New Age Care

New Age Care is a is a community-based care provider that provides personal care to people living in their own homes. At the time of inspection, the provider told us they supported 65 people but not everyone received a regulated activity.

Forty two people were in receipt of the regulated activity of 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 received care calls ranging from 30-minutes up to 24/7 live in support.

People's experience of using this service and what we found

At our last inspection, we found significant improvements were required around managing people’s risks and risks to support safe medicines management, quality of record keeping and quality assurance processes. At this inspection, some improvements in implementing and recording audits and checks had taken place. However, in some cases, audits were not always completed on time and where some audits were completed, the provider had not identified the issues we found at this inspection which could put people at risk of harm. The provider remained in breach of the regulations.

Some care plans continued to require further information to ensure they supported person centred care. Some risk assessments although completed, needed additional information to ensure the overall risks were fully documented. Speaking with staff, this showed us staff knew people's needs and how to manage known risks.

Serious incidents had not always been fully investigated, reported and reviewed to ensure people remained safe. Some safeguarding concerns were not fully investigated and referred to us or other agencies to keep people protected.

People did not always receive their prescribed medicines safely. Systems to support safe medicines practices needed further improvement. Medicine Administration Records (MAR) did not always accurately record what doses people were administered or if those medicines were given in line with manufacturers guidelines. In some examples, people who required ‘as and when’ medicines did not have a detailed protocol in place to tell staff, when, how and what dose, these medicines should be given safely.

Improvements to monitor and organise staff training, staff development and monitoring staff competency had improved since our last visit.

Whilst we found continued issues related to record keeping and a lack of quality assurance, people and relatives spoke highly of the service they received. People and their relatives told us they had built good relationships with those staff who cared for them, and they explained how the service they received, supported positive outcomes.

People told us they received their care at the right times and people said they were supported by a consistent 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. However, we found inconsistencies in the records to evidence where family members had authority to speak on their family members behalf. We also found inconsistencies in how people’s mental capacity was supported, especially if a person’s capacity to make certain decisions varied.

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

The last rating for this service was inadequate (published 05 April 2023) and there were breaches of regulation. Following the last inspection, we requested that the provider sent us an action plan telling us what they had improved. At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The providers action plan told us what they would do and by when to improve.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New Age Care on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safety and oversight of the service at this inspection.

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.

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 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.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

New Age Care is a is a community-based care provider that provides personal care to people living in their own homes. At the time of inspection, the provider told us they supported 44 people who were in receipt of the regulated activity of personal care. People received care calls ranging from 30-minute calls, up to care calls requiring 24/7 live in support.

Everyone who received support at the time of our inspection, 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

We checked examples of updated care plans and found these were not always accurate or they held conflicting information. Some risk assessments although completed, needed additional information to ensure the overall risks were fully documented. Risk assessment scores failed to correctly identify whether someone was at low or high risk. This meant staff did not have accurate information in order to manage people's risks safely.

We could not be confident people received their prescribed medicines safely. Systems to support safe medicines practices were ineffective. Medicine Administration Records (MAR) did not always correlate with people’s care plans. It was not always clear what medicines a person had been prescribed or if staff administered them. In some examples, people who needed ‘as required’ medicines did not have a detailed protocol in place to tell staff, when, how and what dose of these medicines should be given safely.

People were not protected from ineffective staff recruitment checks. In one example, the provider told us about one staff member who had worked under a different identity. We checked this staff member’s recruitment file and found no checks at all were completed. In other staff files, gaps in employment histories were not explored and references were not always requested or completed by the referee. Instead, some references were completed by staff employed by the provider.

Overall, the provider failed to operate and manage a robust and effective quality assurance system. Checks we would expect to be made such as late/missed calls, daily log completion, medicines management, care plans and risk assessments were non-existent. We were not given any records to show checks were completed because the provider told us they had not completed any checks. The provider remained in breach of the regulations.

In spite of the ineffective management of the service, people and relatives told us they were pleased with the support those staff provided to them. People and families said they got on well with staff and they were complimentary about how they were supported. People and relatives confirmed they received their care and support from a regular staff team who knew them well, but in some cases, staff were changed at the last minute with no prior notice.

People’s feedback about the care showed they valued the support they received. However, people’s feedback about the management and the organisation of the service said it needed improving. Not everyone we spoke with felt comfortable sharing their experiences about the service.

Whilst people told us they received their care at the right times, we could not be confident there were sufficient staff employed safely to undertake care calls to people.

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.

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

The last rating for this service was requires improvement (published 14 October 2022) and there were breaches of regulation. Following the last inspection, we formally requested that the provider sent us a monthly action plan telling us what they had improved. At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the poor management and culture at the service. We also received concerns about the lack of effective care planning, staff recruitment practices, management of people’s risks and limited oversight from the provider to ensure the service remained safe. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with management of risks, management of medicines, staff recruitment and a lack of effective oversight and scrutiny by the provider so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well Led.

This report only covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New Age Care on our website at www.cqc.org.uk.

Enforcement

Immediately following our visit, we sent the provider a letter asking them to respond to the immediate concerns we found at our visit. We continued to seek their updates and assurances they had mitigated the immediate risks to people.

We have identified continued breaches in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). We found an additional breach of Regulation 19 (Fit and proper persons employed).

Since the last inspection we recognised that the provider had failed to display their rating on their website. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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 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.

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.

New Age Care is a domiciliary care service providing personal care for people living in their own homes. At the time of the inspection, 52 people were receiving personal care from the service. Staff supported 45 people with care calls ranging from 30 minutes to an hour, staff also supported seven people on a ‘live-in’ 24 hours a day, seven days a week.

People's experience of using this service and what we found

We found the quality and safety of the service people received required improvement. Audits and checks were completed, however there was no information to show what was checked, what needed improvement and how those actions led to improvements in the quality of service provided. Examples of completed audits failed to identify the issues we found around care planning, risk assessments and medicines management. The registered manager and the provider managed the quality of the service independently. However, there was no overall view of the service being recorded to identify where potential shortfalls across both aspects of the service were.

People’s care and support needs were assessed and used to form their care plan. However, when needs or situations changed, care plans and risk assessments were not always consistent with the care provided. Associated risks to people’s care were not always accurate or followed by staff to ensure people remained safe. Following our visit, the registered provider spoke with us and assured us they were committed to make improvements with their own quality assurance processes and with the quality of care provided.

Staff said they worked well as a team, however staff feedback to us indicated issues with communication and a lack of confidence in escalating issues to the provider. Some staff had raised issues but said the issues were not always resolved or that steps were not taken to improve.

People felt safe with staff because staff were recruited safely. Staff and the provider knew how to keep people safe and protected from abusive practice by referring to the relevant agencies.

Staff had received training in recognising signs of abuse and were aware of their responsibilities to report any concerns there may be. People and relatives spoke positively about the service they or their relative received. People and their family members said they felt safe when staff supported them and their support for most of the time was provided by a consistent staff team. People who received 24/7 support, had the same staff stay with them for several weeks to ensure continuity of care was maintained.

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.

Staff followed current infection prevention control guidance when personal care was provided. Staff had access to a plentiful supply of personal protective equipment.

Staff received training to help them meet people’s needs. Specific training was provided when staff supported people with certain medical conditions.

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 was registered with us on 28 February 2022 and this is the first inspection.

Why we inspected

This service had not been inspected since their registration.

Enforcement

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 COVID19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe care and treatment and a breach of good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 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.