All About Care (South West) Limited

All About Care (South West) Limited is a domiciliary care agency providing personal care. The service provides support to people who live in their own homes. At the time of our inspection there were 33 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

A new management team acquired the service in May 2023 and were open and honest throughout the inspection. When the service was taken over the new management team discovered staff had not received adequate training, risk assessments, care plans and mental capacity assessments were not always in place and there were no effective governance systems to ensure oversight and the safe care and treatment of people using the service.

Whilst the new management team had made some improvements by the time of our inspection, they acknowledged there was a lot more work to do to ensure people were receiving safe, effective, and responsive care. At our inspection we found not all incidents had been reported by staff for appropriate actions to be taken to ensure people were kept safe. People had not always been assessed for any risks to their health, safety and wellbeing for instructions to be given to staff to reduce the likelihood of harm. Medicines had not always been managed safely and people had not always received their medicines as prescribed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff had not received effective training in the mental capacity act and people did not always have mental capacity assessments and best interest decisions in place in accordance with the mental capacity act.

We have made a recommendation about regular staff supervisions and appraisals.

Care plans did not always reflect the needs of the people staff supported and had not been regularly reviewed to ensure the information was kept up to date.

We found systems and processes were either not in place or robust enough to identify areas of improvements and this had led to people being placed at risk of harm.

People told us they felt safe and felt well cared for by staff who were kind and caring. One person told us, “They have all been very nice, they make me feel safe.” There were enough staff to meet people’s needs, staff had been recruited safely into the service, staff had access to personal protective equipment (PPE).

Pre-assessments had been completed for every person who started using the service from May 2023. Staff had been provided with an up-to-date effective training programme due to be completed in July 2023. People were assisted with ready meals and prompted to drink to prevent dehydration. People were supported to access healthcare professionals when they needed them.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment, staff training and lack of risk assessments. A decision was made for us to inspect and examine those risks.

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

The provider, who acquired the service in May 2023 along with the new management team were responsive to the concerns found and started to implement systems and process to keep people safe.

Enforcement and Recommendations

We have identified breaches in relation to seeking consent from people who use the service, the safe care and treatment of people using the service and good governance of the service.

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.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager who has worked at the service for over five years, in various roles and was registered as manager in March 2017. 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People needed minimal support and prompting with their medicines and this support was managed safely. Any risks to people were identified and managed in order to keep people safe.

People received care and support in a personalised way. People’s needs were assessed and planned for. Staff knew people well and understood their needs. We found that people received the health, personal care and support they needed.

People and relatives spoke very highly of the caring and compassionate qualities of staff. People and relatives told us they had good relationships with staff and that there was often lots of laughter between people and staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of the Mental Capacity Act 2015.

Staff were recruited safely and there were enough staff to make sure people had the care and support they needed. Staff were trained and had the opportunity for personal and professional development.

People and relatives knew how to complain and raise any concerns. People and their relatives did not raise any concerns with us.

The culture within the service was personalised and open. There was a clear management structure and staff felt well supported and listened to. There were systems in place to monitor the safety and quality of the service provided.

Further information is in the detailed findings below

This inspection took place on 22, 24 and 26 February 2016. It was carried out by two inspectors.

All About Care is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided personal care and support for 112 people. The core hours of the service were 7 am to 10 pm. There was a 24 hour on-call service available.

There was a registered manager. 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.

At our last inspection of All About Care in February 2014 we had concerns that people were not asked for their consent before they received care. The service was not acting in accordance with the legal requirements of the Mental Capacity Act 2005 (MCA), as people’s mental capacity was not assessed appropriately. We had concerns that peoples medicines were not managed safely and that there was insufficient systems to monitor the quality of service that people received. We asked the provider to make improvements and they told us they would meet the requirements by July 2014.

We found the provider had made improvements since our last inspection in December 2014. People had an assessment of their capacity to consent to care and treatment and the service was acting within accordance of the legal requirements of the MCA .The medicines policy had been updated and people had an individual assessment for medicines. There were systems for monitoring the quality of care plans.

People told us they felt safe with the care and support they received. People had their risks assessed and they had support plans which provided guidance to staff on how to minimise people’s risks. People were encouraged to be as independent as possible with their medicines. When medicines were administered, there were checks in place to ensure people had received them correctly.

Staff were aware of what constitutes abuse and what actions they should take if they suspected someone was being abused.

People mostly received their visits on time and some people acknowledged that there were occasional unavoidable circumstances which may delay staff, for example traffic. Staff mostly felt their visits were well organised although some staff identified more pressures with travel times at weekends.

Staff received appropriate training and new staff completed an induction which they told us prepared them for their job role. Staff had regular supervision and an annual appraisal. There was a system for carrying out spot checks on staff.

Staff had received training on the Mental Capacity Act 2005 (MCA) and understood how it applied to their work.

Staff referred people for healthcare when they needed it; healthcare professionals told us that staff communicated appropriately and followed any recommendations they made.

People were treated with dignity and respect and their privacy was maintained. There were positive interactions between people and staff. People received personalised care and staff treated them as individuals. Some people received support from a particular member of staff and described the positive benefits of this. There was recognition that due to staff availability , the location of people and timings of visits, that some people received care from different members of staff.

Concerns and complaints were dealt with appropriately and people told us they could contact the office if they wanted to grumble. Staff stated they could contact the office when needed although there was acknowledgement from some staff that the office was busy. Staff described management as supportive. They were encouraged to enrol in further learning such as health and social care qualifications.

The service was piloting a rapid response service. This was a service to support people to be discharged from hospital. All About Care provided some short term care and support for people to enable them to be in their own homes. There was a small especially recruited team allocated to provide this service.

The provider did not have a formal system to assess mental capacity and record consent to care. There were some people that were receiving care that they had not agreed to, or sometimes withdrew their consent to, without an assessment of their mental capacity.

People received care that was planned and delivered appropriately. Approximately 95% of people we spoke with were happy with the care that they, or their relative, received. Comments made included: “We can’t fault them.”

We looked at the administration of medicines in the agency. We found that processes to ensure people had the medicines they were prescribed were not always followed. We saw that some risks had not been identified and appropriately assessed.

People spoke positively about the capabilities of the staff. One relative told us, “They understand her needs very well and have the right skills to meet them.” Staff told us they felt they had received the training they needed to do their jobs and they felt supported by the agency.

There was a system in place to monitor and assess the quality of the service that people received. However, this system was not always effective in ensuring that risks to people’s health and welfare were identified and appropriate action taken.