Anco Care Limited

Anco Care Limited is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 4 people using the service.

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

This service has been rated inadequate in well-led on 5 occasions since 2019. The provider has not been able to implement, embed and sustain effective governance and oversight of the service. We found continued concerns about the quality of systems and records. The provider could not assure themselves people received safe care due to the lack of effective processes in place.

Quality assurance audits remained ineffective at identifying and driving improvement. This included in areas such as medicines, accident and incident recording and safeguarding processes, all of which potentially impacted upon people's safe care and treatment.

Not enough improvement in people's care records including risk assessments, care plans and mental capacity assessments had been made. There remained gaps, inconsistencies and unassessed areas of known risk. There was no overall service improvement plan to set out the actions identified and underway to make, embed and sustain improvements.

Medicines processes remained unsafe. Recording of medicines administration was inaccurate. There was no guidance to support staff safely administer some 'as needed' medicines. Medicines audits did not identify any concerns.

Not all known risks were identified or assessed. Concerns with risk assessments were found in the last 5 inspections and remained ongoing.

Accidents and incidents were not always recorded. Due to this the provider could not assure themselves appropriate actions were always taken, including learning lessons to reduce the risk of recurrence. Safeguarding referrals were not always made when required.

People's eating and drinking needs were not always assessed or accurately recorded. This included when people were at heightened risk of choking and required physical assistance with eating and drinking.

When people's capacity fluctuated, processes to assess their capacity and make decisions in their best interests were not effective. Issues identified at the last inspection had not been fully rectified in this area. People remained at risk of having decisions made which were not in their best interests or in line with their wishes.

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 did not always support this practice.

There was no easy reference system to check whether staff training was in date, and the chart showing staff training contained gaps. People were potentially receiving care from staff who did not have all required training.

Care plans did not contain sufficient detail to guide staff in people's routines, needs and preferences.

People and relatives felt safe care was provided. Safe recruitment processes were followed. Staff were reliable. Staff used personal protective equipment (PPE) to reduce the risk of any infection spread.

Staff told us they received an induction and feedback confirmed people and relatives felt staff were competent in their roles.

People and relatives told us they were involved in making decisions about their care. People received support from staff who were caring, kind and attentive. People's privacy and dignity was respected, and their independence was promoted.

The provider and staff worked with health and social care professionals to ensure people received timely health 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 and there were breaches of regulation in the areas of people’s safe care and management oversight. We issued a Warning Notice to give the provider a short timescale to make improvements. Due to repeated ratings of requires improvement, the service was placed in Special Measures.

At this inspection we found the provider remained in breach of regulations in relation to people receiving safe care and treatment. We also found a continued breach in provider oversight of the service.

Why we inspected

We undertook this focused inspection to check whether they had met the Warning Notice in relation to management oversight and the Requirement Notice about people’s safe care.

We inspected and found there was a continued concern with mental capacity assessments and staff having access to sufficient information to ensure people were fully involved in decision making. We widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective, caring and well-led.

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 requires improvement to inadequate based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anco Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to people receiving safe care and management oversight 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.

Following the inspection the provider submitted an action plan outlining planned improvements.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Anco Care Limited is a domiciliary care agency providing support to people in their own homes. 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 4 people were receiving personal care.

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

Audit processes were ineffective at assessing, monitoring and improving key areas of the service. There was no detailed and structured plan of how the provider intended to achieve a 'good' rating.

Medicines were not managed safely. Medication administration charts (MAR) had not been fully completed. Systems and processes had failed to identify MAR were not being completed correctly.

The providers systems and processes had not always effectively monitored the quality of the record keeping of people’s care needs. Audits undertaken to monitor the quality had not always identified issues needing improvement. The systems had not identified the issues identified in this inspection.

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 always support this practice.

The provider worked in partnership with other agencies to make sure people received the right care and support when needed.

People were supported by staff who had undergone a safe recruitment process. Staff were supported through ongoing monitoring, which included supervision and assessment of their competence to provide good quality care. However, the frequency of formal supervision carried out with staff needed improvement. Meetings were held to discuss the ongoing development and improvements required.

There were sufficient staff to meet people's needs. A person told us they felt safe and staff ensured they were safeguarded from harm. A person and relatives spoke of the reliability of the service. Staff worked consistently with the providers policy and procedure for infection prevention and control.

People's needs were assessed and kept under review and reflected all aspects of people's care. People and relatives contributed to the assessment process. People's health care needs were recorded, and staff liaised with health care professionals when required.

A person and relatives spoke of the kind and caring approach of staff. A person and relatives said they were involved in decisions about their care, and their views were respected by staff.

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 1 July 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key question of safe and well-led only. The overall rating for the service has remained the same based on the findings of this inspection.

We inspected and found there was not the documentation to evidence that a best interest decision had been made or a Mental Capacity Act assessment had been carried out, so we widened the scope of the inspection to include the key question of effective.

Enforcement and Recommendations

We have identified breaches of regulation in relation to medicines management and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspection is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report.

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 to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. As this service has been rated requires improvement for the last five consecutive inspections, we are placing the service in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of requires improvement or inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Anco Care Ltd is a domiciliary care agency providing support to people in their own homes. 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 one person was receiving personal care.

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

Improvements had been made since the last inspection in care and risk assessment records. Risk assessments were in place to ensure staff were able to provide care which reduced known risks. Strengthening was required in some areas to ensure all aspects of the person’s risks were covered and also to ensure regular reviews were recorded even if there were no changes to be made.

The registered manager engaged consistently with the CQC since the last inspection to provide monthly reporting on the improvements they were making to governance and quality assurance systems. We found improvements had been made. The registered manager undertook quality assurance audits to maintain oversight of key aspects of the service. Ongoing improvements and adaptations were required to ensure the systems remained effective should further packages of care commence.

The person was safely cared for. Staff understood safeguarding procedures. Safe recruitment practices were followed to ensure staff were suitable for their roles. Staff were up to date with refresher and additional training.

The person received support from a consistent and reliable staff team. Medicines support was provided safely if this was required. Infection control measures were in place including staff use of personal protective equipment (PPE).

The registered manager was aware of their legal responsibilities and worked in an open and transparent way. The registered manager and staff worked in partnership with health, social care and community professionals to support the person achieve good outcomes.

The person was 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.

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 2 September 2020) and there were two continued breaches of regulation in relation to governance arrangements at the service and people receiving safe care and treatment. At this inspection, enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to follow up on the rating of inadequate in the Key Question of Well-Led which remained in place following the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-Led. 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 not changed and remains 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 Anco Care Ltd. on our website at www.cqc.org.uk.

Follow up

We decided the conditions placed upon Anco Care Ltd. should be removed. The means the provider will no longer be required to send CQC monthly reports informing us of improvements they were making to quality assurance and governance arrangements in the service. They are no longer required to seek approval from CQC prior to accepting any new packages of care.

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.

Anco Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of inspection two people were using the service and receiving personal care.

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

Improvements in some areas of care records and documentation had been made since the last inspection. The registered manager continued to be involved in providing daily care visits to people using the service, along with a small staff team. This meant the registered manager had less time available to focus on ensuring the service met regulatory requirements.

There continued to be ineffective governance arrangements and quality assurance processes in place. Some audit processes had been introduced since the last inspection but these did not identify issues which required action and follow up. This meant the registered manager did not have effective oversight of the service and of the overall quality of care which people received.

A range of care plans and risk assessments had been developed since the last inspection for people who received support. There were various gaps and inconsistencies in these so further strengthening of the care records was required. This would ensure care was consistently delivered safely and in line with the care plans and risk assessments in place.

Improvements had been made to medicine recording processes although further strengthening was required. People did not have clear medicine assessments outlining how they preferred to receive their medicines and there were no protocols in place for medicines being administered ‘as needed’.

Previously identified gaps in staff files had been resolved and staff training was up to date. A formal system of staff supervision had been introduced and minutes were available from a recent team meeting.

Good infection control practices were in place which mitigated risks to people routinely and during the pandemic emergency period.

Some feedback confirmed people were very happy with the care and service they received from Anco Care Limited. Other feedback confirmed there were no concerns about any aspects of the care. The registered manager remained committed to providing good care to people along with the small staff team.

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 support this practice.

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 25 June 2020) and there were three breaches of regulation. We have used enforcement action to inform the timing of the current inspection.

At this inspection, not enough improvement had been made and the provider was still in breach of two regulations.

Why we inspected

We carried out an announced focused inspection of this service on 27 and 29 July 2020. After the last inspection CQC added positive conditions to the registration of the service. This meant the provider sent us monthly reports informing us of the improvements they were making to the service, and CQC were required to approve any new packages of care before they were accepted by Anco Care Limited.

We undertook this focused inspection to follow up on the inadequate rating in the Key Question of Well-Led which was given to Anco Care Limited following a comprehensive inspection on 26 September 2019. This rating remained in place following the focused inspection on 3 February 2020. This report covers our findings in relation to the Key Questions of Safe and Well-led. Ratings from the previous comprehensive inspection for the other Key Questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anco Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to the safe care and treatment of people, in particular regarding various gaps and inconsistencies in the risk assessment documentation and the safe administration of medicines. We also found a breach of regulation regarding effective governance arrangements. The service were no longer in breach of regulation for their recruitment processes as improvements had been made.

Follow up

We decided the positive conditions should remain in place to support the provider make improvements to the service. This means the provider will continue to send CQC monthly reports informing us of actions they are taking to make improvements. Anco Care Limited will continue to seek approval from CQC prior to accepting any new packages of care.

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 to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Anco Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of inspection three people were using the service and receiving personal care.

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

The registered manager continued to be regularly involved in delivering good care to people using the service. This impacted on their ability to ensure the service met regulatory requirements. There were widespread and significant shortfalls in governance arrangements and quality assurance processes. Care files were incomplete and record keeping was poor. No audit checks took place so issues were potentially not being identified and followed up as required. This meant the registered manager did not have effective oversight of the service, staffing issues and of the overall care provision being given to people.

There were no effective risk assessments or risk support plans in place for people and care plans contained outdated information and were incomplete. This meant people were at risk of receiving unsafe care which did not meet their needs.

Medicine administration and recording practices required improvements There were no medicine assessments outlining how people preferred to take their medicines, no guidance in place for medicines being administered 'as and when needed', and medicine recording was not in line with good practice guidelines.

There were gaps in staff files which meant staff recruitment practices were not robust. Not all recruitment records such as references and employment history were on staff files. All staff had up to date checks with the Disclosure and Barring Service (DBS). Staff were up to date with key training such as safeguarding, medication and moving and handling. There was no system of staff supervision or competency checks in place to ensure staff were fully supported in their roles.

A more effective computer system had been introduced to store care and staff records but needed further strengthening.

Feedback confirmed people felt they received good and safe care which they were happy with. The registered manager remained committed to providing good care to people along with the small staff team.

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 support this practice.

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 4 November 2019) and there were three breaches of regulation. We have used enforcement action to inform the timing of the current inspection.

At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 23 and 26 September 2019. Breaches of legal requirements were found. Enforcement action was taken and warning notices were issued due to concerns about the safe care and treatment of people, and due to the lack of key documentation such as risk assessments and detailed care plans. There were also concerns about the lack of governance arrangements in place in the service. In addition, the provider completed an action plan after the last inspection to show what they would do and by when, to improve their recruitment processes to ensure fit and proper persons were employed.

We undertook this focused inspection to check they had complied with the requirements of the warning notices, 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 of Safe and Well-led which contain those requirements. Ratings from the previous comprehensive inspection for the other Key Questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Anco Care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to the safe care and treatment of people, in particular regarding the lack of personalised risk assessments and the safe administration of medicines. We also found breaches of regulation regarding effective governance arrangements and recruitment processes.

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 to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Anco Care Ltd is a domiciliary care provider registered to provide personal care to people living in the community. Four people were using the service and receiving personal care at the time of our inspection.

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

A number of risks to individuals were identified such as mobilising using a hoist, falls, poor skin integrity, risk of self-neglect, risks associated with eating and drinking. People’s individual risks had not been fully assessed. Risk assessments were incomplete and there were no risk support plans in place. This meant staff could not use these to plan to ensure they provided safe care.

There were no protocols in place to advise staff when people should be supported to receive medicines administered, 'as and when required.' There was insufficient recording of medicines administered through a blister pack system from the pharmacy. People did not have medicines assessments in place, so they could be supported to take medicines in the safest way best suited to their needs and preferences. This meant there was heightened risk of medicines errors which could impact upon people's health and welfare.

The registered manager regularly delivered care to people and this had impacted on their ability to maintain oversight of whether people’s care met regulatory requirements. There were significant shortfalls in quality assurance systems and processes as well as policies, procedures and record keeping. Key documents could not be easily located on the computer. This meant the provider was not able to maintain effective oversight of the service and of the care being delivered to people.

The provider did not follow robust recruitment procedures. There was no reassurance that safe recruitment practices were in place. Various gaps were identified in staff files. This meant we could not be sure that staff were suitable for the roles they had applied for. All staff had up to date Disclosure and Barring Service (DBS) checks in place.

All staff had received safeguarding training although refresher training was overdue for one member of staff. Staff confirmed they knew what to do if they had any safeguarding concerns.

Documentation and recording on people's care files was limited and incomplete. People's needs were assessed prior to the service starting but insufficient information was noted. There were no records to show that people's equality and diversity needs, such as religion, culture, or disability, had been considered. People's care plans contained significant gaps and were not reviewed or updated regularly. Insufficient information about people's eating and drinking needs was recorded. There was no information on care files about people’s health updates or changing needs.

Records in relation to staff induction, training and staff supervision were limited and incomplete. We could not be sure that staff were up to date with mandatory training, and there was conflicting information about what training was considered to be mandatory.

Staff told us how they supported people to make decisions if they did not have mental capacity or their capacity fluctuated, but there was no evidence this had been considered during care planning or that staff had received training about this.

People’s wishes and preferences of how they wanted care to be provided towards the end of their life was not part of the care planning process. The registered manager told us they intended to develop this aspect of care planning.

People, relatives and staff spoke positively about the support offered by the registered manager. People felt communication was effective. Although formal feedback had not been sought from people, relatives and staff, this was sought informally on a regular basis. The registered manager was passionate about delivering good care to people and wanted to make improvements to the service.

People and relatives were very happy with the care provided and felt that people were treated with dignity and respect. People received kind and compassionate care from the registered manager and the small staff team. People received consistent care from staff who knew them well. People were supported to maintain relationships with their family members and follow their interests.

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 support this practice.

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 20 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe care and treatment of people, in particular regarding the lack of personalised risk assessments and the safe administration of medicines. We also identified a breach of regulation regarding effective governance of the service.

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 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 registered provider was also the registered manager of the service. 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.

Staff understood the importance of protecting people from abuse and avoidable harm. They were aware of the actions they needed to take to report any concerns about people’s safety or well-being.

The recruitment systems ensured that only suitable staff were employed at the service. Staffing levels ensured that people received the support they required safely and at the times they needed.

People using the service required minimal support from staff in taking their medicines, although the staff were aware of the importance of ensuring people received their medicines as prescribed.

Staff had received training to equip them with the necessary skills and knowledge to provide specific care to meet individual needs. The provider was in the process of arranging refresher training for staff to fully meet mandatory training requirements.

Staff received day to day supervision and support. Plans were in place to introduce formal staff supervision and appraisal systems to ensure staff had regular opportunities to discuss their learning and professional development needs.

The provider and staff were aware of the Mental Capacity Act 2005 and the importance of seeking people’s consent.

People were supported to eat a healthy diet and to have access to health services in the community to improve their health and well-being. The staff followed the advice of healthcare professionals in meeting people’s needs.

Staff were friendly, caring and compassionate in their approach to supporting people using the service.

People’s needs were assessed prior to taking up the service and the care plans reflected people’s needs and preferences in relation to the care provided. Risk assessments were carried out to identify and minimise risks to keep them safe.

Systems to receive and respond to complaints were in place. People were confident that any complaints they had would be listened to, addressed in a timely manner and appropriately acted upon.

The registered manager was approachable and supportive. Formal and informal systems were in place to regularly seek feedback from people using the service to monitor the quality of the care provided.