Archived: ANA Islington

ANA Islington is a is a domiciliary care agency. It provides personal and nursing care to people living in their own houses and flats in the community and specialist housing. It provides a service to adults of all ages that required support and care due to deteriorating health. At the time of our inspection there were 19 people who received personal care from the agency.

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

The provider had made improvements to how they managed people’s medicines. However additional improvements were needed. This was to ensure medicines administration charts (MARs) only reflected medicines currently taken by people and that when people did not take their medicines this was reflected consistently by staff on MARs.

There were systems in place to protect people from harm and abuse. People and relatives said they felt safe with staff visiting them. Risks to people’s health and wellbeing had been assessed. Staff were recruited safely to ensure only suitable staff supported people. The same staff usually visited people and there were sufficient staff deployed to ensure visits took place as planned. Accidents and incidents had been reported, recorded and analysed so lessons could be learnt so that the accidents and incidents did not to reoccur.

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. Staff asked people’s consent before providing care and support to them.

People’s needs had been assessed regularly and any changes had been reflected in their care plans. Staff were supported through training, regular supervision, spot checks of their direct work with people and yearly appraisal of their performance. People were supported to have diet that met their nutritional needs and personal preferences. Staff supported people to have access to health professionals when people’s needs had changed or their health deteriorated.

Staff treated people with kindness and they respected equality and diversity amongst people they supported. The same staff usually visited people and therefore they knew people’s needs and preferences well. Staff encouraged people to express their views and be involved in making decisions about their care. People and relatives said they felt their dignity and privacy was respected by staff who visited them.

Care plans were holistic and personalised. They provided staff with clear information on what support was needed, who and what was important to people and what their interests and hobbies were. Staff knew how to communicate with people so people understood and could respond. When possible, people’s families had been encouraged to participate in planning and reviewing of care for their relatives.

Overall people and relatives were happy with the care provided. They knew who managers were and they thought overall sufficient action was taken to address complaints and concerns raised by people and relatives.

The provider had a range of checks in place to ensure care provided to people matched their needs and that staff had skills to do it safely. There was a clear leadership structure in place and staff were provided with information on what their role was and what was expected from them. Most staff said they could contact the office any time for support when needed. Staff, people and relatives were encouraged to provide feedback about the service provision. The management team were responsive to feedback received and they were proactive in addressing issues identified.

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 13 October 2018) and there were breaches of regulation 12 related to management of medicines and assessing risk to health and wellbeing of people who used the service. 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

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.

ANA service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to adults of all ages that required support and care due to deteriorating health. At the time of our inspection there were 26 people who received personal care from the agency.

The service had a new 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. The previous registered manager had left in January 2018 and the new manager had registered with the Commission in June 2018. The registered manager was supported by the provider, the general director, members of the office team and the care staff. They had appropriate training and experience to manage the regulated activity.

At our pervious inspection on 04 July 2017, we found that the provider's recruitment policy did not include processes if a criminal record check for potential employees came back as positive. At this inspection we found that this had been addressed.

At our previous inspection we found that the agency had not displayed the performance ratings as required by the law. At this inspection we saw that this matter had been addressed and the most current performance rating had been displayed.

At this inspection we found that the agency had not always managed people medicines as they should and there was a risk that people would receive their medicines not as intended by a prescriber. Issues related to medicines management included insufficient practice in transcribing medicines onto people’s Medicines Administration Chats (MARs), the lack of individual PRN (when required) medicines protocols and changes to people’s medicines not being clearly recorded.

The service had not fully assessed all risk to health and wellbeing of people who used the service. Risks related to people’s behaviour that could challenge the service had not always been evaluated. Consequently, staff had not been given sufficient guidelines of how to provide care that was safe to staff and people who used the service. We saw other examples of risk assessment relating to other aspects of care, such us pressure ulcer prevention, manual handling and risk a of falls. We saw that these were sufficient.

We found that the agency had carried out regular quality assurance checks. However, we saw that these checks were not effective in identifying issues highlighted by us during the inspection. Therefore, they needed to improve.

The agency worked within the principles of the Mental Capacity Act 2005. Staff had a good understanding about their role in supporting people lacking capacity. However, more information was required in people’s files about individual people’s abilities to make their own decisions.

There were systems in place to ensure people were protected from avoidable harm. These included appropriate recruitment procedures, adhering to safeguarding procedures and ensuring sufficient staffing levels so all people had been visited and supported as agreed. Staff at the agency also were aware of the provider’s reporting of accidents and incidents procedures and were following appropriate infection control measures.

The agency had assessed people’s care needs and preferences before they started receiving care. This information was then used to formulate people’s individual plans of care.

Newly employed staff had received training and an induction in relation to the agency’s policies and procedures as well as their roles and responsibilities as a care staff. Other staff had received yearly refresher training, regular supervision and a yearly appraisal of their skills. This was to ensure all staff had an appropriate level of knowledge and skills to support people in a safe and effective way.

People were supported to have sufficient food and drink that met their dietary requirement. When required staff ensured people had prompt access to appropriate health professionals.

People and their family members told us that staff who supported them were kind, caring, patient and compassionate. Staff communicated with people in the way people preferred and understood. This was possible because staff were provided with guidance on how to best communicate with people. The continuity of care from the same care staff helped to build positive friendly relationship with people and improve the effectiveness of communication between them

People’s privacy and dignity was protected at all times. Staff received cultural awareness training to assist in providing a multi-cultural and multi-faith service. When providing personal care staff involved people and explained what they were doing. This way people could be reassured and be more comfortable when receiving personal care.

The agency provided care that was sensitive to people’s need and personal preferences. People and their families could influence support that was provided and overall care package had been regularly reviewed.

The agency had a complaints policy in place and complaints had been dealt with appropriately and to people’s satisfaction.

The agency provided end of life care and staff had received appropriate training to enable them to provide appropriate care and support to people and their family members during the final stages of their life.

People using the service, their relatives, the staff team and external social care professionals spoke positively about the quality of the service provided. They told us that some aspects of communication from the agency could improve, however, overall, they felt the agency was well managed.

The agency had encouraged people receiving the service and staff to give their feedback about the quality of the care provided by the agency.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made one recommendation which was related to working within the principles of the Mental Capacity Act 2015 (MCA).

At our last inspection on 1 June 2016, the service was in breach of Regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found risk assessments had not been updated to reflect people’s current circumstances and did not take into account people’s health needs. Capacity assessments to determine people’s ability to make certain decisions were not being completed in line with the Mental Capacity Act 2005 (MCA). During this inspection we found improvements had been made and the service was compliant with the breaches.

ANA Islington is a domiciliary care service providing personal care to people in their own home. At the time of our inspection there were 23 people who received personal care from the agency. People that received a service were mainly older people that required support and care due to deteriorating health.

The service had 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.

The provider had not displayed the rating of the last CQC inspection carried out on 1 June 2016 at their site and website. This is a requirement under Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. After the inspection, the registered manager confirmed that the ratings had been displayed on the website and at their site.

Pre-recruitment checks had been made to ensure that new staff were suitable to support people in their own homes and maintain people's safety. However, the provider’s recruitment policy did not include processes if a criminal record check came back as positive.

People were protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse.

Risks had been identified and assessed that provided information on how to mitigate risks to keep people safe.

Medicines were managed safely. Staff had been trained in medicines and people and relatives had no concerns with medicine management.

Mental Capacity Act 2005 (MCA) assessments had been carried out using the MCA principles. Staff had received training in MCA and were able to tell us the principles of the MCA.

Staff had completed an induction and essential training to perform their roles effectively.

There were systems in place for quality assurance. Spot checks were carried out, which observing staff performance and outcomes were communicated to staff.

There were systems in place for quality monitoring. Feedback had been sought from people and their relative. Results were analysed to make improvements to the service.

Systems were in place to monitor staff attendance.

People told us they were encouraged to be independent and their privacy and dignity was respected. Staff knew how to protect people’s privacy and dignity.

Care plans listed people’s support needs and were person centred. People's care needs had been reviewed and the care plans were updated to reflect any changes in people's needs.

Complaints were recorded and investigated with a response sent to the complainant.

Staff told us that they were supported in their role, the service was well-led and there was an open and transparent culture where they could raise concerns with management and felt this would be addressed promptly

ANA Islington is a domiciliary care service providing personal care to people in their own home. At the time of our inspection there were 23 people who received personal care from the agency. This was the first inspection of the service.

The service had one 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.

People were protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse. Two staff were not able to tell us they could ‘Whistleblow’ to external organisations such as the CQC and local authority. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

Some risk assessments were not updated to reflect people’s current needs and did not take into consideration people’s health needs. When a risk was identified it did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people from risks with choking and falls.

Staff provided support with medicines. Staff were trained in the safe management of medicines. However, staff had not carried out competency assessments to check their understanding of medicines and how to administer them safely.

People’s capacity was being assessed and some people were determined to have lacked capacity. However, the assessments did not specify what areas people did not have capacity and we did not find evidence of best interests meeting being held to make a decision on the person’s behalf. Assessments were not being completed in accordance to the Mental Capacity Act 2005 (MCA). Staff had not been trained in MCA and three staff were unable to tell us the principles of the MCA.

Quality assurance were not being carried out on people’s and staff record to ensure high quality care was being delivered at all time. Questionnaires were completed by people about the service and people's responses were positive. Spot checks were carried out to provide feedback to staff on areas that needed improving.

The number of staff were sufficient to meet people's assessed needs. Staff were employed according to robust recruitment procedures. Pre-recruitment checks had been made to ensure that new staff were suitable to support people in their own homes and maintain people's safety.

People had choices during mealtimes and staff assisted with meals in accordance to people’s preferences.

People were encouraged to be independent and their privacy and dignity was maintained.

Staff knew the people they were supporting, their needs and expectations, and provided a personalised service. Care plans were in place detailing how people wished to be supported. People were involved in making decisions about their care.

The registered manager promoted an open culture where staff, relatives and people using the service could raise concerns.

People knew how to complain and felt their complaints would be investigated and responded to and staff were able to tell us how to handle complaints. Complaints were being handled appropriately.

We identified breaches of regulations relating to consent and risk management. You can see what action we have asked the provider to take at the back of the full version of this report.