Background to this inspection
Updated
2 November 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was completed by 2 inspectors, a specialist advisor for children who required nursing care and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal and nursing care to people living in their own houses, flats and specialist housing.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 30 August 2023 and ended on 15 September 2023. We visited the location’s office on 30 August 2023 and 12 September 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the Local Authority and professionals who work with the service. We used the information the provider sent us in the provider information return [PIR]. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 8 relatives and 1 family friend about their experience of the care provided. We spoke with the registered manager, the person responsible for quality assurance and staff responsible for the completion of investigations at the service. We texted 8 members of staff so as to have the opportunity to speak with them about their role and what it was like to work at Access 24/7 Healthcare Limited. However, only 2 members of staff contacted the Care Quality Commission. We reviewed a range of records. This included 5 people’s care records and 3 people’s medicine records. We looked at 6 staff files in relation to recruitment, staff supervision and spot visits. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
Updated
2 November 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Access 24/7 Healthcare Limited is a domiciliary care service providing the regulated activity of personal and nursing care to people in their own homes. The service provides support to both children and adults.
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. At the time of our inspection there were 26 people using the service, of which 23 people were receiving the regulated activity of personal care.
People’s experience of using this service and what we found
Right Support:
Staff supported people with their medicines, but improvements were required to ensure they received these as prescribed.
Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.
Right Care:
Although staff had received appropriate training on how to recognise and report abuse, people were not protected from abuse and harm. Improvements were required to ensure investigations were robust.
People were not supported by staff who had received all relevant training. This included training for people with a learning disability and autistic people.
The service had enough staff to meet people’s needs and keep them safe.
Risks to people were identified, assessed, and recorded.
Right Culture:
The registered manager had the knowledge and experience to perform their role but did not have effective oversight of the service they managed.
The management of records was not effective.
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 24 August 2022].
Why we inspected
We received concerns in relation to people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the relevant key questions of Safe, Effective and Well-Led of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Access24/7 Healthcare Limited on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safeguarding, medicines management, recruitment practices, staff training, induction and supervision and the provider’s quality assurance arrangements at this inspection.
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 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.