AMG Nursing and Care Services - Crewe

AMG Nursing and Care Services - Crewe is a domiciliary home care service providing personal and nursing care to 240 people at the time of the inspection. This included adults living with complex health needs, people coming to the end of their life and people who required short term care, for example following a hospital stay.

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

Since the last inspection improvements had been made to aspects of the service including the safe recruitment of staff and medicines management. However, further improvements were required to ensure systems to monitor the service were fully embedded and robust.

Audits and checks were being completed. However, these had not always identified where further improvements could be made, including those found on this inspection.

We have made a recommendation in relation to following relevant procedures for referrals to other agencies as part of safeguarding enquiries.

There had been some staff recruitment issues, which impacted certain geographical areas. The recruitment of new staff was an ongoing priority.

People gave mixed feedback about the timings of care calls and consistency of staff. Some were very positive. However, others felt call timings varied and they did not always see familiar staff. The management team continued to review rotas and schedules to make further improvements to the consistency of care visits. There were enough staff to meet the needs of the people they currently supported.

The provider’s systems had not ensured current government guidance for COVID-19 testing for staff was followed in full. This was immediately addressed by the registered manager and a system implemented to provide better oversight of staff testing results. Staff had appropriate access to PPE and had been trained to use this correctly, and other infection control measures were in place.

Overall, systems were in place to safeguard people for the risk of abuse. Safeguarding concerns had been appropriately identified and reported following relevant procedures. Care plans included detailed risk assessments with information about potential risks and measures to minimise the risk, including environmental risks.

Systems were in place to manage medicines safely and to ensure learning occurred when things went wrong.

Assessments of people’s needs, including detailed information about their health and support needs had been recorded. The provider had reviewed systems to ensure essential information was available to staff about people’s needs as soon as possible.

People were supported by skilled and trained staff who had their competency checked. A small number of supervisions and checks were overdue, the provider had plans to address this. Staff worked closely with other agencies to support people's needs. They supported people with complex health care needs well, with a specifically trained 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.

People were supported by staff who were kind and caring in their approach and they were treated with dignity and respect. We received some very positive and complimentary feedback about the support people received from staff. The service was focused on supporting people’s independence.

Overall, people received personalised care and support to meet their needs and preferences. staff were responsive to people’s feedback, and where needed adjustments were made to meet people’s individual preferences. Care plans were detailed and included information about people’s individual needs and preferences. People told us they felt able to raise concerns or complaints should they need to.

The provider and registered manager were committed to improving the service. Staff feedback about the way the service was managed was positive and morale had improved since the last inspection. Staff told us they were supported in their roles.

People’s feedback about the service was sought and the service worked in partnership with other agencies.

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 did not previously have an overall rating. At the last inspection we inspected the safe and well-led domains which were both rated as requires improvement and there were two breaches of regulation (published 12 November 2020). 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 some improvements had been made and the provider was no longer in breach of the regulation related to recruitment. However, not enough improvement had been made in relation to good governance and the provider remained in breach of Regulation 17.

Why we inspected

The inspection was prompted in part due to concerns received about staffing issues, consistency of call times and the quality of the care provided. A decision was made for us to inspect and examine those risks.

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 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.

AMG Nursing and Care Services is a domiciliary care service. The service provides personal care to children and adults living in their own homes. At the time of the inspection there were 178 people using the service.

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

Quality assurance systems had not always resulted in timely improvements to the service. While systems had been introduced to improve the oversight of the service, the provider was aware that further improvements were required.

Procedures to ensure staff were recruited safely had not been robustly followed.

Improvements were required to the timing of people's care visits and to ensure people had support from regular staff. Rotas had been impacted by the COVID-19 pandemic and action was being taken to address this.

People and family members told us overall, they felt safe with the support provided. There were mixed views about the support provided to people. Some people were positive about the care they received whist other told us improvements were needed.

The provider had introduced systems to improve the way medicines were managed, however there were further improvements to be made. Staff understood infection control requirements and worked in a safe way to limit the spread of infection

Individual risks to people had been assessed and action taken to reduce the risks, however, records did not always reflect the support in place to keep people safe. We made a recommendation in relation to the use of emollient creams within fire risk assessments.

Some staff felt well supported working for the service. Others felt morale was low and were unhappy with the way schedules were managed. There was no clear approach to seeking feedback from people or their family members. People gave mixed responses as to whether their views had been sought.

The management team was responsive during the inspection and took immediate action to address the areas for improvement.

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

Rating at last inspection

This service was registered with us on 24 October 2019 and this is the first inspection

The last rating for the service at the previous premises was requires improvement, published on 4 July 2019.

Why we inspected

The inspection was also prompted in part due to concerns received about the safe management medicines and staffing. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

We have found evidence that the provider needs to make improvements. Please see the safe 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 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 management of risk to ensure people's safety and the governance of the service at this inspection.

We have identified two breaches of regulation at this inspection. These are in relation to the monitoring of quality and care and the safe recruitment of staff.

We will review the action plan we have requested from the registered provider. 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.

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.