A S Care

Updated 13 September 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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector. An Expert by Experience made phone calls to people's relatives, to gather feedback on the care provided. 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

A S Care is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. A S Care is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 were 2 registered managers in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used this information to plan our inspection.

During the inspection

We spoke with 5 people who use the service. We spoke with both registered managers, 2 members of care staff, the quality lead and a director. We reviewed a range of records. This included 3 care records and multiple medicine records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including staff training records, policies and procedures, quality monitoring and staff meeting minutes.

After the inspection we continued to seek clarification from the provider to validate evidence found.

Updated 13 September 2023

About the service

A S Care is a residential care home providing personal care to up to 25 people in one adapted building. The service provides support to older people with dementia, mental health concerns, physical disability, and sensory impairment. At the time of our inspection there were 19 people using the service.

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service had not been fully implemented to support this practice.

The principles of the Mental Capacity Act 2005 had not been fully implemented with regards to people’s medicine. Assessments to determine people’s capacity to make informed decisions about declining their medicine had not been undertaken. The best interest process had not been followed to evidence decisions made to administer some people’s medicines without their knowledge, disguised in food or drink.

Staff were employed in sufficient numbers to meet people’s care needs. However, staff in supportive roles, including housekeeping, laundry and catering were part time. In the absence of supportive staff, their work was undertaken by care staff.

At the previous inspection we identified deep cleaning was not being undertaken. The provider had taken steps to recruit staff for the purpose of deep cleaning and had advertised the position.

Environmental improvements were ongoing in relation to decoration and maintenance as identified by the provider within their action plan. The service had a large garden. However, this was not well maintained, which limited people’s potential enjoyment of the outside space.

Improvements to information contained within people’s care records with specific care needs related to diabetes and oxygen therapy had been implemented. This had been underpinned by targeted training for staff in oxygen therapy and care.

People told us they felt safe at the service. Potential risks related to people's care were assessed. Medicine systems were managed safely.

People told us they were satisfied with the meals provided people's dietary needs were met.

The frequency and complexity of audits had improved to enable shortfalls to be noted more quickly so as action could be taken to bring about improvement.

People told us they were happy with the care provided and that they were supported by staff who were kind and caring. People’s views and that of family members were regularly sought, which included information as to what action was being taken by the provider in response to their feedback.

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 26 June 2023) and there were breaches of regulation. At this inspection we found improvement had been made with regards to Fit and proper persons employed and Good governance and the provider was no longer in breach of these regulations. However, the provider remained in breach of the regulation Safeguarding service uses from abuse and improper treatment.

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 remained requires improvement. 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 A S Care on our website at www.cqc.org.uk.

Why we inspected

We carried out an unannounced focused inspection of this service on 22 and 23 May 2023. Breaches of legal requirements were found in Safeguarding service uses from abuse and improper treatment, Fit and proper persons employed, and Good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve Safeguarding service users from abuse and improper treatment. We issued a Warning Notice in relation to Fit and proper persons employed. We varied the conditions of registration in relation to Good governance.

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those breaches of regulation.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a continued breach in relation to Safeguarding service uses from abuse and improper treatment. The principles of the Mental Capacity Act for the administration of medicines being given without a person’s knowledge, hidden in food or drink, had not been implemented to ensure people’s care and treatment was lawful and in their best interests.

We have made a recommendation for the provider to review the hours provided by housekeeping, laundry and catering staff, to ensure the needs of the service are met without impacting on the role and responsibilities of care staff.

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.