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Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 February 2019

ACAH Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and young people with disabilities.

The Care Quality Commission (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 our inspection, 21 people were receiving personal care.

At our last inspection we rated the service as requires improvement. At this inspection we found that although some improvements had been made these had not always been consistently maintained and embedded; we identified other areas that required improving. The service has been rated overall as requires improvement.

The systems in place to monitor the quality, safety and performance of the service were not always effective and were not consistently maintained.

Risks to people were identified but there were no detailed risk management plans in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in place support this practice. However, it was not always clear which decisions people may not have the mental capacity to make for themselves.

We have made a recommendation in relation to seeking further guidance around the Mental Capacity Act.

Staff did not all regularly receive formal supervision and there was limited opportunity for them to come together and share their experience and good practice.

People continued to be treated with empathy and kindness and their individuality was respected. The staff were friendly, caring and compassionate and go the ‘extra mile’ to help people. Positive relationships had been developed between people and staff; people were happy with the service they received.

Care plans were in place, which enabled staff to provide consistent care and support in line with people's personal preferences and choices. People were supported to maintain good health and nutrition.

People received safe care from a staff team who were experienced and undertook regular training. Staff were appropriately recruited and there were sufficient staff to meet people's needs. People were protected from the risk of harm and received the support they needed to take their prescribed medicines safely.

The service had a positive ethos and an open culture. Development of staff knowledge and skills was encouraged.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they received.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The action we have taken is detailed at the end of this report.

Inspection areas

Safe

Requires improvement

Updated 8 February 2019

The service was not always safe.

Risks to people had been identified however there were no risk management plans in place to guide the staff as to how to mitigate the risk.

People told us that they felt safe in their home with the staff that cared for them and staff understood their responsibilities to ensure people were kept safe.

Safe recruitment practices were in place and staffing levels ensured that people’s care and support needs were safely met.

Effective

Requires improvement

Updated 8 February 2019

The service was not always effective.

The provider and staff did not fully understand their roles and responsibilities in relation to the administration of the Mental Capacity Act 2005.

People received personalised care and support. Staff were trained to ensure they had the skills and knowledge to support people appropriately.

People were supported to access relevant health and social care professionals to ensure they received the care and support they needed.

Caring

Good

Updated 8 February 2019

The service remains good.

Responsive

Good

Updated 8 February 2019

The service remains good.

Well-led

Requires improvement

Updated 8 February 2019

The service was not always well- led.

The quality assurance systems and audits in place had not been sufficiently developed and sustained to ensure that any shortfalls identified were effectively actioned.

There was a culture of openness and transparency; the provider encouraged and supported the staff to provide the best possible person centred-care and experience for people and their families.