Ashley Care

Ashley Care is a domiciliary care service providing personal care and support to people in their own homes. Not everyone who used the service received personal care. At the time of our inspection, the domiciliary care service was providing support to 107 people, 80 of those were receiving support with 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

The provider’s governance arrangements did not provide assurance the service was well led, and regulatory requirements were not being met.

People told us they had not had any missed calls; however, they were often not informed if staff were running late, and this impacted on people receiving their calls at their scheduled times.

We have made a recommendation about the management of some medicines.

Staff had been safely recruited; however, we were not satisfied staffing levels and deployment of staff ensured all people’s care needs were met in a timely way.

Risks to people had been identified, assessed and reviewed.

People and their relatives told us they felt safe using the service. People were cared for by staff who knew how to keep them safe and protect them from avoidable harm.

The majority of staff felt confident their training provided them with the knowledge they needed to support people safely.

Staff had access to personal protective equipment (PPE) and there were effective infection prevention and control measures in place.

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 May 2022) and there were 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 significant improvements had been made with regard to regulation 18 [Staffing] and regulation 12 [Safe care and treatment]. However, the provider remained in breach of regulation 17 [Good governance].

This service has been in Special Measures since May 2022. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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. 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 Ashley Care on our website at www.cqc.org.uk.

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 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 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.

Ashley Care is a domiciliary care service providing personal care to people in their own homes. At the time of inspection, the domiciliary care service was providing support to 142 people.

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

Information relating to people's individual risks were not always recorded or did not provide enough assurance that effective arrangements were in place to keep people safe. People were often not informed if staff were running late and call preferences were not considered or followed. The monitoring of missed and late calls was not robust, and this resulted in some people not having their care and support needs met. Not all staff had up to date mandatory training, with many courses seemingly completed over a one or two-day period. Not all staff had been trained to provide safe catheter and stoma care. Lessons were not learned, and improvements were not made when things went wrong. Staff had not always been given up to date information or training about COVID-19 or warned where people tested positive for the virus.

The leadership, management and governance arrangements did not provide assurance that the service was well-led, that people were safe, and their care and support needs could be met. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. There was a lack of understanding of the risks and issues and the potential impact on people using the service. The lack of effective oversight of the service has resulted in continued breaches of regulatory requirements and the Warning Notice issued following our last inspection in November 2020, was not complied with.

Improvements were noted relating to some aspects of medicines management and staff recruitment practices.

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 January 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of Regulation 12 [Safe care and treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing].

Why we inspected

We received concerns relating to missed and late visits and the impact this had on the overall delivery of care. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. 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 Ashley Care on our website at www.cqc.org.uk.

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 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 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 breaches in relation to risk management, staffing and governance 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 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.

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.

Ashley Care is a domiciliary care service providing personal care to 200 people of all ages in their own homes. They also provide a rehabilitation service. This is where people are supported with care in their own homes to support their recovery following a hospital admission, for example, or where they may need short term care during an illness.

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

The concerns raised during our last inspection had not been effectively addressed and we found repeated concerns. People were mostly positive about the care staff who looked after them but often received care from staff they did not know. People were unhappy that their call times were inconsistent, and they did not know what time staff would arrive.

People’s individual risks had not always been identified and information was not always available to staff to help manage those risks. Medicines were not always managed safely. Staff recruitment was not always carried out safely or in line with regulatory requirements.

There was insufficient oversight by the registered manager and the required improvements had not been sustained. Where action plans had been put in place, improvements were not always implemented or sustained.

Improvements were required to ensure people’s needs and choices were fully assessed, to ensure people’s care needs were met effectively.

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 training had improved, and staff were supported by induction, mandatory training, supervision and spot checks.

People told us they felt safe with their care staff who were kind and caring. Staff knew how to recognise and report abuse.

The provider worked in partnership with other organisations and had provided support to their local community throughout the COVID-19 pandemic.

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 20 February 2020) and there was a beach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when. At this inspection not enough improvement had not been made and the provider was still in breach of the regulations.

Why we inspected

We carried out an inspection of this service in July and August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

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, effective 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 remained 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 Ashley Care on our website at www.cqc.org.uk.

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 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 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 breaches in relation to safe care and treatment, staff recruitment and good governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Ashley Care is a Domiciliary Care Service providing personal care to 200 people of all ages in their own home. They also provide a rehabilitation service. This is where people are supported with care in their own homes to support their recovery following a hospital admission, for example, or where they may need short term care during an illness.

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

The provider did not have full oversight of all quality assurance processes for the service including training and audits.

Risk assessments for people were in place but did not always reflect how staff could manage risks.

People felt safe and told us staff coming to visit them were kind and reassuring. Staff knew how to report concerns and knew safeguarding procedures well.

People said although the service did respond to complaints and concerns, lessons were often not learned, and things would slip back to how they were.

Staff told us the training they received was good, but this was not up to date for all staff and competency assessments had not been done in all cases. Staff felt supported through induction, spot checks and supervisions.

Staff had not always been recruited safely or in line with company policy

The provider had introduced new initiatives to provide extra support to people in their homes.

People were very happy with their regular carers, who were kind and compassionate and provided them with good care. Changes to care staffing arrangements and the use of agency staff meant that people’s experiences varied and was not consistently good.

People gave mixed feedback about respect for their choices particularly around call timings, gender of the carer and involvement in developing their care package.

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.

The registered manager was passionate about providing good care but people that used the service did not know who the registered manager was or the name of the office staff. People felt reliant on their regular carers as a point of contact.

The provider had developed and strong and valuable relationship with the Local Authority and were working closely with them to improve their service and outcomes for people

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 Good (published 16 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement:

We have identified breaches in relation to how quality and safety was effectively managed at this inspection.

We made a recommendation the provider familiarise themselves with recruitment checks and documents required for staff recruitment.

We made a recommendation to put in place a robust system for monitoring staff training.

We made a recommendation the provider takes peoples feedback into consideration when reviewing how care and support are provided.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashley Care is registered to provide personal care (often called domiciliary care) to people in their own homes in and around the Southend on Sea area. The service caters for adults of all ages including people living with dementia and/or mental health needs. They provide various services such as short term Reablement, A home again service (HAS) which provides people with immediate cover on return from hospital for up to 72 hours or until a longer term provider can be found and mainstream care.

There was 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.

Although people generally received their care and support in a way that ensured their safety and welfare there were not always enough care staff to support people when their regular care staff were not working. Improvements were in progress as the registered manager/provider had taken steps to remedy this and people confirmed there had been recent improvements to their evening and weekend calls when their regular care staff were not working. Although some people felt the service did not always respond appropriately to their concerns about relief care staff being late and missing calls most people told us, and the records confirmed that people’s concerns and complaints had been listened to and acted upon.

Staff understood how to protect people from the risk of harm. They had been trained in safeguarding people and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had care plans and risk assessments in place to ensure people were cared for safely. The service had a robust recruitment process and staff had been safely recruited to protect vulnerable people. Where the service managed people’s medication they received it as prescribed.

The registered manager/provider and staff had a good understanding of the Mental Capacity Act (MCA) 2005. Staff were well trained and supported to enable them to meet people’s assessed needs. Advocacy services were available should people need them.

Where people were supported with their meals they were given sufficient food and drink to meet their individual needs. People were supported when necessary to obtain healthcare advice and to maintain their health. People said their regular care staff were kind, caring and thoughtful, knew them well and treated them with respect and their dignity was maintained. Although people had different views about relief care staff saying they were often rushed they said that improvements had been made recently.

People’s needs had been assessed and their care plans gave staff the information they needed to meet people’s needs and preferences and to care for them safely. They were kept involved in their care and were able to express their views and opinions on a regular basis.

There was an effective system in place to assess and monitor the quality of the service and to drive improvements.