ACAH Limited

ACAH limited is a domiciliary care agency, providing personal care to people in their own homes. At the time of inspection, 20 people were using the service. Only 14 people were receiving 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

Risks to people’s safety were assessed and details around the care they required were documented. People felt safe using the service.

Safe recruitment practices were followed, and there were enough staff employed to meet people’s needs.

Medicines were administered safely.

People told us staff wore personal protective equipment (PPE) as required, and staff were trained in infection control.

Staff were given the training and support they required to carry out their roles.

When required, people received the support they needed with nutrition, hydration, and healthcare needs.

Audits and checks took place to ensure that standards were high, and any mistakes were found and resolved.

The registered manager understood their responsibilities, and worked in an open and transparent way. People and their relatives knew how to contact them if required.

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

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 requires improvement (published 11 March 2020).

Why we inspected

This was a focused inspection based upon the providers previous rating of requires improvement. We undertook a focused inspection to review the key questions of Safe, Effective, and well-led only.

The overall rating for the service has changed from requires improvement to good, based on the findings of this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Not everyone who used 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. At the time of inspection 23 people were being supported with personal care.

People’s experience of using this service

The provider had taken steps to improve the service and ensured people received care from staff who were supported through supervisions and team meetings. The provider had implemented systems to ensure they maintained effective oversight of the quality and safety of the service.

Staff training requirements had been met. All staff had received the provider’s mandatory training and there was improved oversight; the provider checked what training had been completed or was required.

People and their relatives had been given an opportunity to feedback about the quality assurance of the service. Feedback we viewed was positive and complimentary of the service provided.

The provider had developed a more detailed auditing system which ensured better oversight of the management of the service. The provider was continuing to make improvements to quality assurance processes and how the feedback received could be collated and presented to people using the service and their relatives.

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 requires improvement (published 11 March 2020) when there was a breach of regulation.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 30 April 2020.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider following our last inspection. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

We undertook this targeted inspection to check they now met legal requirements. This report only covers our findings in relation to the governance of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

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 service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Not everyone who used 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. At the time of inspection 23 people were being supported with personal care.

People’s experience of using this service

The systems in place to monitor the quality, safety and performance of the service were not always effective and were not consistently maintained.

Risks to people’s care were assessed but there was a lack of detailed information for staff to follow to mitigate the risk identified. Staff training had not been regularly refreshed to ensure they followed best practice and they did not benefit from regular supervision and opportunities to get to together to share experience and good practice.

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; however, the policies and systems in the service did not fully support this. Staff had not undertaken up to date training around the Mental Capacity Act.

People were cared for safely and staff understood their responsibilities to keep people safe from abuse or harm. They received their medicines safely and there were effective practices in place to protect people from infection.

Staff were kind and considerate and had developed positive relationships with people. They arrived on time and were consistent in their approach.

People had individualised care plans which ensured they received person-centered care. Care plans included people’s preferences, their likes and dislikes and their diverse needs.

The provider was open and honest and listened to people, taking action when necessary.

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 requires improvement (8 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in regulation in relation to the governance and management of the service at this inspection.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority and clinical commissioning group to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Care Quality Commission (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, 21 people were receiving personal care.

At our last inspection we rated the service as requires improvement. At this inspection we found that although some improvements had been made these had not always been consistently maintained and embedded; we identified other areas that required improving. The service has been rated overall as requires improvement.

The systems in place to monitor the quality, safety and performance of the service were not always effective and were not consistently maintained.

Risks to people were identified but there were no detailed risk management plans in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in place support this practice. However, it was not always clear which decisions people may not have the mental capacity to make for themselves.

We have made a recommendation in relation to seeking further guidance around the Mental Capacity Act.

Staff did not all regularly receive formal supervision and there was limited opportunity for them to come together and share their experience and good practice.

People continued to be treated with empathy and kindness and their individuality was respected. The staff were friendly, caring and compassionate and go the ‘extra mile’ to help people. Positive relationships had been developed between people and staff; people were happy with the service they received.

Care plans were in place, which enabled staff to provide consistent care and support in line with people's personal preferences and choices. People were supported to maintain good health and nutrition.

People received safe care from a staff team who were experienced and undertook regular training. Staff were appropriately recruited and there were sufficient staff to meet people's needs. People were protected from the risk of harm and received the support they needed to take their prescribed medicines safely.

The service had a positive ethos and an open culture. Development of staff knowledge and skills was encouraged.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they received.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The action we have taken is detailed at the end of this report.

There was 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.

Improvements were required to ensure that people’s risk assessment procedures were fully documented and were updated when changes had occurred. The registered manager also needed to document the action they had taken to ensure that safe recruitment practices had been adhered to and that staff were given adequate feedback about their performance and development needs.

Improvements were also required to the understanding of the Mental Capacity Act and the documentation that this requires when considering if people who use the service have the capacity to make particular decisions about their care. The registered manager showed competence at delivering good quality care but improvements were required to their knowledge of the regulations with which they must comply.

Further improvements were required to ensure that policies and procedures reflected the current practices adopted by the service and that effective quality assurance systems were in place to review the quality of care that people received.

People felt safe using the service and felt that they were treated well by staff. Systems were in place to help protect people from harm and people received their care from consistent members of staff in a timely way.

People were supported to have their medicines as they needed them and people were suitably protected by the prevention and control of infection. Systems were in place to identify if lessons could be learned if anything within the service went wrong and this was quickly shared amongst staff if improvements had been identified.

The registered manager had good systems in place to complete a detailed assessment of people’s needs, and they worked to match staff and people together with common interests or backgrounds if this would be beneficial. People were happy that staff had appropriate skills and competencies to provide the care they required, even in challenging circumstances.

People’s nutritional needs were met and monitored by staff if people required this support, and people’s healthcare needs were well supported with good liaison between services if necessary.

People spoke highly of the staff and the caring approach they took with them. People commented that the staff often went above and beyond expectations and they were thankful to have found ACAH. People were treated with kindness and respect and staff had developed positive relationships with people that helped to empower them.

People’s care needs were met in a personalised manner and staff were responsive and considerate in their approach. Staff provided flexibility when it was required and people were able to rely on the service. People’s care plans were person centred and each one was individualised to meet the specific needs of each person.

The registered manager was approachable and took an open approach to improving the service and providing the best care for people. The culture of the service promoted people’s independence and encouraged and empowered people. People were able to provide feedback to the service and this was very complimentary.

This is the first inspection of the service, and the first time it has been rated as Requires Improvement. We have made a recommendation about increasing knowledge and understanding of the regulations which govern this service.