Agincare UK Chippenham

Updated 18 November 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of two inspectors, who attended the site visit.

Prior to the inspection an expert by experience carried out phone calls to people using the service and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We spoke with 14 people and eight relatives to seek their experiences of using the service. We spoke with 10 staff members.

During the inspection

We spent time with the registered manager at the office location. We reviewed a range of records. This included six people’s care plans and associated medicine records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records and staffing rotas.

Updated 18 November 2020

About the service

Agincare UK Chippenham is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using Agincare UK Chippenham receives a regulated activity, CQC only inspects the service being received by people provided with 'personal care', help with

tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of our inspection 72 people were being supported by this service.

People’s experience of using this service and what we found

Where a risk had been identified, there was not always a risk assessment in place to manage this risk and give guidance to staff. Risk assessments did not always contain sufficient detail to mitigate risks. Medicines were not always recorded safely. We saw one person had consistent gaps on the medicines recording sheet and protocols for medicines to take when required were not always in place.

Since March 2020, we have received seven whistleblowing concerns and four provider complaints about this service. When we spoke with staff they told us they did not always feel confident or comfortable in raising concerns internally and the management of these. People told us they felt safe with the staff that supported them.

We had received a number of whistleblowing concerns regarding staff not wearing personal protective equipment (PPE) appropriately. The registered manager had continued to take appropriate action when they had been made aware of these incidents. The service had implemented additional infection control measures in response to the coronavirus pandemic.

Quality assurance systems were in place to monitor the quality of service being delivered. However, these did not always identify concerns such as shortened call times, medicine errors or risk management. This meant that there were gaps in the auditing system where information was not checked, and action needed was not taken in a timely manner to keep people safe.

People were put at potential risk from not receiving the full duration of care and support they required during visits. We saw evidence that staff were not staying with people the full amount of time they had been assessed as needing and which was documented in their care plans. Staff raised concerns that missed and late visits were a regular occurrence within the service, and this was not taken seriously by the office staff.

Prior and during the inspection, staff had raised concerns with us about low morale, a negative culture and a breakdown of communication and support between them and the office and staff.

People were given the opportunity to provide feedback to the service about their experience of the care received. The registered manager told us they had tried to engage with people more during the pandemic, so they did not become isolated. Increased phone calls and welfare checks had been made and quizzes and word searches had been sent out to 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 1 March 2019).

Why we inspected

The inspection was prompted in part due to seven whistleblowing concerns and four provider complaints received. These were about staff not wearing appropriate personal protective equipment (PPE), falsification of documentation, missed and shortened visits to people and a negative culture between office and management staff and care staff. A decision was made for us to inspect and examine those risks.

We undertook an unannounced 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 Good to Requires Improvement. This is based on the findings at this inspection.

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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Agincare UK Chippenham 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 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 two breaches of the Regulations at this inspection in relation to the management of risks, medicines and the overall governance of the service in effectively assessing the quality of care people receive. 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 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.