This inspection took place on the 12 and 13 April 2018 and was announced. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. Not everyone using AQS Homecare receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.At the time of our inspection a registered manager was not in post. The previous registered manager had left the service on 7 March 2018. The service was being managed by one of the provider’s locality managers who was planning to register with the Commission. 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. We have therefore referred to the locality manager as ‘the manager’ in this report.
At our last inspection of the 7 and 8 March 2017 we found a breach of Regulation 18 (Registration) Regulations 2009 Notification of other incidents. This was because the provider had failed to notify the Commission without delay of any abuse or allegations of abuse in relation to people who use the service. At this inspection we found the provider had failed to make the required improvements and this Regulation had not been met.
This inspection was the third inspection since the service had been registered. The previous two inspections identified failures to meet the fundamental standards of care and both inspections awarded a rating of overall requires improvement with each key question rated as requires improvement. At this inspection we have continued to find that this service is not meeting fundamental standards and has been unable to improve their rating in any key question or overall. This demonstrates a lack of understanding of the principles of good quality assurance, a lack of effective quality assurance, a lack of learning, reflective practice and a lack of drivers for service improvement.
Whilst a system of audits was in place to monitor and assess the quality and safety of the service, these were not effective in identifying and addressing all of the concerns we found.
People told us they felt they were safely cared for by the provider’s staff. However, risks associated with people’s needs had not always been assessed and when they had risk management plans did not always provide sufficient guidance for staff to ensure they minimised these risks. People told us they were supported appropriately with food and drinks were applicable. Risks to people from eating and drinking required more detail to ensure safe guidance was available for all staff to follow.
Incidents were recorded, acted on and monitored to address safety issues and prevent a reoccurrence. Staff were aware of their responsibilities to report concerns and protect people from abuse. Action was taken when safeguarding concerns were identified but people’s care records were not always updated following these to reduce risks for people.
People’s records did not always evidence a mental capacity assessment had been completed to determine if the person had the capacity to agree to their care and treatment. We found inconsistent and incomplete information in people’s care plans about their capacity to consent. Not all staff were aware of the principles of the Mental Capacity Act (2005) and how these should be applied to support people to have maximum choice and control of their lives.
At the time of our inspection there were enough staff to meet people’s needs. However, people told us they did not always receive their care in an informed, consistent or timely manner that met their preferences. The manager told us local authority commissioning arrangements meant care calls were needs led and this meant people could not always have their preferences for call times met.
People and their relatives told us the care they received met their or their relative’s needs. Some care plans we reviewed contained clear information about people’s needs and how these should be met by staff. Some people’s care plans did not fully reflect their choices, preferences, personal history and important information to ensure staff would know how to provide person-centred care when they did not know the person well.
People and their relatives told us they were supported by kind and caring staff who respected their privacy and dignity. Some people said they did not always experience a caring response from office staff and told us they did not always feel listened to. People were not always able to make decisions about the preferred time for their care due to commissioning arrangements. People were not always given information about when to expect their care call and who would be delivering their care. This meant people did not always feel involved, valued and respected by all staff.
The management of people’s medicines required improvement. Medicine administration records (MARs) were not always completed to show people had received their medicines as prescribed. Care plans did not always include accurate and up to date information about people’s medicines. The provider was taking action to improve this for people, however, the provider required more time to embedded improvements into practice to ensure people’s medicines were safely managed.
People told us they were aware of how to raise any concerns or complaints with the provider. We saw records which showed complaints received had been responded to. However, people did not feel their concerns were always sufficiently heard or responded to. Whilst records showed actions had been taken in response to complaints received, the system in place did not evidence trends were monitored to identify learning which would drive improvements in the service people received. We have made a recommendation about improving the management and learning from concerns and complaints.
Not all staff had completed training in line with the provider’s requirements. This meant people could be supported by staff without the knowledge or skills to provide effective care. Following the inspection the provider confirmed all staff had been booked to attend any outstanding training.
People’s needs were assessed when their package of care commenced and this included their needs in relation to the protected characteristics under the Equalities Act 2010. The provider had policies and procedures in place to guide staff in providing a service which took account of people’s diverse needs and respected their beliefs and lifestyle choices. Staff acted promptly to support people with their healthcare needs. The provider had an ‘end of life care’ policy to support staff in providing appropriate care and treatment when supporting people approaching the end of their life.
A new manager was in post and staff spoke positively about their leadership. Staff were confident any concerns raised would be acted on by managers and told us the culture of the organisation was open and transparent. Staff were supported to understand their roles and responsibilities through supervision, spot checks and team meetings.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the (Registration) Regulations 2009, we have made one recommendation. You can see what action we told the provider to take at the back of this report.