Assured Care (Stockport) Ltd

About the service

Assured Care (Stockport) Limited is a domiciliary care agency providing personal care to 214 people at the time of the inspection.

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.

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

The provider had not always ensured detailed individual risk management plans were in place to guide staff on how to provide care to people with specific needs in the safest way possible. Care documentation was not always reviewed in a timely way to reflect people’s current care needs.

The provider had not ensured staff had the necessary, up to date training in place before providing care and support to people. Also, the provider had not satisfied themselves on an ongoing basis that staff providing care and support were competent to do so.

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. However, we found concerns regarding legal safeguards around decision making for people in the form of Lasting Power of Attorney (LPA).

We have made a recommendation around the lawful use of LPAs.

We received mainly positive feedback from people who used the service about the care they received and about the care staff. People felt safe and they told us staff read their care plan and staff always wore personal protective equipment (PPE) when visiting them.

Policies, procedures and audits were in place. However, they had not always been followed and audits had not identified the concerns we found on this inspection. Staff mostly felt supported in their role and felt they could report concerns to the senior staff.

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

Rating at last inspection

The last rating for this service was good (published 18 July 2019).

Why we inspected

The inspection was prompted due to concerns received about the management of and escalation of people’s individual risks to their health, staff training levels and non-notification of safeguarding incidents. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Assured Care (Stockport) on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of people’s individual risks, staff training and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Assured Care (Stockport) is a domiciliary care agency providing care and support to 180 adults at the time of the inspection.

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 170 people were receiving personal care.

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

People were kept safe by the service assessing people's needs and the risks associated with supporting people in the way they chose. Staff had the skills they needed to support people safely. Checks were done on people's backgrounds and previous conduct before they were offered employment.

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.

At the time of our inspection, the service was working to make people's care plans more about the person and what they wanted rather than task based information. People using the service told us they were asked for their consent by care workers before they supported them and that care workers supported them in the way they wanted to be supported.

People were encouraged to be as independent as possible. People told us they usually saw the same team of care workers and built good relationships with them. People and their relatives spoke highly of the care workers and felt the care workers looked after them well.

The service was responsive to people's needs and we saw how people's commissioned packages had been amended, in conjunction with the person's social worker, to better suit people's needs. Information was available for people in ways they understood.

Managers of the service worked to continually try and improve. They welcomed comments and feedback from people and made changes to the way staff worked to improve people's experiences. Other organisations involved with the service were complimentary about them.

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

Rating at last inspection

The last rating for this service was good (published 30 November 2016)

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.

This was an announced inspection on the 12 October 2016. Two days prior to the inspection, we contacted the provider and told them of our plans to carry out a comprehensive inspection of the service. This was because we needed to be sure that someone would at the office.

The service had a registered manager in place at the time of our inspection. 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.

Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were recruited robustly to ensure they were suitable to work with vulnerable adults.

Policies, procedures and staff training should mean the administration of medicines was safe.

Staff had access to infection prevention and control training, policies and procedures to help prevent the spread of infection.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

People were supported to take a nutritious diet and sufficient fluids to remain healthy.

Staff induction and training was ongoing to support them to look after people who used the service. Supervision had recommenced after a gap. Staff told us they felt able to contact managers if they needed to and felt supported. We made a recommendation that the registered manager look at best practice guidance around the frequency and content of formal supervision sessions for staff.

We saw the office was sufficiently well equipped to provide a good service.

We saw from looking at plans of care and speaking with people who used the service that people were asked to give their consent to care and treatment.

People who used the service told us staff were kind and caring. From our observations we saw that staff had a good rapport with people and knew them well.

We saw records were stored confidentially and plans of care were individualised to each person, were kept up to date and audited by managers.

People told us they felt staff would listen to them if they had any concerns and were given information about how to complain if they wanted to.

There were systems in place to monitor the quality of service provision. Policies and procedures gave staff information about best practice for many topics such as medicines administration, safeguarding and infection control.

People and professionals were given documentation which informed them of what the service did or did not provide to help assist them to make a choice to use the service.

People were asked their views in questionnaires to help the service maintain or improve the quality of the service. Staff were also able to air their views at meetings.

Below is a summary of what we found. The summary is based on our inspection of care worker personnel records and speaking with a senior care coordinator about the way in which care workers were recruited. If you want to see the evidence supporting our summary please read the full report.

We inspected Assured Care (Stockport) Ltd in December 2013. We found the provider had not gathered enough satisfactory information through their interview process to determine the person's suitability for the role and did not follow the services own recruitment and selection procedure by carrying out the relevant pre-employment checks when employing staff. Therefore it could not be determined if people were competent to perform their role to meet the needs of people who use the service.

Is the service effective?

Recruitment and selection procedures were in place which included the provider obtaining up to three written references before the person commenced employment. This ensured as far as possible that only people with a good character were employed at the service.

We saw needs assessment records that included useful information about the care and support the people needed.

We saw there were policies and procedures that were in place to ensure that people who used the service would be safe.

We looked at staff records and saw evidence that some employees had not been appropriately recruited and the provider had not followed the services own recruitment and selection procedure to carry out all of the relevant checks when employing staff.

We saw there was a system in place to monitor and evaluate the service.