people from abuse and they knew how to report it if they suspected it was occurring.

Risks were assessed appropriately with detailed risk reduction plans in place and the registered managers sought advice when they identified a risk to ensure people were protected from harm.

Staff recruitment files were not well organised and did not all contain the necessary information.

Effective

Requires improvement

Updated 21 February 2019

The service was not always effective

Not all staff supervision, training and appraisals were up to date or in line with recommended evidenced-based guidance.

The registered managers utilised the two stage mental capacity assessments although this was not decision specific. The new provider had introduced their new paperwork the week of the inspection to ensure they met the requirements.

Staff supported people to ensure their hydration and nutritional needs were met.

Caring

Good

Updated 21 February 2019

The service was caring.

People who used the service and their relatives spoke highly about the care staff supporting them and were positive about the way care and support was provided.

People told us their privacy and dignity were respected always by the care staff.

Staff involved people in the care they were providing and promoted independence where this was appropriate

Responsive

Good

Updated 21 February 2019

The service was responsive.

People’s care needs were assessed prior to the service being delivered. Care plans detailed the support people required.

People told us care was person-centred and the staff went above their expectations to provide care in line with their preferences and wishes.

The service had a complaints policy and people were aware of how to complain. No complaints were recorded, and concerns were dealt with informally

Well-led

Requires improvement

Updated 21 February 2019

The service was not always well-led.

Most staff told us the registered managers were supportive and listened to the staff. Staff told us they worked as a team and supported each other.

There was a lack of robust and regular audits to demonstrate the provider had continuously assessed the quality of the service provided. Feedback from people and staff would have provided them with a basis for an action plan.

The service worked in partnership with other bodies such as local professionals who all gave very positive feedback about the service which was well respected in the area