This inspection took place on 12 and 20 January 2017 and was announced. At the last inspection in April 2014 we found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the planning and delivery of care to people and respecting and involving people. We found at this inspection these Regulations continue to be breached. We also identified some new concerns.
Agincare UK Surrey is a domiciliary care agency providing personal care for people in their own homes. There were 173 people using the service at the time of the inspection.
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. We have been informed since the inspection the registered manager had left the service. They are no longer registered with us.
People were not being protected against potential risks because risk assessments and guidelines for staff were not in place.
There were not sufficient staff to meet people’s needs.
Medicines were not managed safely. People did not always receive the medicines they required and staff had not had their competency checked.
Staff did not always receive refresher training to help ensure they remained up to date with best practice. We have made a recommendation about staff having access to up to date training.
Staff did not receive appropriate support to enable them to carry out their duties.
People's rights were not protected because the staff did not act in accordance with the Mental Capacity Act 2005. People were not consenting to their care and not all staff had knowledge of the Mental Capacity Act 2005.
People were not treated as though they mattered or made to feel at the centre of the service as they were not always receiving person-centred care. People did not always know which care worker would be visiting them or receive the care they expected because staff did not stay for the allocated time.
Peoples care plans were not person centred and lacked the detail required for staff to help ensure they provided care that met people’s needs, and care was not always planned and delivered to meet the nutrition and hydration needs of people..
The provider did not have effective systems in place to monitor the quality of the service they provided and the registered manager did not have good management oversight of the agency.
Staff had mixed views on whether the registered manager was supportive and complained about a lack of support from head office.
People were protected against the risks of potential abuse because staff knew how to identify potential abuse and report safeguarding concerns. The provider followed safe recruitment practices and had developed plans to help ensure that people’s care would not be interrupted in the event of an emergency, such as loss of utilities or severe weather.
People were supported by staff who had received induction training which included shadowing more experienced staff.
People had access to health care professionals and people and their relatives were involved in developing and reviewing their care plans. People told us their privacy and dignity was respected by staff.
People knew how to complain and the provider had a written complaints procedure. We have recommended that the way complaints are handled is improved.
During the inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent
enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.