J.C.Michael Groups Ltd Wandsworth Also known as Aquaflo Care Ltd

J.C. Michael Groups Wandsworth is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of inspection, the service supported people with conditions such as dementia and mobility needs. Out of a total number of 68 people, 64 people were receiving personal care from this provider.

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

Some feedback we received from people and their relatives was that staff did not attend the visits on time. We made a recommendation about this.

Although training provided for staff was meeting their role expectations, some staff's understanding of the Mental Capacity Act (2005) and Whistleblowing was limited. The provider was aiming to appropriately evaluate applicants during the interview process. Audits carried out by the registered manager were not always recorded. CQC records were not always up to date because the provider had not notified us about the changes taking place. Action taken by the provider to address these gaps will be reviewed at our next planned inspection.

People and their family members told us that the care provided was safe and met the needs of the people the service supported. People felt respected and had a choice of how they wanted to be cared for.

People's risk assessments were up to date and assessed the risks associated with people's care making sure staff supported people safely. There were systems and processes in place to safeguard people as necessary. Safe medicines management practices were followed by the provider. The provider followed current best practice guidelines to effectively manage risks associated with infection prevention and control (IPC).

There was a good delegation between the management team which supported the monitoring of the care provision. Staff felt supported in their role. Healthcare professionals were involved in care delivery when people needed their 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 overall rating for this service was good (published 22/11/2019). At this inspection the overall rating remained the same.

Why we inspected

This was a planned inspection based on when the service was last inspected.

We did not inspect the key questions of effective, caring and responsive. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for J.C. Michael Groups Wandsworth on our website at www.cqc.org.uk.

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.

J. C. Michael Groups Ltd Wandsworth is a domiciliary care agency that provides personal care and support to people living in their own homes. At the time of our inspection, 46 people aged 40 and over were using the service. Approximately half the people currently using the service were living with dementia. Some people also had physical disabilities, complex health care needs or a learning disability. Two people using the service received 24-hour care from live-in staff.

All 46 people currently using the service received personal care. The Care Quality Commission (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

People told us they remained happy with the home care service they received from J. C. Michael Groups Ltd Wandsworth. A quote we received from a relative summed up how most people felt about the service - “Our regular carer is like one of the family…They are kind and generous, and my [family member] looks forward to their visits.”

Since our last inspection, the provider had improved the way they monitor the quality and safety of the service people received by ensuring their existing governance systems were more effectively operated. For example, the new registered manager demonstrated a good understanding of the importance of quality monitoring and continuous learning and improvement and the new regional operations manager now routinely visited the services offices to audit records. The new registered and regional operations manager also both recognised the importance of analysing and learning lessons when things went wrong to continuously improve the quality and safety of the home care service they provided.

People, their relatives and staff all spoke positively about the way the relatively new management team ran the agency. They promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff. They also worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

In addition, people were now supported by staff who knew how to prevent and manage risks they might face and to keep them safe from avoidable harm. This positive point notwithstanding the registered manager agreed staff who supported people with behaviours considered challenging would benefit from additional training in how to positively support these individuals to prevent or appropriately manage such incidents.

We have made a recommendation about staff training on the subject of preventing or positively managing behaviours considered challenging.

Staff continued to undergo all the relevant pre-employment checks to ensure their suitability and fitness for the role. People received continuity of personal care and support from staff who usually arrived on time for their scheduled visits and were familiar with their needs and wishes. People received their medicines as they were prescribed. The service’s arrangements for controlling infection remained effective.

People continued to receive personal care from staff who had completed training that was relevant to their roles and responsibilities. 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. Where staff were responsible for this, people were supported to maintain a nutritionally well-balanced diet. People continued to be supported to stay healthy and well.

Staff continued to treat people with dignity and respect. People were treated equally and had their human rights and diversity respected, including their spiritual and cultural needs and wishes. People were encouraged and supported to develop their independent living skills. Assessments of people’s support needs were carried out before they started using the service.

Care plans remained personalised, which ensured people received personal care that was tailored to meet their individual needs and wishes. People were encouraged to make decisions about the care and support they received and had their choices respected. Managers and staff understood the Accessible Information Standard and ensured people were given information in a way they could understand. People were satisfied with the way the provider dealt with their concerns and complaints. When people were nearing the end of their life, they had received compassionate and supportive care from this agency.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was requires improvement (published 23 October 2018) and there was a breach of the regulations. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for J. C. Michael Groups Ltd Wandsworth on our website at www.cqc.org.uk.

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.

This inspection took place on 17 and 18 September 2018 and was announced. 48 hours before the inspection we contacted the service to let them know that we will be coming to inspect them. We wanted to make sure that the management team would be available on the day of inspection.

The service had a registered manager in post. 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.

This was the first inspection of the service after they changed the name from Aquaflo Care Limited to J.C. Michael Groups Ltd. At the last inspection on 17 and 21 August 2017 the service was rated overall Requires Improvement, with Requires Improvement in safe and well-led. We found two breaches of Regulations relating to people’s care records and quality assurance processes.

At this inspection we found that the service continued requiring improvement. We identified a breach of regulation and rated the service Requires Improvement, with Requires Improvement in safe and well-led. This was in relation to people’s safe care and treatment and good governance. You can see the action we have told the provider to take with regard to these breaches at the back of the full version of this report.

Risks to people's health and safety were not sufficiently identified and there were no appropriate risk management plans in place to mitigate potential risks to people.

The provider did not have robust systems in place to monitor the quality of the services provided for people, including accuracy of care records and reviewing of incidents and accidents, safeguarding and complaints.

The service used a new electronic system to monitor staff’s punctuality and length of their visits. However, the monitoring system was not used appropriately to monitor staff's scheduled visits. We made a recommendation about this.

Staff had to undertake appropriate checks before they were employed by the service. Staff followed the service’s processes to provide immediate support to people if they noticed people being at risk to harm or when incidents and accidents took place. People told us that staff arrived for their shifts mostly on time and they were told if they were running late. People were supported to manage their medicines safely.

Systems were in place to review and monitor staff developmental needs. Staff completed appropriate training on the Mental Capacity Act (2005) to ensure they had the required knowledge and skills to support people effectively. Where people required support to prepare their meals or attend to their health needs, staff had provided them with the assistance as required.

People were treated with dignity and kindness. People’s views were listened to and staff had time to have conversations with people. Staff provided support that was respectful towards people’s care needs and privacy. Staff encouraged people to be as independent as possible and make choices about their daily activities.

People were involved in planning their care and staff were provided with a care plan that included information on how people wanted to be supported. People’s care records had information about people’s health conditions and the support they required to manage their health needs. People provided feedback about the services they were provided with. Staff received training and had skills to support people at the end of their lives.

People felt that the service was well run and that the management team was responsive to their care needs. There was a clear management structure in place with shared responsibilities to monitor the services being delivered to people. Appropriate systems were used to share information quickly where necessary.

The service had a new registered manager who had been in post since May 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC). Registered managers like registered providers 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 newly registered manager was also responsible for managing another of this provider's similar sized domiciliary care agency’s located in the neighbouring London Borough of Croydon.

At our last comprehensive inspection of this service, which we carried out on 3 May 2016, we rated them ‘requires improvement’ overall and for two key questions is the service ‘safe’ and ‘well-led?’ This was because we found the provider had failed to always check the suitability and fitness of new staff they employed or notify the CQC in a timely manner about significant incidents that adversely affected the health and welfare of people using the agency.

We carried out a focused inspection on 2 December 2016 to check the provider had improved their arrangements for checking the suitability of new staff and submitting statutory notifications to us without delay. At the time of our focused inspection we found the provider had resolved the aforementioned issues and now met the regulations and fundamental standards. However, we continued to rate them 'requires improvement' overall because we needed to see the service could consistently maintain these improvements over a more sustained period of time.

At this comprehensive inspection we found the provider had maintained improvements in the way they assessed the suitability of new staff and dealt with statutory notifications. However, we have continued to rate the service 'requires improvement’ overall and for two key questions is the service ‘safe’ and ‘well-led?’ This was because we found the provider to be in breach of two new regulations in relation to the way they managed risk and oversight of the service.

Specifically, the provider failed to ensure all the risks people might face had been properly assessed and that adequate risk management guidelines were always in place for staff to follow and ensure identified risks were managed safely. This meant the provider had not done all that they should to identify and manage risks to people using the service and ensure they were sufficiently protected from the risk of injury and harm.

Furthermore, although the provider had established some good governance system to assess and monitor the quality and safety of the care and support people using the service received; we found these measures were not always operated effectively. Moreover, these governance systems had failed to identify a number of the issues we identified during our inspection in relation to guidance for staff to help them prevent or mitigate risks people might face and ensuring staff kept up to date with their core training and annual work performance appraisals. In addition, in the last 12 months managers had failed to carry out direct observations of all their staffs working practises during scheduled visit, contrary to the provider’s staff performance monitoring policy. This meant the provider lacked the ability to effectively challenge staff providing poor care to people as they did not have documentary evidence to support any issues or concerns they may have identified.

These failings represent two breaches of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We also received some mixed comments from people using the service and their relatives regarding staff turning up late for their scheduled visits. In response to concerns raised by people about their care workers’ time keeping the provider was in the process of introducing a new centralised electronic system that would allow the care coordinators to closely monitor staff punctuality and length of their stay. This would help the provider plan carer workers scheduled visits more effectively.

The negative points described above notwithstanding people we spoke with felt safe with their regular care workers. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. Medicines were managed safely and people received them as prescribed.

Most staff received appropriate training and support to ensure they had the right knowledge and skills to effectively meet people’s needs. Staff adhered to the Mental Capacity Act 2005 code of practice. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals. People received the support they needed to stay healthy and to access healthcare services.

People and their relatives told us they were happy with the care and support provided by their regular carer workers. Staff were caring and treated people with dignity and respect. They ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. People were involved in planning the care and support they received. Each person had an up to date support plan. People felt comfortable raising any issues they had about the provider. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

The provider had an open and transparent culture. They routinely gathered feedback from people using the service, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided. Staff felt supported by the newly registered manager.

This inspection took place on 2 December 2016 and was announced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried on 3 May 2016. At that time we rated the service as 'Requires Improvement' overall because we found the provider to be in breach of two regulations we looked at. Specifically, we found the provider failed to operate safe staff recruitment procedures or notify the CQC without delay about an allegation of abuse involving a person who received a service from this agency.

This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focused inspections, by selecting the 'all reports' link for ‘Aquaflo Care Limited’ on our website at www.cqc.org.uk.

Aquaflo Care Limited is a domiciliary care agency located in Wimbledon that provides personal care and support to people living at home in and around South West London. At the time of our inspection approximately 40 people received a service from this agency, which included two people who lived in residential care homes in the area. Most people receiving a service from the agency were older adults who had a range of health care needs and conditions, including dementia care needs.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC). Registered managers like registered providers 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 registered manager was responsible for the day-to-day running of this agency in Wimbledon, as well as another of the provider’s South London branches located in Croydon. Both the Wimbledon and Croydon branches are of a similar in size and are within close proximity to one another.

During this focused inspection, we found that the provider had followed their action plan and now met legal requirements. Specifically, the provider had improved their staff recruitment practices. Appropriate employment and criminal records checks had been carried out on all new staff to ensure they were suitable and fit to work for the agency. In addition, we found the provider had notified the CQC in a timely way about the occurrence of any incidents and events that affected the health, safety and welfare of people using the service, which they are legally required to do.

Aquaflo Care Limited is a domiciliary care agency that provides personal care and support to people living in their own homes in and around South West London. A few people who receive one-to-one personal care and support from this agency live in residential care homes. Most people using the service are older people living with a range of health needs and conditions, including dementia and end of life care. When we inspected the agency 32 people were receiving a service from the Wimbledon branch of Aquaflo Care Limited.

The service had a registered manager in post. 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 Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the provider did not operate effective staff recruitment procedures. This was because the provider had failed to undertake all the relevant employment checks on prospective new staff before they started working for the agency. This meant people might be at risk of receiving care from staff who were not fit to work in the adult social care sector.

The provider had also failed to notify the CQC without delay about the occurrence of a safeguarding incident involving a person who used the service. This meant the CQC had not been able to check if the action taken by the provider to deal with these incidents was appropriate at the time because we were unaware of their occurrences.

We identified two breaches of the Health and Social Care (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

People’s relatives told us they were happy with the standard of care and support their family members received from Aquaflo Care. They also said staff who worked for the agency were kind and caring, and always respected their family member’s privacy and dignity.

The registered manager and staff knew what constituted abuse and who to report it to if they suspected people were at risk. They had all received training in safeguarding adults at risk. Staff had access to appropriate guidance to ensure identified risks to people were minimised. Regular maintenance and service checks were carried out on equipment used by staff in people’s homes, which included mobile hoists. This ensures equipment remains fit for purpose and safe for people receiving a service to use.

People were supported to stay healthy and well. Staff were knowledgeable about the signs and symptoms to look out for that indicated a person’s health may be deteriorating. If staff had any concerns about a person’s health, appropriate professional advice and support was sought. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals. People received their medicines as prescribed and safe medicines management processes were followed.

Staff were knowledgeable about the people they supported. This included their preferences, routines and their support needs. Staff provided people with the support they required in line with their care plans. Staff regularly discussed people’s needs to identify if the level of support they required had changed, and care plans were updated accordingly.

People were involved in decisions about their care. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. People were supported to make decisions about end of life care and how they would like to be supported during that time. Staff were also aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Staff supported people to be as independent as they could and wanted to be.

Staff had developed caring and friendly relationships with people. There were enough suitably competent staff to care for and support people. People were matched with staff with the right mix of knowledge, skills and experience to meet their needs and preferences.

Staff received the training they required to ensure they had the knowledge and skills to undertake their role. Systems were in place to ensure staff remained up to date with the training considered mandatory for their role. Staff were supported by the registered manager and care coordinators who ensured staff had regular opportunities to discuss their work and professional development during individual supervision sessions and team meetings.

Staff were invited to express their views and opinions, and these were used when looking at service improvements. People and their relatives were also encouraged to express their views about the service and where they had made suggestions for improvements these had been implemented. Staff told us they felt valued and appreciated for the work they did by the agency’s registered manager and care coordinators.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through telephone monitoring calls and satisfaction surveys. Care coordinators carried out unannounced spot checks to make sure people were supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the registered manager. They said there was an out of hours on call system in operation that ensured management support and advice was always available when they needed it. The provider also used external scrutiny and challenge to ensure people received appropriate care and support from the agency.