Background to this inspection
Updated
28 October 2022
The inspection
We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.
Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was announced. We gave 22 hours notice due to the previous unavailability of the manager.
Inspection activity started on 24 August 2022 and ended on 12 September 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We used information gathered as part of monitoring activity that took place on 9 March 2022 to help plan the inspection and inform our judgements.
We used all this information to plan our inspection.
During the inspection
We spoke with the provider who is also the registered manager and nominated individual. This person currently has sole legal responsibility for supervising the management of the service. We also spoke with two carers and two relatives of the people using the service. We were unable to communicate directly with the people using the service due to their young age and capacity, but family members provided feedback about their and their loved ones’ experience of care. We liaised with the local authority and reviewed a number of documents including care plans, risk assessments and daily call notes. We also reviewed policies, procedures and records relevant to the management of the service.
This performance review and assessment was carried out without a visit to the location’s office. We used technology such as video calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation.
Updated
28 October 2022
About the service
Achievers Care Solutions Ltd is a domiciliary care agency providing personal care to three people at the time of the inspection. 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
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support: It was not possible to ascertain if people were supported to have maximum choice and control of their lives due to the limited information provided. Care plans lacked detail about people’s needs and preferences so we could not be confident people were always receiving the support they needed. Information about the risks people faced when receiving care was not detailed enough to ensure people received safe support. We saw from care notes that people were supported by staff to pursue their leisure interests.
We could not determine if the service made reasonable adjustments for people so they could be involved in discussions about how they received support. We asked how the service sought feedback from people receiving care but did not get a response.
Right Care: People’s care, treatment and support plans did not reflect their range of needs and thus did not fully promote their wellbeing. Care was not planned in a person centred way. Records of care were not always clear. Not all staff understood how to protect people from poor care and abuse, whilst the service had not worked well with other agencies to do so.
People’s families provided feedback and contributed to reviews of their care. Relatives told us they were happy with the care their family members received. From care notes it appeared people could communicate, to a degree, with staff because staff supported them consistently and understood their individual communication needs.
Right Culture: The provider could not evidence that people were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant we could not be sure people received compassionate and empowering care that was tailored to their needs.
Whilst staff and families spoke highly of the registered manager and said they found them supportive and approachable, we found the registered manager lacked understanding of how to manage a registered service. The quality assurance and governance processes in place were not effective as they had not identified issues we found with, for example, the quality of care plans and risk assessments.
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 requires improvement (published 25 November 2019).
At our last inspection we recommended that the provider take steps to improve their assessment of risk, their management of medicines and their quality monitoring systems. At this inspection we found the provider had not taken adequate steps to act on these recommendations.
Why we inspected
This inspection was prompted by a review of the information we held about this service which included concerns in relation to the management oversight of this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe 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 Achievers Care Solutions Limited on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 will take further action if needed.
We have identified breaches in relation to assessing and managing risk, safe care, safeguarding people from abuse, staff training and support and good governance at this inspection. We made recommendations around COVID 19 guidance and engagement with people, their families and staff.
Follow up
We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.