24 November 2022
We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.
Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.
The inspection was completed by one inspector and an Expert by Experience who completed phone calls to people and their relatives. 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.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was not a registered manager in post. The previous registered manager had left the service in June 2022. The provider had employed a new manager following our inspection. The new manager had applied to register with CQC.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we wanted to ensure the provider was available to support the inspection.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with eight people about their care and support and five relatives. We reviewed a range of records including the relevant sections of six people’s care records and medicines records. We looked at audits and quality checks. We looked at four staff files in relation to recruitment and we checked supervision, appraisal and training records of all staff. We spoke with the nominated individual, a consultant who supported with managing the service and five care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
This performance review and assessment was carried out without a visit to the location’s office. We used technology such as video calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation.
24 November 2022
About the service
Assured Community Care is a domiciliary care agency providing care to people living in their own homes. 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. At the time of our inspection, 30 people were receiving personal care.
People’s experience of using this service and what we found
Safeguarding was not always prioritised by the provider because several members of staff were not up to date with safeguarding training. There was an increased risk that safeguarding concerns could be missed as a result.
Whilst medicines were mostly managed safely, we found some errors which were not identified prior to our inspection due to poor oversight. Not all staff had completed medicines training and competency checks were not regularly taking place.
Staff training records evidenced significant concerns around staff induction, training and ongoing supervision. Serval staff had not completed mandatory training and not had their competency assessed as per the provider’s own training schedule. Staff had limited opportunity to continue to learn and improve care. People’s feedback confirmed that staff would benefit from a more thorough induction and training programme.
The provider’s quality assurance processes were being developed, however at the time of our inspection they were not fully effective. The provider did not have robust audits and checks that monitored quality and safety. The shortfalls the provider was aware of were not always promptly addressed and others were not identified by the provider prior to our inspection.
There was enough staff to provide care. The majority of people had not experienced missed care calls or significant staff lateness. Mostly, staff notified people if they were running late due to unforeseen circumstances. Some people were supported by regular staff, whilst others felt that consistency of care was compromised due to high staff turnover. Recruitment was ongoing and followed safe recruitment checks.
People’s individual care needs were assessed, and staff had guidance of how to provide care and support that was individual to the person. However, people’s mental capacity assessments were not completed in line with the Mental Capacity Act Code of Practice.
People received support to access health services when required, and staff provided support with eating and drinking if this was required.
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, caring and respectful. Positive feedback was received about staff’s caring attitudes. Independence was promoted and people were supported with their interests and hobbies if this was identified as a care and support need.
People’s communication needs had been assessed and staff had information on how to communicate with people effectively.
The provider had a complaints procedure which was accessible to people. People felt confident their complaints would be taken seriously and the ones who raised concerns with the provider, felt they were mostly managed effectively and timely.
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 23 June 2021 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about the governance of the service and staff training and induction. A decision was made for us to inspect and examine those risks.
You can see what action we have asked the provider to take at the end of this full report.
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 and will take further action if needed.
We have identified breaches in relation to good governance and staffing.
Please see the action we have told the provider to take at the end of this report.
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.
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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.