Assured Care Southport

Assured Care Southport is a domiciliary care agency providing personal care to people living in their own houses, flats and specialist housing. At the time of our inspection the service was supporting 180 people with personal care.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Risk was not appropriately assessed, monitored and mitigated. We found widespread concerns with a lack of information regarding the management of people’s individual risks. People were exposed to avoidable risk of harm as systems to ensure the safe and proper management of medicines were inadequate. Staff were administering medicines without any competency checks being completed to ensure they had the skills to do so safely.

The provider failed to ensure the required recruitment checks were carried out on staff which significantly increased the risk of unsuitable staff caring for people.

Safeguarding systems were in place, however, not all staff had received safeguarding training in line with best practice guidance and we were not assured staff had the necessary skills and knowledge to protect people from the risk of abuse.

People were placed at increased risk of harm as staff had not received the required training to meet their needs safely and effectively. Staff who were new to health and social care were not enrolled on The Care Certificate. Relevant training was not provided to ensure staff had the required skills to support people with a learning disability and autistic people in line with right support, right care, right culture guidance.

Care plans did not effectively guide staff on how to meet people's dietary needs, preferences and risks.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider failed to ensure care and treatment was planned for people in a personalised way. There was a lack of person-centred detail in all care plans we reviewed. People's care plans and risk assessments were not always completed, up to date and reflective of their current needs. Accessible formats of communication for people with impaired vision or cognition were not in place to aid their understanding and involvement.

Inadequate governance and quality assurance measures meant people were exposed to unnecessary risk and avoidable harm. The significant shortfalls found with risk assessments, recruitment practices, capacity and consent and person-centred care were not picked up by the registered manager's or provider's monitoring processes. The registered manager failed to have adequate oversight of the running of the service to ensure the required legal regulations were met. Multiple breaches of regulation found at the inspection showed the registered manager and provider lacked a clear understanding of their role and regulatory responsibilities.

People were generally treated with kindness by staff who delivered care. However, the shortfalls found with recruitment, training and care planning did not reflect a caring approach to people’s care and support. People told us they were well treated by staff.

Most people and their relatives told us they received support from a consistent staff team who generally arrived to their care calls on time. People told us staff mostly wore PPE and followed good hygiene practices to reduce the risk of infection spread.

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 23 October 2018).

At the last inspection, we recommended the provider reviewed their processes relating to The Mental Capacity Act 2005.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, 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.

Following the inspection, the provider sent us an action plan to demonstrate how they would improve the safety and quality of the service.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed, need for consent, person centred care and good governance at this inspection.

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 ‘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.

At the time of our inspection the service was providing small packages of care to 67 people and employed 33 staff.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to older adults and younger disabled adults.

This was the registered providers first inspection due to a change of legal entity in 2017.

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.

Staff were able to describe the process they would follow to report actual or potential abuse and this mostly consisted of reporting the abuse to the line manager. The service had a safeguarding policy in place and staff told us they were aware of the policy. Safeguarding training took place as part of the induction for new staff and was refreshed every year.

Staff recruitment records showed that staff were safely recruited after a series of checks were undertaken on their character and work history. We discussed at the time that some of files viewed would benefit from more detail being in place with regards to employment history.

Risk assessments were in place and were reviewed regularly or when people's needs changed. These contained basic details of how to support the person appropriately, while mitigating risk. They were instructive and clear however, were not personalised in their presentation, which was something the registered manager had identified themselves and were working towards.

Staff were supplied with personal protective equipment (PPE). This included gloves, aprons and hand sanitizer. Staff told us they were always able to ask for more PPE when needed. Staff had completed infection control and prevention training, and understood the importance of reporting outbreaks of influenza and vomiting to the manager, so they could cover their work so as not to spread the infection.

People were supported with their medication in accordance with their assessed needs and in line with recent guidance.

The registered manager and the staff understood the principles of the Mental Capacity Act 2005 and associated legislation. Some information in care plans with regards to the MCA and consent and best interests required some further development to ensure a consistent approach. We have made a recommendation concerning this.

Staff undertook training in accordance with the registered providers training policy. Staff told us they enjoyed the training. Staff spoken with confirmed they had regular supervision and appraisal.

People were supported as part of their assessed care needs with eating and drinking and staff were aware of people’s preferences.

Additional role specific training took place to help people manage their support needs. The service had recently branched out into offering their own in-house training in partnership with a registered trainer.

Staff supported people to access other healthcare professionals such as GP’s and District Nurses if they felt unwell.

People told us that the carers who visited were all very caring and would always ask them how they were feeling and ask them what they would like help with.

People were complimentary about the caring nature of the staff, and the registered manager, who often completed care calls themselves.

People told us that they were always kept informed and involved in their care.

We did not observe care being delivered, however, people told us staff were kind and caring in their approach.

Information in care plans was regularly reviewed and updated in line with people’s needs. This meant that the registered provider was responsive to people’s needs and preferences. Care plans contained some detailed information about people, what their preferences were and how they liked their care to be conducted, however, we did raise that some information would benefit from being more personalised.

Complaints were investigated in line with the complaints procedure and responded to appropriately. There had been no complaints recorded.

Audits took place which checked service provision and action plans were implemented to improve practice.

Feedback was gathered from people using the service, however this had not been done for some time. The registered provider assured us they would send the feedback forms out by the end of the month. Feedback was conducted every few months over the telephone, and annual audits were due to be completed.

Team meetings took place and minutes were available.