Agincare UK Chippenham

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.

At the time of this inspection Agincare UK Chippenham was providing a service to 53 people. This inspection took place on 11 January 2019 and was announced.

A registered manager was in place and available throughout the inspection. 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 the last inspection in December 2017 the service was rated as Requires Improvement for the second consecutive time. At that inspection we found three breaches of the regulations in relation to Safe care and treatment, Good governance and the Notification of other Incidents. Requirement notices were served and the service sent an action plan to demonstrate how they would meet these Regulations.

At this inspection we found the service had made the necessary improvements to no longer be in breach of these Regulations and has now received an overall rating of Good.

Where a risk to a person had been identified, an assessment was in place, however there was not always enough information recorded on managing the risk. Although there was evidence of when a care plan had been reviewed there was not always a date to know when a written update had occurred.

There were some areas of improvement needed around medicine management. We observed gaps on some people’s medicine records but these had been identified by the registered manager and action taken with individual staff.

People had confidence in the staff to keep them safe. Staff understood their safeguarding responsibilities and how to report any concerns.

People told us there were sufficient staff to meet their needs. A rota was sent to people weekly which sets out which staff member will be visiting them and what time they are due.

The service followed safe recruitment practices. Staff files were organised clearly and included application forms, records of interview and appropriate references.

Staff spoke positively about the training received and the opportunity to progress if they wished. There was a clear induction checklist in place to ensure staff were signed off as competent before they started working. Records of probation periods were reviewed and documented.

We saw that some mental capacity assessments needed more detail to be recorded around how the person was given the information and how it was discussed in order to identify they lacked capacity.

People received care and support from staff who had got to know them well. The feedback obtained from people was particularly positive. Everyone confirmed that they had regular staff supporting them, who they valued.

Care plans were personalised and detailed daily routines specific to each person. There was reference to how each person communicated and information on their life history and interests.

Quality assurance systems were in place to monitor the quality of service being delivered. The registered manager completed a monthly audit overview of the service which included looking at medicines, incidents and accidents, complaints, feedback and care plans.

A new manager had registered in December 2018 and had worked for the service for seven years in different roles, prior to registering. People we spoke with told us the new registered manager was a welcome addition and they would recommend the agency to others.

People and staff and felt the communication was much improved and felt supported by the registered manager and confident to raise concerns.

At the time of this inspection Agincare UK Chippenham was providing a service to 65 people. The inspection office visit and phone calls to people and their relatives took place on 18 December 2017 and health and social care professional feedback was received 21 December 2017. This inspection was announced which means the provider had short notice that we would be visiting.

A registered manager was in place and available throughout the inspection. 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 the last inspection in November 2016 we found two breaches of the legal requirements. We asked the provider to take action to make improvements to meet legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and The Care Quality Commission (Registration) Regulations 2009 in relation to Regulations 12 Safe care and Treatment and Regulation 18 Notification of other incidents.

At this inspection we found the service continued to be in breach of Regulation 18 Notification of other incidents and Regulation 12 Safe care and treatment. A further breach of Regulation 17 Good governance was identified. This is the second consecutive time the service has been rated Requires Improvement and we are considering our response to this. The provider has voluntarily agreed to submit a monthly report of actions and quality monitoring within this service, to show how improvements will be addressed. We will continue to closely monitor this service and return to inspect and ensure the required improvements have been made and sustained.

Medicines were not always safely managed within the service. The recording of people’s medicines was not always accurate and information was not detailed to provide guidance to staff. The service was found to be in breach of the Regulation.

The recording and processing of incidents and accidents had not always been appropriately managed. There was not always detailed information on the outcome of an incident or preventative measures that had been taken as a result. The information recorded was also at times inconsistent. Risks had not always been assessed fully in order to provide sufficient information for staff to manage these. The service was found to be in breach of the Regulation.

Notifiable events such as safeguarding concerns had not been reported to The Care Quality Commission (CQC). This had been raised at the last inspection and had continued to be a concern. This was a repeated breach of the Regulation. You can see what action we told the provider to take at the back of the full version of the report.’

Staff were able to demonstrate how they supported people who may lack capacity. Consent to receive care from the service had not always been signed by the person themselves, despite the person having capacity to agree to this.

People’s care plans were informative and clear in some areas but lacked details in other areas. We saw that the service had not always taken steps to review how information could be made more accessible for people with additional communication needs.

Although there were systems in place to monitor the quality of the service provided we saw that these were not always effective in identifying concerns and taking immediate action.

People’s care records showed relevant health and social care professionals were involved with people’s care. We saw that information was available in people’s care plans about specific health conditions that they might have.

People told us they were happy with the care they received and had a group of regular staff who they saw most of the time. People valued the fact that these staff knew them and understood their needs.

People, their relatives and staff spoke positively about the registered manager and their availability and approachableness. Staff felt they were well supported.

Agincare Chippenham provides personal care to people in their own homes in Chippenham and the surrounding areas. At the time of inspection there were 61 people using the service.

A registered manager was in place and available throughout the inspection. 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.

People who used the service told us they felt safe. Staff had received training in safeguarding vulnerable adults, were aware of their responsibility to report any concerns and knew who to inform if this was required.

There were not always sufficient numbers of staff employed to provide consistent and safe care to people. Staff attended visits which were not within the planned schedule times and there was no system in place to monitor this. This meant people were not always fully supported and did not always know when staff would arrive to support them.

People and their relatives said staff treated them with dignity and respect. Staff spoke about how they helped people retain their independence and encouraged them to be in control of their decision making and choices. People told us they were cared for in a person centred way and were able to contribute meaningfully in day to day decisions about how their care was provided. Staff spoke fondly about the people they supported and gave good examples of how they developed positive relationships with people using the service.

Medicines were not always managed safely. Documentation of when medicines had been administered was not consistently completed and the reasons medicines had not been given were not always available. This meant people were at risk of not receiving their medicine as prescribed.

Effective systems were in place to manage risk and ensure people were cared for in a safe way. Risk assessments had been completed and actions recorded to manage identified hazards and concerns. However some care plans did not provide guidance on how to support people with specific medical conditions for example, what immediate support people needed when their condition worsened.

Staff completed competency assessments as part of their induction followed by regular supervisions and training. Staff were knowledgeable about people’s needs and said they received the necessary training to equip them with the skills they needed to provide the care people required.

Staff had received training around the Mental Capacity Act 2005. Staff explained they understood the importance of ensuring people agreed to the support they provided. Consent forms were filed in people’s care plans, some were signed by people receiving care. However, some consent forms had been signed by a next of kin or relative. In some cases, there was a record that the person had a legal right to do this on a person’s behalf but this was not consistent in all care files.

Staff helped ensure people who used the service had sufficient food and drink to meet their needs. Some people were assisted by staff to cook their own food and other people received meals that had been prepared by staff.

People had access to health care professionals to make sure they received appropriate care and treatment. Records of people’s healthcare and GP contacts were available in case staff needed to contact them.

Care plans detailed limited information about peoples likes, dislikes and preferences. However, staff told us how they supported people, gave them choices and knew their preferences. People and their relatives told us staff were polite and friendly.

A complaints procedure was available and people we spoke with said they knew how to raise a complaint if they needed to. When complaints or concerns had been made these had been handled in an appropriate way.

Staff said they felt supported by the management team. There was an open door culture and staff said the management team were approachable and supportive.

Quality assurance systems were in place. Where issues had been identified in the quality of care, actions had been implemented. However the actions in response to gaps in medicines administration records (MAR) that had not being signed for did not demonstrate thorough investigation of these errors.

People had the opportunity to give their views about the service. People were sent quarterly newsletters informing them of upcoming community events and seasonal advice.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that consent was obtained before staff supported them. Their needs were assessed and comprehensive care plans were devised that supported people in all aspects of daily living. The care records demonstrated that people were involved in their care planning and had signed to agree to their care package.

There were good arrangements in place to protect people from abuse. Staff attended training in safeguarding vulnerable people and when abuse was suspected appropriate responses were made. The provider had appropriate systems in place for the recruitment and selection of care staff and an induction period which included the mandatory training that took place for each new member of staff. When complaints were received they were handled appropriately.