Accolade Care Services UK Limited

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Accolade Care Services UK Limited is a domiciliary care agency providing personal care to people living in their own houses and flats. The service provides support to older people, people living with dementia, people with disabilities, people with mental health needs and people living with a learning disability and/or autism. At the time of our inspection there were 28 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

Right support

The provider had not always followed guidance for the administration of medicines and people's medicines had not always been managed safely. We found no evidence anyone had been harmed but this had put some people at risk of potential harm.

Accidents and incidents were reported and recorded. However, the provider had not regularly analysed and used the information to identify why things had gone wrong. This meant the process for learning lessons when things went wrong was less likely to be timely and therefore, less likely to be effective. During our inspection the provider said they would carry out accident and incident audits more regularly.

Infection prevention and control followed guidance and we were assured the provider was responding effectively to risks and signs of infection.

The service followed the Mental Capacity Act (MCA) and supported people to make decisions in accordance with the principles of the MCA.

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.

Right care

The provider had not always carried out risk assessments and put risk management plans in place for people and had not always updated people’s risk information. We found no evidence anyone had been harmed but this had put some people at risk of potential harm. People’s assessments and care plans were not always person-centred enough. However, there was a consistent staff team in place and staff knew people’s needs and preferences well and people received their care how they wanted it.

There were enough staff to meet people's needs and staff recruitment followed safer recruitment procedures.

People and their families said staff were caring, friendly and kind and respected their choices and privacy and dignity. Staff supported people to be as independent as possible.

There were systems and processes in place to safeguard people from the risk of abuse. Staff had received safeguarding training and knew how to recognise and report abuse and raise concerns. Safeguarding incidents and been reported appropriately and in a timely manner.

Right culture

There were quality assurance systems in place. However, not all the provider's audits were effective. The provider had not identified the issues we found.

Managers and staff were clear about their roles, they understood regulatory requirements and their duty to be open and honest with people when something went wrong.

There was a positive and supportive culture that was open, inclusive and empowering, which achieved good outcomes for people. The provider engaged and involved people, their relatives and staff in people's care and the development of the service. Managers provided staff with appropriate support. People, their families, staff and managers spoke positively about each other and feedback from people and their families about the service was very complimentary.

There were systems and processes in place to support continuous learning to improve the service. Staff worked in partnership with other organisations and services to provide people’s care and support.

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 21 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The overall rating for the service has changed to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Accolade Care Services UK Limited on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have also recommended the provider familiarise themselves with the principles and requirements of the Accessible Information Standard.

Follow up

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

This inspection took place on 18 January 2018. We gave two days’ notice to the provider to ensure someone was available to assist us with the inspection.

We last inspected the service in October 2015 and found the provider was meeting the fundamental standards. We rated the service ‘Good’ overall.

People felt safe with the staff who cared for them. Risks relating to people’s care were reduced as the provider assessed and managed risks. There were systems in place safeguarding people and staff understood their responsibilities in relation to this. Systems were in place to manage people’s medicines safely. There were enough staff deployed to care for people and staff were recruited through processes to check their suitability.

Staff received a programme of induction, training, support, supervision and appraisal to help them understand and meet people’s needs.

People received the support they required in relation to maintaining their health and also eating and drinking. People received care in line with the Mental Capacity Act 2005 (MCA).

The provider assessed people’s care needs holistically through consulting with people and their relatives and reviewing any professional reports. The provider developed care plans which guided staff on people’s physical, mental, emotional and social needs and informed them of their personal history. Staff knew the people they cared for and developed positive relationships with them.

People were treated with kindness, dignity and respect by staff and their privacy was maintained. The provider encouraged staff to become Dignity Champions and follow the ‘ten dignity do’s’ expected of high quality services in respecting people’s dignity. Staff were provided with sufficient training and also time to care for people in a person-centred way. Staff supported people to maintain their independence and people were involved in decisions about their care.

The provider used concerns and complaints as a way of monitoring quality and improving the service. The provider investigated and responded to complaints appropriately.

The service was well-led by a competent registered manager who was also the director of the service and had led the service for 17 years. Staff also understood their role and responsibilities.

The provider had suitable systems in place to assess, monitor and improve the service. The provider gathered feedback from people and relatives regarding the quality of care and carried out observations of staff to check they provided care at the expected standard. The provider communicated openly with staff and external professionals.

One person using the service said 'The service I receive is excellent. The carers turn up on time and do what they are supposed to. I have a care plan and know what staff are supposed to do for me'. Another person said 'The provider visits to check on staff and to make sure I am happy and everything is being done as it should be'.

A relative of a person using the service said 'They are doing a great job. My mother cannot speak English and they sent us a carer who can speak my mother's language which is Urdu. This is very helpful as my mother can communicate with them. The agency is fantastic'.

We found that the provider had appropriate arrangements in place to manage medicines. They had effective systems in place to regularly assess and monitor the quality of service that people received. However we found that appropriate checks were not always undertaken before staff began working at the service.

Croydon Social Services commission services from the agency. They told us they had no concerns about the service.

They said they could voice their concerns and had been given all the information they needed. Although the service had recently lost two members of office staff the manager had recruitment processes in place and we were assured that the positions were to be filled quickly. Staff told us that they felt well supported from the office and received appropriate training to meet people's needs. There were a range of systems in place to help monitor the quality of the service and to identify improvements.