Agincare UK Poole

Agincare UK Poole is a domiciliary care agency providing person care and support to people in their own homes, flats and specialist extra care housing. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 76 people receiving 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.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right Support

Developments and changes to the leadership of the service had strengthened oversight. This meant the service was safe. Improvements had been made in various areas of the service but specifically in the prevention of avoidable harm. Since our last inspection the service had improved in areas such as; infection prevention and control, medicines management and staffing levels.

People, their loved ones and staff told us Agincare UK Poole provided a safe service, many commenting on the improvements which had been made. Staff had received training in safeguarding adults and knew who to report to if they had concerns. They told us they felt confident their concerns would be followed up appropriately.

Right Care

People received their medicines as prescribed and the introduction of an electronic system had improved safety with medicines. There were enough staff to meet the needs of people using the service, procedures were in place to manage last minute changes and staff shortages with minimal effect on people. Communication between the service and people when changes were made to their visits had improved. However, for some people this was still a concern, the registered manager told us they were continually working on improving this for people.

Staff were recruited safely, trained and supported to settle into their role. People and their relatives told us staff were kind and caring, they were complimentary about the service. People’s needs were assessed before the service started; they were given an opportunity to discuss the things important to them during their assessment. People were treated with dignity and respect; staff knew the importance of asking consent and offering privacy.

Right Culture

Quality assurance systems were in place and embedded within the service. Additional checks at provider level ensured the service operated effectively. The registered manager and staff understood their roles and responsibilities within the service.

Staff felt appreciated and proud to work at the service. The service had made all notifications to CQC as required by law and appropriate referrals to external agencies. We received overwhelmingly positive feedback about the management of the service and office team at Agincare UK Poole.

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.

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 25 January 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced inspection of this service on 9 and 15 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and the governance of the service.

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, Caring 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 requires improvement to good. 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 Agincare UK Poole on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Agincare UK Poole is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 99 people were receiving personal care and support from the service.

Not everyone who used the service receives 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

Personal Protective Equipment (PPE) was not always worn in line with Government guidelines. When the provider was made aware of this they acted promptly.

We found gaps in Medicine Administration Records (MAR) so it was unclear if people had received their medicines as prescribed.

People told us inconsistencies in staffing was affecting their care experience, and staff were sometimes rushed and did not always stay for the length of the care visit.

The provider did not always have effective systems and processes to make sure they assessed and monitored their service.

The recently employed manager was aware of some of the shortfalls and had plans in place to ensure action would be taken and had started the process of applying to register with CQC.

Recruitment processes were robust. Staff were aware of safeguarding procedures and accidents and incidents were reported and investigated.

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.

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

The last rating for this service was good (published 20 November 2019).

Why we inspected

We received concerns in relation to infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe, caring 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, caring and well-led sections of this report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Agincare UK Poole on our website at www.cqc.org.uk.

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.

Agincare UK Poole is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 76 people were receiving care and support from the service.

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

People felt safe and well supported. Care was well planned, and responsive to people’s individual needs. Staff knew people well and understood and respected their choices and preferences.

The service supported people to access healthcare services and were encouraged to be involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people.

Staff supported people to take medicines safely. Risks to people were assessed and regularly reviewed. Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

People and relatives told us they could confidently raise any concerns, and these were addressed appropriately.

There were sufficient numbers of trained, experienced staff to meet people’s needs. Safe recruitment practices were followed, and appropriate checks completed to ensure that only suitable staff were employed. Staff received induction and on-going training and support that enabled them to carry out their roles positively and effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People, and where appropriate their relatives, were involved in decisions about their care.

Governance systems and oversight of the service ensured any issues were identified, and actions taken to address any shortfalls.

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 26 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is a domiciliary care service that provides personal care to adults in their own homes in and around Poole. At the time of our inspection there were 90 people using the service.

The service had a registered manager, which is a condition of its registration with CQC. 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. The registered manager at the time of the inspection was the area manager with oversight of the service, rather than the branch manager. The branch manager had been in post since July 2016 and an application was in progress to register with CQC.

At our last inspection in January 2016, we found breaches in the regulations relating to good governance and asked the provider to take action to improve communications, quality assurance processes and the way they addressed problems and concerns. We rated the service as ‘requires improvement’. This action has been completed.

People were treated with kindness and compassion in their day-to-day care. They mostly received care and support from staff who knew them. Continuity of staff had been a problem for some people, but had improved. The manager checked each month whether people were getting regular staff and reported the continuity figures to the provider.

People’s care needs were met. Their needs were assessed before their care package started and they were consulted and involved in developing their care plans. Care records were organised; care plans were up to date and reflected the needs of people we visited. Where people received support with food preparation and eating and drinking, they were generally satisfied with this and their choices of meals were respected.

Where possible, people consented to their care. Where there was doubt about their ability to give informed consent to aspects of their care, the manager and staff followed the requirements of the Mental Capacity Act 2005.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

Medicines were managed and administered safely. Staff had up to date training in handling medicines and their competence in handling medicines was assessed during observations of their practice.

Where necessary, the service had been flexible to accommodate changes in people’s needs. Someone told us that when a friend who usually provided some care was unable to assist, the service had stepped in and managed to provide a care worker at very short notice. However, someone else told us a staff member was allocated to visit who they had previously requested not to be included on their rota. We asked the service to rectify this and the following day a member of the office staff confirmed they had changed the person’s rota. The manager had already identified there had been some issues with communication and that there was scope for office communication to improve. They were taking steps to address this.

Some people said care calls were scheduled earlier or later than they preferred or needed. We fed this back to the manager, who said they would take action to improve this for the people concerned. They explained there had been some discrepancies between the preferred times stated by commissioners when care packages were commissioned and by people themselves.

Risks to people’s personal safety, and to staff visiting them at home, had been assessed and plans were in place to minimise these risks. There were arrangements in place to keep people safe in an emergency, for example in the event of severe weather.

There were enough staff with the right skills and knowledge to meet people’s individual care needs. Staff were supported through training and supervision. They told us that although they were busy, care calls were long enough for them to complete the expected tasks. They said there was generally enough travel time and the rotas we saw confirmed this.

People were protected from abuse and neglect because staff were aware of their responsibilities for safeguarding adults, and safe recruitment practices were followed. Checks were made to ensure staff were of good character and suitable for their role. The provider had a whistleblowing procedure and staff were aware of how to raise concerns. The concerns and complaints files contained a number of examples of concerns raised by staff. These had been taken seriously and the appropriate action taken.

Quality assurance systems were in place to monitor the quality of service being delivered. These included spot checks to ensure staff were working safely and properly, and regular audits by the service manager and by the area manager. Where audits identified shortfalls, the manager developed action plans, which set out the actions necessary to improve the service and the deadline for these to be completed. The management team had identified challenges that affected the service and were working to meet these.

People and those important to them had opportunities to feed back their views about the quality of the service they received. When we raised the reservations some people and staff had expressed regarding communication, for example about being informed when staff were running late, it was clear the manager was already aware of issues with communication and was working to improve this.

Our previous inspection on 15 and 16 December 2014 identified breaches of the regulations relating to: safeguarding people who use services from abuse, care and welfare of people who use services and records. This inspection visit took place to ensure the provider had made improvements in regard to the breaches in the regulations we had found during our visit in December 2014. At this inspection we found the provider had made some improvements however we did identify one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 . You can see what action we told the provider to take at the back of the report.

There was a registered manager in place. 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. There was also an acting manager in place who was registering to become the registered manager at the time of our inspection.

People were safe. Staff had received regular training to make sure they stayed up to date with recognising and reporting concerns. The registered manager had systems in place to notify the appropriate authorities where concerns relating to suspected abuse were identified.

Where risks to people had been identified, risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

People were asked for their consent before care was provided. However the provider did not always act in accordance with the Mental Capacity Act 2005. Following our inspection the provider sent us copies of newly implemented Mental Capacity assessments and best interest decision forms.

Staff were provided with relevant induction training to make sure they had the right skills and knowledge for their role. Staff understood their role and what was expected of them. They were happy in their work, motivated and had confidence in the way the service was managed.

People told us they could speak with staff if they had any worries or concerns and felt confident they would be listened to.

Most people were supported in accordance with their care plans. However some people or relatives told us that staff did not always stay for the required time and did not always carry out all of the tasks that people required. This was an area for improvement.

There were systems in place to monitor and improve the quality of service. Regular checks and audits were undertaken, but these were not always effective in improving the quality of the service. We were told by some people who used the service that improvements were not sustained.

The agency had systems in place to assess and plan people's care. There was positive feedback from the people who received a service, their relatives and members of staff.

There were safe systems in place for managing people's medication when they required this assistance from the staff.

The agency employed sufficient numbers of staff to meet the needs of people contracted with the agency. There were systems in place to make sure staff received training, making sure they had the competencies to carry out their role.

The agency had systems in place to monitor the quality of service provided to people.

We found that Agincare Poole had systems in place to gain and review consent from people who used their services.

We found that care plans accurately reflected people's needs and had been drawn up with their involvement or the involvement of their next of kin.

People were supported by staff that had been recruited in a safe manner and were appropriately qualified to carry out their role.

Records we looked at were accurate and up to date and were easily accessible to us during our visit.