This inspection was announced and took place on 14, 15 and 16 June 2016. At the last inspection on 20, 22 and 28 October 2015, we found that the provider had breached seven regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014).We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we found that improvements had been made with regard to each of the breaches identified. However more time was needed to ensure that the processes put in place to support the safe record keeping of medicines were effective and sustainable.
Agincare UK Andover (Agincare) is a domiciliary care agency which provides personal care and support to people who live in their own homes in Andover and the immediate surrounding areas. Agincare also offer additional services such as ‘Take a break’, which allows people’s family and full time care staff a short period of rest, as well as companionship services such as assisting with shopping. This inspection focused on the provision of personal care and did not review the ‘take a break’ and companionship services as these are not activities which are regulated by the Care Quality Commission (CQC).
People who received this service included those living with dementia, people with medical conditions such as multiple sclerosis and those suffering physical impairments due to their medical condition. At the time of the inspection Agincare was providing a range of support services to 76 people of which 50 people were receiving personal care.
Agincare had a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the HSCA 2014 and associated Regulations about how the service is run. The registered manager had joined the service at the end of February 2016 and had taken positive steps to improve the quality of the service provided.
People’s Medication Administration Records (MARs) had not always been completed fully. As a result it could not always be easily identified whether people had received their medicines at the correct time and as prescribed. The registered manager was aware of the incorrect completion of the MARs and had taken appropriate steps to address this concern and we could see that improvements had been made.
People were protected from unsafe administration of their medicines because staff were trained effectively. Staff had completed mandatory training to ensure they could prompt people to take their medicines where required and where they administered people’s medicines this was carried out safely. Staff skills in medicines administration were reviewed on an annual basis by trained senior members of staff to ensure they remained competent.
People using the service and their relatives told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people.
People’s safety was promoted because risks that may cause them harm in their own home had been identified and were managed appropriately. People were supported by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.
Thorough recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. Induction training for new staff was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely. There was sufficient staff employed to ensure that people’s individual needs were met.
Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations which could affect service delivery and to protect the loss of people’s information if a fire or flood affected the main office. These included plans to ensure the continuity of care for people should staff be unavailable due to an outbreak of sickness. Office staff were appropriately trained and available to be deployed to deliver care if staff reported in sick.
People were supported by staff to make their own decisions. Staff were knowledgeable about the actions to take to ensure they met the requirements of the Mental Capacity Act 2005. The service worked with people, relatives and social care professionals when required to assess people’s capacity to make specific decisions regarding their care. Staff sought people’s consent before delivering care and support.
Where required, people were supported to eat and drink enough to maintain their nutritional and hydration needs. Records showed that people’s food and drinks preferences were documented in their care plans and understood by staff.
People’s health needs were met as staff and the registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.
Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. Staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times. People were encouraged and supported by staff to make choices about their care which included making any changes they required to their documented care plan at each visit.
People had care plans which were personalised to their needs and wishes. These were in the process of being updated to ensure that they contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives and those with the legal authority to make decisions on people’s behalf were encouraged to be involved at the care planning stage, during regular reviews and when their family member’s health and care needs changed.
People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People and relatives were encouraged to provide feedback on the quality of the service during regular telephone quality assurance checks.
Care workers were not always able to recognise the provider’s values. However all staff were able to demonstrate that they understood the values of the registered manager to provide good quality, respectful, safe care which protected people’s dignity and promoted people’s independence. People told us that these values were evidenced in the way that care was delivered.
The registered manager, office and care staff promoted a culture which focused on providing individual person centred care. People were assisted by staff who were encouraged to raise any concerns associated with their role with the registered manager. Staff told us they felt supported by the office staff, senior staff and their colleagues and were able to seek advice whenever required.
The registered manager provided positive leadership which instilled confidence in staff and people using the service. The registered manager had informed the CQC of notifiable incidents which occurred at the service, allowing the CQC to monitor that appropriate action was taken to keep people safe.
The provider carried out regular monitoring to assess the quality of the service being delivered and saw this as an opportunity to improve wherever possible.