AMG Nursing and Care Services - Crewe

Updated 21 July 2021

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 two inspectors and two Experts by Experience. One inspector attended the service and the other worked offsite. 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 had a manager registered with the Care Quality Commission. 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.

Notice of inspection

We gave a short period notice of the inspection because we needed to be sure the registered manager would be available to support the inspection. This also enabled us to check if there were any COVID-19 related matters we needed to consider before our site visit. Inspection activity started on 24 May 2021 and ended on 10 June 2021. We visited the office location on 25 May 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, including safeguarding events and statutory notifications sent by the provider. A notification is information about important events which the provider is required to tell us by law, like a death or a serious injury. We also considered feedback about the service from relevant local authorities.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We requested the provider send information to us prior to our site visit. Due to the risks of COVID-19, we did not make home visits to people who used the service. Instead, we sought feedback from people and their relatives over the telephone.

We spoke with twenty-one people who used the service or family members about the care provided. We also spoke with fourteen members of staff, along with the registered manager and the operations director. We reviewed a variety of records including multiple medication records, care plans, risk assessments and four staff recruitment files. We also reviewed audits, a range of policies and other records relating to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 21 July 2021

About the service

AMG Nursing and Care Services - Crewe is a domiciliary home care service providing personal and nursing care to 240 people at the time of the inspection. This included adults living with complex health needs, people coming to the end of their life and people who required short term care, for example following a hospital stay.

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

Since the last inspection improvements had been made to aspects of the service including the safe recruitment of staff and medicines management. However, further improvements were required to ensure systems to monitor the service were fully embedded and robust.

Audits and checks were being completed. However, these had not always identified where further improvements could be made, including those found on this inspection.

We have made a recommendation in relation to following relevant procedures for referrals to other agencies as part of safeguarding enquiries.

There had been some staff recruitment issues, which impacted certain geographical areas. The recruitment of new staff was an ongoing priority.

People gave mixed feedback about the timings of care calls and consistency of staff. Some were very positive. However, others felt call timings varied and they did not always see familiar staff. The management team continued to review rotas and schedules to make further improvements to the consistency of care visits. There were enough staff to meet the needs of the people they currently supported.

The provider’s systems had not ensured current government guidance for COVID-19 testing for staff was followed in full. This was immediately addressed by the registered manager and a system implemented to provide better oversight of staff testing results. Staff had appropriate access to PPE and had been trained to use this correctly, and other infection control measures were in place.

Overall, systems were in place to safeguard people for the risk of abuse. Safeguarding concerns had been appropriately identified and reported following relevant procedures. Care plans included detailed risk assessments with information about potential risks and measures to minimise the risk, including environmental risks.

Systems were in place to manage medicines safely and to ensure learning occurred when things went wrong.

Assessments of people’s needs, including detailed information about their health and support needs had been recorded. The provider had reviewed systems to ensure essential information was available to staff about people’s needs as soon as possible.

People were supported by skilled and trained staff who had their competency checked. A small number of supervisions and checks were overdue, the provider had plans to address this. Staff worked closely with other agencies to support people's needs. They supported people with complex health care needs well, with a specifically trained staff team.

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.

People were supported by staff who were kind and caring in their approach and they were treated with dignity and respect. We received some very positive and complimentary feedback about the support people received from staff. The service was focused on supporting people’s independence.

Overall, people received personalised care and support to meet their needs and preferences. staff were responsive to people’s feedback, and where needed adjustments were made to meet people’s individual preferences. Care plans were detailed and included information about people’s individual needs and preferences. People told us they felt able to raise concerns or complaints should they need to.

The provider and registered manager were committed to improving the service. Staff feedback about the way the service was managed was positive and morale had improved since the last inspection. Staff told us they were supported in their roles.

People’s feedback about the service was sought and the service worked in partnership with other agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

This service did not previously have an overall rating. At the last inspection we inspected the safe and well-led domains which were both rated as requires improvement and there were two breaches of regulation (published 12 November 2020). The provider completed an action plan after the last inspection to show what they would do and by when, to improve.

At this inspection we found some improvements had been made and the provider was no longer in breach of the regulation related to recruitment. However, not enough improvement had been made in relation to good governance and the provider remained in breach of Regulation 17.

Why we inspected

The inspection was prompted in part due to concerns received about staffing issues, consistency of call times and the quality of the care provided. A decision was made for us to inspect and examine those risks.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.