AMG Care Services Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

As part of this assessment, we looked at all quality statements for the key question of safe. Staff were not recruited safely. Records evidenced staff had not completed all the necessary training as outlined by the provider’s policy. Management had not conducted competency checks with staff to ensure they were competent and could meet people’s needs. The service was not always reporting safeguarding concerns to the appropriate authorities. Staff had not completed safeguarding or Mental Capacity Act (MCA) training. The Mental Capacity Act 2005 (the Act) provides the legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves. Everyone working with and/or caring for an adult who may lack capacity to make specific decisions must comply with this Act when making decisions or acting for that person, when the person lacks the capacity to make a particular decision for themselves. The service did not always have risk assessments to ensure safe care and treatment for people, for example when using moving and handling equipment. There was no evidence of information being shared following incidents and accidents to encourage learning. The registered manager did not always follow the regulations, best practice guidance or their own policies and procedures. Although staff we spoke with were competent, they had not received the necessary training in most areas required to ensure they could safely support people, staff had only been trained in moving and handling at the time of the assessment. Medicine processes required improvement. There was no oversight or auditing of medicines and people were not protected from the risks associated with the unsafe management of medicines. People told us they felt safe, and their care delivered safely. However, we found 3 breaches of the legal regulations in relation to safe care and treatment, staffing and fit and proper person employed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they knew how to escalate any concerns or issues and to who. One person told us they had “raised issues. It usually gets addressed.”

Staff said there was good communication between the team. There had been a recent team meeting, however information regarding incidents and accidents to encourage learning was not shared with them.

The service was recording incidents. The registered manager told us there had been 1 incident since they started operating in August 2022. It was not clear from the record what was done following the incident whilst the concern was investigated. Actions taken by the registered manager had not been recorded. The registered manager did not notify CQC or other appropriate agencies of the incident. The registered manager and staff did not have up to date safeguarding training, this could impact on their ability to identify the signs of abuse which could put people at risk. There wasn’t a process of reflection or learning following incidents which could lead to them happening again.

People told us initial care assessments were completed before people were supported by the service and there were regular reviews of care. One person said, “There was a very in-depth conversation and assessment to begin with” and another person told us “There was an initial assessment, and we also have regular reviews.”

Staff had sought medical assistance on a client’s behalf when needed, and raised to the management team if a referral to an external health professional may be needed. Staff told us action had been taken to make a referral. All services users had care plans before their packages of care began.

External health and social care professionals were positive about their involvement in the service and felt staff and providers worked with them to ensure people received a safe and effective service. One professional told us the service were “professional and thorough in their initial assessment” of a person. They worked with the person to ensure person centred care was delivered and were “responsive and flexible to changing needs.” However, a recent visit by the local authority identified concerns about the quality of care and people’s safety.

The service assessed people's needs before they provided a package of care however, we did not see a copy of an initial assessment during the inspection.

People and their family members said they felt safe. People told us “I have always felt safe in their care” and “Every single 1 of them are wonderful and I’m in safe hands.”

Staff had not received safeguarding training; however, staff we spoke with told us they knew how to identify and report allegations of abuse. Staff had not received training in the Mental capacity Act (MCA), however staff we spoke with demonstrated an understanding of the principles of MCA, including capacity and consent.

The service was not always reporting safeguarding concerns to the appropriate authorities. The service was not completing mental capacity assessments and best interest decisions in line with the Mental Capacity Act 2005. Where relatives had told the service they held Power of Attorney for Health and Welfare the registered manager did not have evidence of this. The registered manager and staff had not undertaken Mental Capacity Act training or safeguarding training at the time of the assessment. This meant the provider did not ensure decisions about people’s care were made with their consent or where a person lacks capacity to make a decision, they have followed the process to make a decision in the person’s best interests. The registered manager showed us all staff were booked for training in May 2024. We did not find evidence anyone had come to harm.

People said they received care that is safe and meets their needs. One person said, “There was an initial assessment, and we have regular follow ups if needs change”. People told us staff use moving and handling equipment they used to keep them safe and said, “They manage all of this very well.”

Staff told us risk assessments contained the required information and knew how to mitigate risk to keep people safe. Staff told us there is two-way communication to ensure any new risks are identified and added to the care plan. They told us the process they would follow in an emergency and knew the process to follow to report incidents and accidents.

People were not always supported by staff to manage their risks. Improvements were required in identifying risk and assessing needs accordingly. The service did not always have risk assessments for staff to follow when providing care for people, for example with moving and handling and catheter care. We raised this with the registered manager during our visit, who told us they would update the care plans and risk assessments. Following the assessment, the registered manager provided us with a template the service will use for care planning and risk assessing going forward. The service supports people with catheter care, epilepsy and diabetes, however the registered manager and staff had not undertaken training in these areas to safely support people.

We heard people’s moving and handling equipment was used safely by staff. One person told us “I have (name of moving and handling aids) and they have always used all of this safely.”

There were support systems for staff when lone working. Risk assessments contained information about some risks in the environment including pets. Staff had completed moving and handling training which covered the use of equipment that clients use in their own homes, and they felt confident to support clients with their equipment. Staff did not have direction on what to do in the event of a disaster such as a flood in a person’s home, but this would be covered in the new risk assessment template that was to be introduced.

Staff received a handbook as part of induction, this covered processes for data security, email, internet, and social media use and outlines individual responsibilities and information sharing processes. The provider had an up to date health and safety policy. The service had a contingency plan, this detailed plans of how the service would be able to continue working in adverse conditions with regards to office procedures and accessing client information and how priority would be assessed in the event of a shortage of carers being available, based on their priority level. However, there was no information recorded within the person’s care plan or in other documentation we reviewed, on their priority level and if this was regularly reviewed. This meant staff were unable to prioritise visits based on people’s needs. A new risk assessment template, covering environmental risks and risks to staff, created following feedback from the local authority (LA) was shared with us. The registered manager plans to implement this for all service users.

People said there were enough staff. One told us “There are a lot of different carers, I know them all and they are wonderful”. We heard mixed views about staff training. People told us “The experienced staff know what to do” and “I’m not sure if some of them have been adequately trained and are just learning on the job.” We also heard there were occasional issues with the timings of calls.

Staff we spoke with told us they had not received an induction but had completed shadow shifts and were confident when they started to work alone. Training had not been provided for staff in safeguarding, mental capacity act, medicines or infection control. Staff were supporting clients with diabetes and catheter care; however, they had not received any training to ensure their competence in these areas. Staff had spot checks completed by management, but they were unsure what was covered, and the forms were not always shared with them so they were unaware of what learning was required.

People were not supported by staff who were adequately trained and supported to meet people's needs. The registered manager did not have an up to date training matrix to enable them to carry out competency checks on staff. Some people were living with dementia, diabetes or required support with catheter care. Staff had not received training in these areas to ensure they were competent and could support people safely. People were at risk due to the lack of training. This was a breach of regulation 18(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager told us some training was planned which included safeguarding and medicines. The registered manager used tools to plan their staff provision and monitored calls to people. A quality compliance officer had been employed to assist with the office responsibilities of the service. People were not protected because staff had not been through a robust recruitment process. We found missing information including insufficient references and unexplored gaps in employment history. Some staff had started working with people before their Disclosure and Barring Service (DBS) check had been received. This meant the provider could not be assured that they were suitable to work with vulnerable adults. Agency staff were working for the service, the registered manager had not seen evidence of their DBS checks, training or competence, so they could not be assured they had the right skills and experience to support people. The registered manager requested this information during our assessment. The provider did not always follow their recruitment process and ensure adequate checks were in place for new care workers. We identified a breach of the staffing regulation.

People and relatives were happy with the hygiene standards provided. One person said “Yes, good hygiene and they wear masks where appropriate. We have no worries on that score.”

Infection control training had not been provided however staff were able to explain the steps they would take to prevent the spread of infection and had access to personal protective equipment (PPE).

The provider's infection prevention and control policies and procedures reflected current best practice guidelines and referenced other policies such as the use of PPE. However, care needs assessments we reviewed did not contain any evidence of infection control measures. We saw a new risk assessment template that the provider intends to implement going forward. Although the policy stated infection control training is a mandatory requirement for all staff, they had not completed the training. Spot checks were being completed and included assurance on whether staff were wearing correct PPE. In a staff survey, provided by the registered manager, staff confirmed they had access to appropriate PPE.

People we spoke to were either independent with medication administration or had family members that assisted them. Therefore, we were not able to gain any evidence of people’s experience of being supported with medication.

Staff had not been trained to administer medicines. However, staff could explain the process they would follow to administer and record the administration of medication. They were also confident in the process to follow when a medication change occurred.

We were not assured staff and the registered manager were trained and skilled to provide safe medicines care to people. The registered manager lacked knowledge about the medicines people had and their effects. The service was not carrying out regular competency checks on staff who gave medicines and there was no oversight, auditing or monitoring of medicines within the service. Where a necessary decision was needed regarding a person's ability to consent to staff giving them medication, this was not carried out by the registered manager, in line with the Mental Capacity Act (MCA). The registered manager told us medicines training for all staff was now booked. They had also requested some changes to their electronic recording system to improve medicines management monitoring. The provider had failed to protect people from the risks associated with the unsafe management of medicines. We identified a breach of the safe care and treatment regulation.