Background to this inspection
Updated
8 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector and one Expert by Experience.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission, although an application was in progress at the time of our inspection. When a manager is registered with the Care Quality Commission, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 25 November 2021 and ended on 3 December 2021. We visited the office location on 25 November 2021 and 26 November 2021.
What we did before the inspection
We reviewed information we had received about the service since it was registered with the Care Quality Commission on 4 June 2020. We also sought feedback from the local authority.
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with one person using the service and received feedback from six family members. We also spoke with 10 members of staff, including two senior support workers, four support workers, the care coordinator/care lead, the head of recruitment, the manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also received email feedback from four additional members of staff.
We reviewed a range of records. This included six people's care and support plans, these people’s daily records, as well as medicines records where they received support with this task. We looked at four staff files in relation to recruitment, training and supervision. We reviewed a variety of records relating to management of the service, including policies and procedures, quality assurance surveys, induction training content, staff meeting records and evidence of auditing.
After the inspection
We continued to review records shared electronically and continued to seek clarification from the provider to validate evidence found. We sought feedback from seven professionals and received a response from four professionals during the inspection process.
Updated
8 January 2022
About the service
Acacia Homecare South Bucks is a service providing care and support to people in their own home. At the time of the inspection the service was supporting 10 people, some of whom required live-in care support. This included both younger adults, people with physical or sensory impairments, and older people. Some people using the service lived with dementia or experienced complex health needs.
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 found risks to people using the service were not clearly identified and managed. We also identified concerns in relation to the safe management of medicines and concerns regarding staff testing for COVID-19. People were safeguarded from risks of abuse and staff understood their responsibility to report signs of abuse or neglect. We have made a recommendation about the policies and procedures in place to inform staff about types and signs of abuse.
People and relatives told us they felt the service was safe, and people benefited from consistent continuity within staff rotas. The service promoted diversity and inclusion within its workforce. Staff were given sufficient travel time, and stayed the required length of time to meet people’s needs. A relative advised, “We have a weekly rota to say who is coming. I have no concerns about my relative’s safety, in fact my relative looks forward to them coming and their company.” A second relative added, “The staff from Acacia arrive on time and they stick to the same people.”
We identified concerns about arrangements for staff training. Some staff had provided specialist care without training from a suitably qualified professional. Staff competency records did not provide assurances that staff had demonstrated the knowledge and skills to perform specialist tasks. Staff supervisions and staff spot checks had not been carried out at frequencies in line with the provider’s policy. Some families expressed concerns in relation to whether all staff had the required skills to meet people’s needs, particularly when care first commenced.
We found management systems were not fully effective in monitoring the quality and safety of the service. Quality assurance systems were not fully conducted in line with the provider’s policy, and audits had failed to identify some of the issues we found. A manager had joined the service in August 2021 following the departure of the previous registered manager. We received positive feedback from staff, people and families regarding the management of the service. A relative commented, “I do think the service is well managed because they keep me completely informed and send the rota.” A second relative told us, “The new manager has their finger on the pulse and I have faith in her…the new manager responds properly and appears to be managing.”
We made a recommendation the service ensure people understand their rights to raise complaints with relevant external agencies, including the Local Government and Social Care Ombudsman.
People received support from staff who were caring and compassionate. Staff understood people’s diverse communication needs and offered emotional support, respecting people’s rights to dignity, privacy and autonomy. A person using the service commented, "Acacia were the best I have had because they were very professional and amazing. The manager was amazing as well.”
People's needs were assessed, and care plans provided an overview of people's physical, social and emotional needs. Where appropriate, people were supported by family members as part of care assessment and review processes to make decisions about their care and support. The service identified where technology could promote people’s independence and safety and made referrals to agencies such as occupational therapy (OT). A relative told us, “They are conscientious because they called OT when my relative was struggling with the equipment. They pushed it [the referral] on and they arranged it.”
People received person-centred care from staff who understood their needs. Staff could speak in detail about people they support, with knowledge of people's likes, dislikes and preferred routines. Care plans outlined people’s needs and preferences in relation to eating and drinking, and records showed people were offered healthy food choices. In some cases, care plans and risk assessments did not reflect a full and accurate picture of people’s support, we found some people had complex daily routines and staff also undertook additional tasks in response to people’s requests.
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; however the policies and systems in the service did not consistently support this practice. We recommended the service refer to best practice guidance to ensure written records can evidence how decisions are made and people are supported in their best interests.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 3 June 2020 and this is the first inspection.
Why we inspected
This was a planned inspection following the service's registration with CQC.
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.
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.
We have identified breaches in relation to safe care and treatment, staffing, staff recruitment 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.