We carried out a review of the data available to us about Agincare UK Medway on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Agincare UK Medway, you can give feedback on this service.
Agincare UK Medway is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection, 97 people were accessing support from the service. Most of the people receiving support were older people. 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
People were positive about the support they received from staff. Comments included, “I've got a good carer, nice and kind, helps you all the time.” And, “The carers are on the whole lovely. I can't fault them at all.”
Staff knew how to protect people from the risk of harm through abuse. Where concerns were raised these were reported and acted upon. Staff had the training, information and knowledge they needed to support people with risks to their health. Medicines were managed safely to ensure people received their medicines as prescribed. Staff had access to personal protective equipment such as masks and gloves to protect them and people during the pandemic. People told us staff wore these. When incidents and accidents occurred, these were reported and acted upon.
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 were positive about the support they received and had regular supervision and appraisals. Checks were undertaken to ensure staff were competent administering medicines and moving people. Staff told us they felt listened to. There had been surveys for people and their relatives and staff to seek their opinion on the service. Auditing had been improved and actions were taken when shortfalls were identified. The service to worked in partnership with healthcare professionals to improve outcomes for 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 requires improvement (published 17 September 2019). There were two breaches of regulation in relation to safe care and treatment and good governance. The provider completed an action plan to show what they would do and by when to improve. We undertook a targeted inspection (published 08 October 2020) where we found they were no longer in breach of the regulations. However, the last inspection did not change the ratings.
Why we inspected
This was a planned inspection based on the previous rating.
We undertook this focused inspection to review the rating of the service. This report only covers our findings in relation to the Key Questions Safe, and Well-led where the service was rated Requires Improvement.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Agincare UK Medway 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.
Agincare UK Medway is a domiciliary care agency providing personal care to about 161 people at the time of the inspection. Most of the people who used the service were older people. 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.
People’s experience of using this service and what we found
People were generally happy with the care and support provided.
However, while care staff were trained in certain areas with the right skills and knowledge to provide people with the care and assistance they needed, the training programme did not contain adequate provision for dementia, epilepsy, diabetes, catheter care and Huntingdon’s disease, which was relevant to the people supported. We have made a recommendation about this.
Although, there was an audit system in place to check the quality of the service, audits records were not robust and had not been updated when actions had been completed. The new manager only gave us feedback on steps to being taken to resolve the concerns. We have made a recommendation about this.
People and staff felt communication with office staff could be improved upon. This is an area for improvement.
At the time of our inspection, the service had a new manager in post who was undergoing registration with the Commission. This meant there was no registered manager in the service.
Since our last inspection, the provider had ensured that medicines were managed safely or in line with best practice. Medication administration charts were completed accurately. Staff had been trained and their competency checked.
Care plans contained risk assessments which were appropriately linked to their support needs. Risks were consistently assessed and there were information for staff about how to support people to remain safe in care plans.
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 rating at the last inspection was Requires Improvement (published 17 September 2019) and there were multiple breaches of regulation. 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 the provider had improved the service by ensuring that medicines were managed safely. However, the provider requires further improvement in the operation of adequate quality assurance system.
Why we inspected
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at the entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of the key question.
We undertook this targeted inspection to check whether the Requires Improvement we previously gave in relation to regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The inspection was prompted in part due to concerns received about medicine administration and staffing. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of 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 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.
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.
Agincare UK Medway is a domiciliary care agency providing personal care to people living in their own homes. 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. The service was providing personal care to approximately 90 people at the time of the inspection.
People’s experience of using this service and what we found
The service people received was not always safe. The recording and administration of people’s medicines were still not carried out in a safe way, for those who needed the assistance of staff to help them to take their medicines. Other elements of care had improved. Individual risk assessments were now in place and plans to manage the risk and prevent harm were better recorded. People told us they felt safe with staff and were confident in their care. People said they felt there were enough staff as their care was rarely cancelled and staff stayed the full length of time when visiting.
The systems to monitor the quality and safety of the service had failed to pick up the areas of concern we found around people’s medicines and how these were managed and recorded. People did not provide positive feedback about how the service was run. They told us the office staff did not always contact them to make them aware of changes, such as when staff were going to be late, or not able to get to them.
Assessments were carried out with people before they started to use the service to make sure their needs could be met. People were supported to access healthcare advice and given assistance with their nutrition and hydration when this was needed. People and their relatives told us they were involved in and directed their care, making their own choices and decisions. Staff received the training and support they needed to provide safe care.
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.
People and their relatives were positive about the staff supporting them, saying staff respected them and describing them as caring and kind.
Care plans were more person centred than before and provided better information about people’s lives and what was important to them. People had the information they needed to make a complaint if they needed to and any complaints made were investigated and followed up.
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 (report published 17 July 2018) and there were four breaches of regulation. 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 in some areas which meant the provider was no longer in breach of two of the regulations. However, further improvement was needed in other areas and there were two continued breaches of regulation.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified two breaches, in relation to the management and administration of people’s medicines and the monitoring of the quality and safety of the service, 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 set out what they will do to improve the standards of quality and safety. 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 any adults who require care and support in their own houses and flats in the community. Not everyone using Agincare UK Medway receives 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 inspection, although the service supported approximately 250 people in total, only approximately 60 people were receiving personal care in their own homes.
A registered manager was employed at the service by the provider. 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 our last inspection on 23 February 2016, the service was rated as ‘Good’. At this inspection, we found that there were now areas that required improvement. This is the first time the service has been rated 'Requires Improvement'.
Individual risks were not always identified in order to ensure measures were in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were highlighted to keep people, staff and others safe from hazards.
Accidents and incidents were recorded by staff but not always followed up by the registered manager to identify themes and ensure appropriate action had been taken and to learn lessons.
Some areas of the management of people’s prescribed medicines needed improvement to ensure people received their medicines in a safe way at all times. Gaps were evident in medicines administration records (MAR). Creams were not always applied as per prescription or with the advice of a healthcare professional. It was not always clear whether staff were expected to sign their name when prompting people with their prescribed medicines.
A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew who they would talk to if they did not.
The provider and registered manager followed safe recruitment practices to make sure only suitable staff were employed. Enough staff were available to be able to run an effective service and be responsive to people’s needs. Most people told us that staff were on time when visiting and always stayed to support them for the whole time they were allocated. Staff had suitable training at induction when they were new as well as continuing regular updates.
Most staff training was up to date, however, staff did not have their competency checked when administering peoples’ prescribed medicines to ensure they continued to carry out this task safely.
People told us they made their own decisions and choices. The registered manager understood the basic principles of the Mental Capacity Act 2005 and made sure their processes upheld people’s rights.
People were supported with their nutrition and hydration needs where necessary, although many people did not require this assistance. People and their relatives told us they were happy with the support given by staff.
Many people did not require the assistance of staff to take care of their health care needs as they either managed this themselves or had a relative or friend to help. Where assistance was required, people told us staff were observant and willing to help to refer or make appointments with healthcare professionals.
The caring approach of staff was evidenced by people and their relatives making positive comments about the staff who supported them. People told us they had regular staff providing their care and support who had got to know them well, creating confidence and trust. People were given a service user guide at the commencement of their care and support with the information they would need about the service they should expect.
An initial assessment was undertaken of people’s personal care needs so the registered manager could be sure they had the resources and skills available to support people. People had a care plan to detail the individual support they required as guidance for staff, however the information in the care plan was not always consistent with the care given by staff and recorded in the daily records. Care plans had not always been responsive to people’s changing needs as reviews had not been carried out regularly to update the plans.
The provider had an up to date complaints procedure and people told us they would know how to make a complaint. Complaints made had not always been followed up by the provider or registered manager to ensure actions were taken and lessons were learnt in order to make improvements. We have made a recommendation about this.
Although the provider had auditing systems in place to monitor the quality and safety of the service, these were not always used effectively to identify where improvements were needed and take action.
The provider sought people’s views of the service on an annual basis. Most feedback was positive, however, it was not evident if action had been taken to respond to areas that required improvement. Regular feedback from people during their care plan reviews had not always been pursued, missing an opportunity to act on comments made.
The registered manager had daily meeting with office staff to aid communication and plan the day. These meeting were not documented so an opportunity was missed to evidence this work and to be able to share the information with the wider staff team. We have made a recommendation about this.
We received good feedback from people and their relatives about the running of the service, particularly about their regular care staff.
During this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.
Agincare UK Medway is a domiciliary care agency which provides personal care to older people, including people with dementia and physical disabilities. Agincare UK Medway also provides a Medway Carers Respite Service. This is a four hour service, usually once a week that enables the relative of the person needing support to have a period of time for themselves. The agency provides care for people in the Medway area and the office is situated in Chatham. There were over 200 people receiving support to meet their personal care needs on the day we inspected.
The service had a registered manager. 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’s views about the service they received were positive. People told us staff were kind, caring and communicated well with them. Communication between staff within the service was good.
The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the registered manager, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.
The registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support peoples best interests if they lacked capacity to make certain decisions about their care.
People were able to express their opinions and views. The field care supervisors involved people in planning their care by assessing their needs on their first visit to the person, and then by asking people if they were happy with the care they received. There was a strong emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. The service was flexible and responded positively to changes in people’s needs.
The field care supervisors carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the service and the individual person concerned. People were supported by their family members to discuss their care needs, if this was their choice to do so.
People were supported with meal planning, preparation and eating and drinking. Staff supported people, by contacting the office to alert senior staff of any identified health needs so that their doctor or nurse could be informed.
People were supported and helped to maintain their health and to access health services when they needed them.
There were suitable numbers of staff available to meet people’s needs, and people were informed if their planned care had been allocated to another member of staff.
The service had robust recruitment practices in place. Applicants for post were assessed as suitable for their job roles. All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding people and infection control. New staff worked alongside experienced staff and had their competency assessed before they were allowed to work on their own. Refresher training was provided at regular intervals. Staff had been trained to administer medicines safely. Staff received regular support and supervision from the branch manager and the field care supervisors.
People said that they knew they could contact the registered manager or senior staff at any time and they felt confident about raising any concerns or other issues. The field care supervisors carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement.
The service had processes in place to monitor the delivery of the service. As well as talking to the field care supervisors at spot checks, people could phone the office at any time, or speak to the senior person on duty for out of hours calls. People’s view and experiences were sought through review meetings and through surveys.
Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. Risks were assessed and the steps taken to minimise them were understood by staff. The registered manager ensured that they had planned for foreseeable emergencies, such as severe weather conditions, so that should they happen, people’s care needs would continue to be met.
People told us that the service was well run. Staff were positive about the support they received from the registered manager. They felt they could raise concerns and they would be listened to. Audit systems were in place to ensure that care and support met people’s needs.
People’s information was treated confidentially. People’s paper records were stored securely in locked filing cabinets.