Archived: A Plus Care Ltd

A Plus Care Ltd is a domiciliary care provider in the East Sussex town of Bexhill, which is situated close to the coast. On the first and second day of inspection, 38 older people received personal care support from the service. On days three and four of the inspection, 27 older people were receiving personal care. Some of these people were living with dementia.

Not everyone using A Plus Care Ltd received the regulated activity ‘Personal care’ that CQC inspects, which includes support with personal hygiene, eating and drinking. Where they do we also take into account any wider social care provided.

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

People’s experience of using this service:

Before the inspection, the provider had limited involvement with the service and had allowed the registered manager to manage it independently. Therefore, when the registered manager left the service earlier than expected, the provider was not familiar with people, their needs, the regulations or their responsibilities. We found two incidents were not reported to the local authority or CQC within relevant timeframes. The provider required guidance in how to complete these referrals. Some areas for improvement identified at the previous inspection had not been actioned. There was a lack of oversight for concerns that had been raised previously with the registered manager. Supervisions, spot checks and team meetings had not been completed consistently. Although the registered manager acknowledged this was an area for improvement, they had not notified the provider. The current CQC rating was not displayed on the website as per regulation.

It was identified at the previous inspection that people without capacity to make decisions, did not have mental capacity assessments. We recommended that research was completed into responsibilities under the mental capacity act. The registered manager had undergone training in this area to develop their knowledge. However, they advised us they were still unclear of their responsibilities. They had not sought any further guidance on this.

Although people told us they felt safe, one person had not received their medicines consistently. Actions were not taken in a timely way by the provider or interim manager to ensure their wellbeing and notify relevant others.

People had assessments that detailed risks to their health and wellbeing and actions staff should take to reduce this. Staff knew people well and how to manage these risks. There were contingency plans for staff shortages or emergency situations that highlighted those people who would need priority support. Staff had a good understanding of potential signs of abuse and of who they would need to report any concerns to.

Despite frequent changes to staff and people’s care packages, the company administrator was managing the rotas well. People still received support from familiar staff. There had been no missed or late care calls since the registered manager had left. The provider and company administrator were speaking to people and staff to understand their care needs and ensure these were being met. The provider also advised they would not be taking on any other care packages until a robust management structure had been implemented.

People and their relatives told us that people’s health and nutritional needs were met. If they required support from staff with appointments, this was given. People had involvement from health and social care professionals frequently to improve their wellbeing. Where staff had identified concerns with the person’s environment, the registered manager had made referrals to professionals to gain equipment that would support them. Staff told us that training was good and gave them the skills they needed to meet people’s needs.

People and their relatives were consistent in their responses that staff were kind, caring and attentive to their needs. Many people considered staff to be extended family. They told us their independence, privacy and dignity was respected and promoted at all times. Staff had a good understanding of equality and diversity and supported people in their diverse beliefs and choices.

People and their relatives told us that the registered manager and staff were responsive to them and any changing needs. Pre-assessments completed before the person received support were then used to create a care plan about the person, their needs and preferences. People and their relatives told us any concerns they had were dealt with immediately by the registered manager. Staff had a good understanding of people’s communication needs.

Although staff had initially been concerned about the registered manager leaving, they told us that the provider, business director and company administrator had worked hard to ensure that changes did not impact on people. Staff had been able to talk to the provider directly with any concerns or worries about the future and been reassured. The provider advised that this inspection had identified their need for clear oversight of the service. They had already considered how this could be improved to prevent a similar situation occurring again. They had also arranged for support by the local authority to improve their knowledge of roles and responsibilities.

Rating at last inspection:

At their previous inspection, A Plus Care Ltd were rated Requires Improvement. (Report published 15 March 2018) At this inspection we found not all concerns raised at the previous inspection had been addressed. The registered manager left halfway through the inspection and the provider did not have clear oversight to manage the service. This is therefore the second time that A Plus Care Ltd have been rated Requires Improvement overall.

Why we inspected:

We brought this inspection forward following information that the registered manager was planning to leave. We required reassurances that the service would be managed effectively in their absence by the provider.

By day three of the inspection process, the registered manager, care co-ordinator and three other staff had left the service. We received four staff and two relative’s concerns. Therefore, we completed a further two inspection days to ensure people were safe.

Enforcement:

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

We have served a warning notice for Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider must be compliant by June 2019. We will check the warning notice has been complied with at our next inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Not everyone using A-Plus Care 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.

This was the first inspection for A-Plus Care Ltd in Bexhill since they became registered in November 2016.

The service had 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 2008 and associated Regulations about how the service is run.’ There was also a Care Co-ordinator, who supported the registered manager to monitor staff and manage office documents.

It was recognised that A-Plus Care Ltd is a fairly new provider and so were developing their systems for monitoring and auditing. However a number of shortfalls were found within record keeping which suggested current auditing processes needed to be developed. Staff had a thorough knowledge of people and their support needs, which meant where shortfalls were identified, there was limited impact to people. However support needs were not consistently identified within care documentation. There were limited assessments with regard to specific support needs, such as Diabetes, Epilepsy or positive behaviour support. Documentation that was missing, incomplete or due for review, was not always identified. Care documentation also lacked information on the process of decision making and did not always address the support needs of those people with fluctuating capacity. There was a potential risk that if unfamiliar carers were to complete call calls, they would not have all the information they required to support people.

Although people’s views of the service were sought during reviews, no further feedback had been sought from relatives, professionals or other stakeholders. This was something that had been identified by the provider and registered manager and that they were in the process of implementing.

There were no protocols for supporting people who required medicines to be given on an ‘as required’ basis. Guidance needed further clarification to ensure that ‘as required’ medicines were effective for people. More detailed information was also needed for people who required medicines to be given covertly. This is when medicines are administered in a disguised format without the knowledge or consent of the person receiving them, for example in food or in a drink.

Staff told us that they received a wide variety of training and people and their relatives were equally confident that staff had the right skills and knowledge to support people effectively. However it was identified that more specialised training relating to Diabetes, continence care, pressure care and positive behaviour support was needed for people who required support in these areas.

People felt safe and staff had a clear understanding on how to safeguard people and protect their health and well-being. There were suitable numbers of staff to meet people’s support needs.

Staff spoke positively about their induction into the service and advised that regular supervision was given. These and regular spot checks meant that they felt positive practise was recognised and areas of improvement identified.

Staff treated people with kindness, compassion and respect and promoted people's independence and right to privacy. People and their relatives were positive in their views of care provided; they also achieved continuity of care through familiar staff attending care calls.

Records showed that the provider sought guidance from health professionals where additional support needs were identified. People, relative’s and a health professional confirmed that they felt the service was responsive to needs that changed.

There was a clear complaints policy and people, relative’s and staff knew how to raise concerns. Complaints were resolved within a timely manner and people were satisfied with outcomes.

People, their relatives and staff spoke highly of the management team and felt that an open, transparent and supportive culture was promoted.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.