A24 Group Ltd - Sutton

A24 Group - Sutton is a domiciliary care agency that provides personal care and nursing care to adults and children living in their own homes across the UK. At the time of our inspection seven people with complex needs were receiving personal care from the provider.

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

People’s risks were assessed and mitigated to prevent avoidable harm. People received their medicines safely and medicines administration was audited. A robust recruitment process was in place which ensured only suitable staff were deployed to deliver care and support. Staff followed appropriate infection prevention and control practices to keep people safe.

People’s needs were assessed. Staff were trained and supervised to meet people’s assessed needs. People’s mental capacity was assessed and their relatives actively participated in best interest decision making. People received the support they required for their nutritional needs to be met.

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.

The registered manager oversaw quality audits of the service people were receiving. Relatives felt there was good communication with the provider. The provider worked in partnership with statutory agencies to plan, deliver and review people’s care and support.

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 07 September 2021). 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.

We carried out an announced comprehensive inspection of this service on 10 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, the need for consent, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and 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 requirements.

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 A24 Group Ltd – Sutton on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information we may inspect sooner.

A24 Group - Sutton is a domiciliary care agency that provides personal care and nursing care to adults and children living in their own homes across the UK. At the time of our inspection 10 people were receiving personal care.

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’s risks were not always managed safely. Where people presented with health associated risks and behavioural support needs, staff did not have clear guidance in place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity they were not supported with appropriate assessments or best interest meetings.

Staff were not appropriately supported. They did not receive regular supervision of training from the registered manager.

The provider did not have robust quality assurance in place to make appropriate improvements were shortfalls were identified. One relative told us, “The office staff haven’t met the family and they’re so far away, they can’t effectively run a service when they’re not around to see things.” This was in reference to the majority of the provider’s management team being permanently based in Cape Town, South Africa.

Relatives felt people were safe and staff were trained in safeguarding and understood the providers procedures for keeping people safe. Staff were recruited safely and followed appropriate infection prevention practices.

Staff met people’s nutritional needs in line with their assessments and supported people to engage with healthcare services. The provider ensured that all staff received training. The registered manager supported nursing staff to maintain their registrations with professional bodies.

Staff were considered by relatives to be caring. People were supported by staff they had known for a long time and this made for positive and trusting relationships. Staff respected the people, the relatives and their homes and promoted people’s dignity.

Staff provided people with personalised and responsive care. People and their relatives participated in reviews, reassessments and the development of care plans. Relatives understood how to make a complaint and were confident action would be taken by the provider.

The provider worked collaboratively alongside other providers where people received care and support from more than one agency.

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 24 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and was carried out to follow up on action we told the provider to take at the last inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A24 Group -Sutton on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s safety and consent as well as good governance and support for staff.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A24 Group - Sutton is a domiciliary care agency that provides personal care and nursing care to adults and children living in their own homes across the UK. The agency has been in operation for around 22 years and provided personal and nursing care to people in healthcare settings as well as in people’s own homes. We only regulate personal care and nursing people receive in their own homes so did not look at the other part of the business. The agency provides domiciliary care as several distinct brands: Ambition 24 Nurses, British Nursing Association, Grosvenor Nursing and Mayfair Nurses. People had a wide range of complex nursing needs. The registered manager told us there were five people receiving care at the time of our inspection . However, our inspection findings showed this number was inaccurate. We again asked the registered manager to clarify the number of people and they gave us a list of seven people using the service. This list did not include everyone staff told us they provided personal care to. This meant the registered manager lacked robust oversight of the service.

There was a registered manager in place. 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 this inspection we found standards had deteriorated and the service was rated requires improvement overall. The registered manager and provider lacked good oversight of the service which meant they had not identified and resolved the issues we found. For example, the provider had not established systems to regularly and consistently audit medicines records to check people received medicines safely. The provider’s record keeping could also be improved, such as records of the care people received.

The provider did not always assess risks relating to people’s care and did not always ensure comprehensive, reliable care plans were in place for staff to follow. Instead for some people the provider relied on documentation from other services which was several years out of date.

The provider did not always supervise staff in a way which supported them to do their jobs and some staff had not had any supervision for several years. The provider had not established systems to assess the competency of staff to check they provided care in the best ways.

People may not have received care in line with the Mental Capacity Act 2005 (MCA) as the provider had not established systems to assess people’s capacity in relation to their care when they suspected people lacked this.

People were safeguarded from abuse by the provider as staff understood their responsibilities in relation to this. Staff received training in safeguarding adults to help keep their knowledge current.

People were supported by sufficient numbers of staff to meet their needs. The provider followed suitable recruitment processes so that only suitable staff worked with people.

Staff received a programme of training to help them understand their roles, including clinical training for nurses which helped them maintain their registration with their regulatory body.

People received the support they needed in relation to eating and drinking. People also received support in relation to their day to day health.

People and relatives were positive about the staff who supported them and developed good relationships. Staff treated people with kindness, dignity and respect. Staff understood the people they were working with and the people received consistency of care from regular staff. People were supported to maintain their independence.

The provider had systems to communicate openly with people and their relatives, staff and professionals.

The provider responded to and investigated concerns and complaints as a complaints handling system was in place.

During this inspection we found breaches relating to good governance, safe care and treatment, consent and staff support. You can see the action we told the provider to take at the back of the full version of this report.

A24 Group Ltd - Sutton is a domiciliary care agency that provides nursing and personal care to people in their own homes. Some people are privately funded, although the vast majority are funded by their local Clinical Commissioning Group (CCG). The service specialises in providing nursing and/or personal care to children, younger adults and older people with complex health care needs. The support people receive varies greatly and the time staff can spend providing nursing and/or personal care in a person’s home ranges from four to 24 hours a day. There were 6 children and 14 adults living in various parts of the country receiving nursing and/or personal care and support from the service when we inspected A24 Group in Sutton.

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 and associated Regulations about how the service is run.

The relatives of people using the service told us they were happy with the standard of the nursing and/or personal care their family members received from staff working for A24. They said the nurses and/or care workers always turned up on time and delivered the care package they had planned and agreed with the agency. People also said staff looked after them in a way which was kind and caring. If people were nearing the end of their life they received compassionate and supportive care.

People and their relatives told us they felt safe when staff from the agency visited them in their home. The manager knew how and when to report abuse or neglect if they suspected people were at risk. Risks to people’s health, safety and wellbeing had been assessed and staff had been provided with guidance about how to manage these in order to keep people safe. The agency also ensured each person’s home environment was risk assessed to identify any potential hazards people living there might face.

People were supported to keep healthy and well. Staff ensured people were able to access community health and social care services whenever they needed them. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration. People received their medicines as prescribed and staff knew how to manage medicines safely.

People and their relatives (where appropriate) were involved in making decisions about their care and had care plans that focused on their needs and preferences. People and their relatives had agreed to the level of support they needed and how they wished to be supported. Care plans provided staff with guidance about how people’s needs and preferences should be met. When people's needs changed, senior nurse coordinators responded by immediately reviewing the person’s care plan.

The registered manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 and acted according to this legislation.

There were enough suitably competent staff to care for people using the agency. The registered manager matched people with nurses and care workers who had the right mix of knowledge, skills and experience to meet their specific nursing and/or care needs. Staff were suitably trained and knowledgeable about the individual needs of the people they cared for. They were also well supported by the registered manager and the nurse coordinators. The provider carried out appropriate checks to ensure staff were suitable and fit to work with people receiving services from the agency.

The views and ideas of people using the service, their relatives, professional representatives and staff were routinely sought by the provider and used to improve the service they provided. Most relatives felt comfortable raising any issues they might have about the service with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

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. The provider carried out regular spot checks on staff to make sure people were supported in line with their care plans. There was an out of hours on call system in operation that ensured management support and advice was available when they needed it.

The agency had a clear management structure in place. The registered manager demonstrated a good understanding of their role and responsibilities.

We were able to speak with the representatives of four people who received a service and a nurse who was supporting one other person. All of the feedback we received was positive, with people telling us that 'staff are wonderful', 'really caring', and 'very efficient'.

People told us that the agency contacted them regularly to make sure the package of care they were receiving still suited their needs. They said if anything was not quite right it was addressed quickly.

We looked at the recruitment processes used by the agency and saw that all of the necessary checks had been undertaken. We also looked to make sure that staff supporting people had the skills and training to help them in their role. The information that we received showed us that there was an ongoing staff training programme in place.

This service is managed centrally in South Africa. However it retains a registered location in Sutton.

We were able to speak with nine people who have arranged support packages for a client or relative. All of them were happy with the care that was being delivered and we received positive feedback from them. Comments we received included, 'my ladies are fab, they allow us to have a proper life' and 'the ladies that come are wonderful'. One person told us 'they're 110 percent, I trust them completely, they're a really good team. They work with me completely to provide the best possible care for my relative'. Another person told us 'they're absolutely wonderful, my relative is very happy'.

We were told that the agency kept in constant contact with people to ensure that the care package remained suited to the persons needs. Any problems were addressed promptly. The only concern that was raised by one person was related to the lack of continuity of the package coordinators. They had found that key people changed frequently and it had meant explaining everything to them all over again.