Agincare is a domiciliary care service providing the regulated activity of personal care. The service provides support to people living in their own homes. At the time of our inspection there were 53 people using the service. The service also supports people who are discharged from hospital and require support with rehabilitation for an initial proposed period of six weeks. People receiving this rehabilitation care are referred to by the service as ‘reablement care clients’. At the time of inspection 15 people out of 53 were receiving a reablement care package.
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 did not operate effective quality assurance systems to oversee the service. These systems did not identify shortfalls in the quality and safety of the service or ensure that expected standards were met.
The provider did not ensure consistent actions were taken to reduce risks to people and plans were not in place to minimise those risks. The management of medicines was not always safe. Staff did not always follow correct infection prevention and control processes when carrying out personal care. Records indicated that not all staff had completed mandatory training. Following the inspection, we were informed by the managing director that staff receive a minimum of one supervision and team meeting a year as per their policy. We did not feel that staff received regular supervisions and team meetings.
When incidents or accidents occurred, it was not always clear these were investigated, and if any lessons were learnt. The provider did not follow and accurately record and keep a copy of incidents and the actions taken as required in the duty of candour regulation when a notifiable safety incident occurred.
The registered manager did not ensure clear and consistent records were kept for people who used the service and the service management and did not always inform us about notifiable incidents. Staffing levels did not always support people to stay safe and well.
People, their families and other people that mattered gave mixed feedback about being involved in the planning of their care. Care plans did not always contain information specific to people's needs or contain information on how to support people to manage any conditions they had. Staff were not provided with detailed guidance to follow when supporting people with complex needs.
The provider did not ensure their safeguarding systems were operated effectively to investigate and follow the provider's procedure after becoming aware of an allegation of abuse. Records indicated that not all staff were trained in this.
People and relatives gave good feedback about staff being kind, caring and respectful. The majority of staff members felt staffing levels were sufficient to do their job safely and effectively, we heard from people using the service that often staff were late and felt turnover was high.
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.
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.
At the time of the inspection, the location did not care or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
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 10 March 2022 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement and Recommendations
We have identified six breaches in relation to quality assurance; risk management, safeguarding, record keeping, responding and acting upon complaints, effective and person-centred care planning, management of medicine and staff training and competence at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
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 6 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.