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We are carrying out a review of quality at MCH House. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 24 May 2018

The inspection was carried out on 03 April 2018, and was an announced inspection. The provider was given 48 hours’ notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us.

Ambley Care Limited is a domiciliary care agency registered to provide personal care for people who require support in their own home. Ambley Care Limited is a wholly owned subsidiary company of Medway Community Healthcare (MCH) C.I.C. Ambley Care Limited was established in July 2016 to provide personal care and enablement to residents of Medway aged over 18. They provide enabling services to assist service users to regain independence. This could be after discharge from hospital to home or within community rehabilitation units. Services are provided for a short time period of six weeks. However, in some instances, the service provided had lasted up to four months.

Not everyone using Ambley Care Limited 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 comprehensive inspection since the agency was registered on 09 May 2017. At the time of our inspection, they were supporting 101 people who received support with personal care tasks.

There was no registered manager at the service. The last registered manager left in January 2018 and the provider was in the process of registering a new manager with the 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 and associated Regulations about how the service is run.

The provider had not carried out appropriate risk assessments when they visited people for the first time. There were no care related risk assessments identified for people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider did not understand their responsibilities under the Deprivation of Liberty Safeguards. People’s capacity to consent to care and support had not been assessed and recorded within their care plans.

Staff [Enablers] had not received regular supervision as is necessary to enable them to carry out the duties they are employed to perform.

People’s needs had not been properly assessed by Ambley Care prior to receiving support from the service. Care plans had not been developed with people by Ambley Care on how to meet their needs. Care plans did not contain information about people’s likes, dislikes and personal histories.

The provider did not have adequate processes in place to monitor the delivery of the service.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. We have made a recommendation about this.

The provider had not managed medicines safely. Staff had not been trained in medication administration which would have equipped them for prompting medicine administration. We have made a recommendation about this.

The provider had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the service’s whistleblowing policy. They were confident that they could raise any matters of concern with the management, or the local authority safeguarding team.

The provider provided sufficient numbers of staff to meet people’s needs and provide a flexible service.

All staff received induction training at start of their employment. Refre

Inspection areas

Safe

Requires improvement

Updated 24 May 2018

The service was not consistently safe.

People were not protected from the potential risk of harm.

Medicines were not consistently managed in a safe way. Staff had not been adequately trained.

The provider had not always followed safe recruitment practices.

There were enough staff available to meet people’s needs.

Staff knew how to recognise any potential abuse and so help keep people safe.

Effective

Requires improvement

Updated 24 May 2018

The service was not consistently effective.

People’s human and legal rights were respected by staff. Staff had the knowledge of the Deprivation of Liberty Safeguards and Mental Capacity Act (2005). However, MCA assessments had not been carried out to ascertain capacity of people receiving care and support.

Staff received on-going training in areas identified by the provider as key areas. However, one to one supervisions had not taken place.

People were supported to be able to eat and drink sufficient amounts to meet their needs.

Staff were knowledgeable about people’s health needs, and contacted other health and social care professionals if they had concerns about people’s health.

Caring

Good

Updated 24 May 2018

The service was caring.

People felt that staff provided them with good quality care. Staff kept people informed of any changes relevant to their support.

Staff protected people’s privacy and dignity, and encouraged them to retain their independence where possible.

Wherever possible, people were involved in making decisions about their care and staff took account of their individual needs and preferences.

Responsive

Requires improvement

Updated 24 May 2018

The service was not consistently responsive.

People’s care plans had not reflected their care needs, had not been updated and care reviews had not taken place.

People felt comfortable in raising any concerns or complaints and knew these would be taken seriously.

Well-led

Requires improvement

Updated 24 May 2018

The service was not consistently well-led.

Quality assurance systems had not been implemented effectively or embedded to improve the quality of the service people received.

The provider had reported incidents to CQC appropriately.

Staff felt the provider was approachable and would listen to any concerns. Staff felt well supported by the provider.