Archived: Amandacare

Amandacare is a domiciliary care agency that provides personal care and support for people living in the London Borough of Bexley and its surrounding areas. Not everyone using Amandacare receives a regulated activity. CQC only inspects the service being received by people provided with personal care; that 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 the service was providing personal care and support to 19 people.

People’s experience of using this service

People and their relatives spoke positively about staff and told us they were very happy with the service they received. There were safeguarding policies and procedures in place and staff had a clear understanding of these procedures and the actions to take if they had any concerns. Recruitment checks took place before staff started work and there were enough staff to meet people’s needs safely. Risks to people were assessed, documented, reviewed and monitored to ensure their needs were safely met. The service had procedures in place to reduce the risk of infections and staff had enough personal protective equipment.

Assessments of people’s needs were carried out before they started using the service. People received support to maintain good health. People were supported to maintain a balanced diet where this was part of their plan of care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were treated in a kind and caring manner and were consulted about their care. People knew how to make a complaint if they were unhappy with the service.

There were effective systems in place to assess and monitor the quality of service that people received. The provider took people’s views into account on a regular basis and feedback was used to help improve the service. The provider worked well with health and social care professionals.

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

Rating at last inspection

The last rating for this service was requires improvement (published 19 June 2020) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned focused inspection based on the previous rating. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. 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 Amandacare on our website at www.cqc.org.uk.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Amandacare is a domiciliary care agency that provides personal care and support for people living in the London Borough of Bexley and its surrounding areas. 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 the inspection the service was providing care for 20 people.

People's experience of using this service

Medicines were not safely managed. Information in relation to medicines in care plans was contradictory and staff had administered one person’s medicine without a full assessment of the risks relating to it being in place. Risks in relation to choking and falls were not always assessed, reviewed and the provider did not always have appropriate risk management plans to guide staff on how these risks should be minimised. All other risks were assessed fully. Accidents and incidents were not always recorded, fully investigated or analysed to determine trends or themes and learning was not disseminated to staff.

We found that in two cases staff had not received training specific to their roles. We have made a recommendation about this.

Care plans and risk assessments were not always updated when there was a change in people’s needs and there was not always updated guidance in place for staff to follow. The provider's quality monitoring systems were not effective. Internal audits did not identify the issues we found at this inspection.

People said they felt safe and that their needs were met. There were enough staff to meet people’s needs in a timely manner. People were protected against the risk of infection. Recruitment checks were robust, and the suitability and competence of staff had been assessed appropriately and recorded. Assessments of people’s needs were carried out prior to using the service to ensure their needs could be met. People nutritional needs were being met. Information was available to people in a format to meet their individual communication needs when required. Staff were supported through regular supervisions.

Regular staff meetings were held. The service was not currently supporting people who required end of life care support, but relevant information was recorded in care plans so this was available when people required this support.

The provider worked in partnership with key organisations to ensure people's individual needs were planned. People's rights were upheld with the effective use of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests. Their needs were accurately assessed, understood and communicated.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 06 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, training and good governance.

Follow up:

We will ask the provider to complete an action plan to show what they will do and by when to improve. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The service had a registered manager in post. 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.

At this inspection, we found that medicines were not always managed safely. Falls risk assessments and management plans were not in place for people at risk of falls. The provider did not have effective processes in place to monitor the quality of the service as they had not identified the issues we found at this inspection. You can see what action we have told the provider to take at the back of the full version of the report.

There were appropriate safeguarding procedures in place to protect people from the risk of abuse. Staff understood the different types of abuse and knew who contact to report their concerns. There was a system to log accidents and incidents which were investigated in a timely manner and learning was disseminated to staff. Staff had been trained in infection control and people were protected from the risk of infection. Appropriate recruitment checks took place before staff started work. There were enough staff deployed to meet people's care and support needs.

Staff completed an induction when they started working for the service and they were supported through a programme of regular training and supervision to enable them to effectively carry out their roles. People's needs were assessed prior to joining the service to ensure their needs could be met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff told us they asked for people’s consent before offering support. People were supported to have enough to eat and drink and had access to healthcare professionals when required to maintain good health.

Staff were caring and respected people’s privacy and dignity. People were involved in making decisions about their daily care and support needs. People were supported to be as independent as possible. People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services on offer.

People were involved in planning their care needs. People were aware of the service’s complaints procedures and knew how to make a complaint if necessary. People's religious and cultural needs were recorded and they would be supported to meet their individual needs if required. The service was not currently supporting people who were considered end of life. However, if there were this would be recorded in their care plans.

The provider carried out spot and competency checks to make sure people were being supported in line with their care plans. Regular feedback was sought from people about the service. Staff were complimentary about the registered manager and the service. The registered manager was knowledgeable about the requirements of their role and their responsibilities about the Health and Social Care Act 2014. Notifications were submitted to the CQC as required. The philosophy of the service was to provide a top-quality service, tailored to meet people’s individual needs. The registered manager told us that they worked with the local authority to meet people's needs.

At our last inspection in March 2014 the service was compliant with the regulations.

Staff had completed medicines training and the provider had a medicines policy in place to support staff. The provider maintained adequate staffing levels to ensure calls were attended to.

Staff had regular group supervisions three times a year and these sessions were also used as team meeting and training sessions. Staff were safely recruited with necessary pre-employment checks carried out.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in abuse and demonstrated an understanding of types of abuse to look for and how to raise safeguarding concerns.

Risks to people using the service were assessed, reviewed, recorded and managed appropriately. Detailed and current risk assessments were in place for people using the service.

People we spoke with told us that staff were caring and staff knew the needs and preferences of the people using the service. Care plans were personalised and reviewed annually.

Staff sought consent from people when providing them with support. The provider worked within the requirements of the Mental Capacity Act 2005, should the service offer support to a person who lacked capacity to make specific decisions about their care and treatment.

People were supported to maintain a balanced diet and had access to healthcare professionals when required.

Systems were in place to monitor and evaluate the quality and safety of the service. The provider regularly reviewed medicines records, and put an appropriate recording system in place for this at the time of our inspection.

An appropriate concerns and complaints system was in place. Staff we spoke with told us that the manager was accessible to people, and staff spoke positively about the support available to them.

On this occasion we did not speak to people using the service due to the nature of essential standards inspected.

People's care needs were assessed and their care was delivered in line with their individual care plans and risk assessments. The provider had effective recruitment and selection procedures in place to ensure that staff were experienced and suitable for the role. We found that people's complaints were listened to and responded to appropriately. However, we found that where people did not have the capacity to consent to a specific decision, the provider had not acted in accordance with their own policy and legal requirements. In addition, the provider did not have suitable arrangements in place to ensure that staff had received refresher training in medicines management.