Ace Homecare London

Ace Homecare London is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection 68 older people or people with dementia received personal care support from Ace Homecare London.

Not everyone who used the service received personal care. 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

Whilst most people spoke positively of the level of care and support, they received from Ace Homecare London, we found weaknesses in risk assessments and risk management, care planning and governance arrangements. Risk in relation to people receiving personal care were assessed, however the service failed to provide clear plans and guidance in how to manage such risks. Care plans were in place, however, there was a lack of person specific detail in how people’s needs were best met. The service quality assurance system was not fully effective and did not address the shortfalls we found during our inspection.

People who used the service were safe from harm and abuse and care workers demonstrated a clear understanding of their role when reporting and responding to abuse. Overall staff were recruited safely, and sufficient staff were deployed to meet people’s needs. People who used the service were protected from infections such as COVID-19. The service documented and analysed accidents and incidents to improve outcomes for people who used the service.

Care workers had access to training and received support from their line manager through supervision and appraisals. Peoples’ needs were assessed, and care plans were based on such assessments. When people received support around eating and drinking this had been documented. Relatives of people who used the service supported people to access health care professionals such as doctors and hospitals However, relatives told us that care workers would contact clinicians if this was required. 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.

Complaints and concerns raised by people were investigated and where necessary actions were taken to improve outcomes for people who used the service.

The service had a clear management structure and care workers and staff were clear of their responsibilities. Feedback in respect to the management and office staff was positive and care workers told us that the registered manager listened to them and was supportive.

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 good (Published 20 April 2021).

Why we inspected

We received concerns in relation to the support people received to minimise the risk of theme developing pressure ulcers care and that; care records and risk assessments lacked detail about people’s needs and the care they received and there was a lack of management oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

For the key question 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 safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the 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 monitor the service and will take further action if needed.

We have identified breaches of regulations in relation to safe care and treatment, person centred care and good governance.

We recommended that the service sought further advice and guidance from a reputable source around the assessment of people’s mental capacity to make particular decisions about their care and support, how peoples communication needs were met and how the service ensured that people were protected from potentially unsuitable care workers.

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.

Ace Homecare London is a domiciliary care agency providing personal care to 50 people living in their own homes.

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

Our previous inspection identified that risk assessments were not always in place and we found a breach of regulation in respect of this. During this focused inspection, we found that the service had taken action to improve this. Appropriate risk assessments were in place and covered areas such as the environment, physical health and personal care. These also contained guidance for minimising potential risks associated with the COVID-19 pandemic. During our previous inspection we found that some calls had been missed and some calls were late. We saw that since our last inspection the service had made improvements in the monitoring of calls and people who used the service raised no concerns during this inspection.

Our previous inspection found that there were some instances where the service failed to effectively check various aspects of the service and we found a breach of regulation. During this focused inspection, we observed that the service had made improvements and had an effective system in place to monitor the quality of the service being provided to people.

People who used the service and relatives told us that they were well supported and felt safe with their care workers. One person told us, “I feel very safe with my carer. I am quite hard of hearing and she makes allowances for that in the way she communicates to me.” Polices and systems were in place to safeguard people from the risk of possible harm. Care workers told us that they had received training and report any issues to the registered manager. The service had safe recruitment procedures in place. People who received assistance in taking their medicines can be assured that this was managed safely.

Care workers we spoke with told us that they felt supported by the registered manager. They told us that management were approachable and they raised no concerns in respect of this. People and relatives confirmed they were involved in their care and feedback was actively sought about the quality of the care provided.

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 14 February 2020).

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

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 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 Ace Homecare London 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.

Ace Homecare Limited is a domiciliary care agency. The agency provides personal care to people living in their own homes in the community. There were approximately 36 people using the service at the time of our inspection.

People’s experience of using this service:

There were arrangements to protect people from potential risks. However, we found that not all risks to people’s health and wellbeing had been fully assessed. This placed people at risk since staff may not be fully informed of risks to people and action to be taken to minimise potential risks. We have made a requirement accordingly.

Some aspects of the service were not well managed. Although checks and audits had been carried out, these were not sufficiently comprehensive or effective. A high proportion of calls to people were not on time and staff did not stay the agreed duration. Some scheduled visits to people by staff had also been missed. Similar concerns had also been expressed by a care professional. We have made a requirement accordingly.

With one exception, people received their medicines as prescribed. Staff had received medicines administration training and knew how to administer medicines safely. There had however, been a recent incident where a person had not been administered their medicines as prescribed. The service had taken action to prevent such incidents.

People and their relatives told us they were mostly satisfied with the care they received. They stated that staff were capable, did their jobs well and people felt safe when cared for by staff. We however, noted that there had been a recent incident when staff did not turn up as agreed.

Staff were safely recruited, and essential pre-employment checks had been carried out. There were enough staff to attend to people’s needs. Staff were supported to carry out their duties. Essential training had been provided. The registered managers and senior staff carried out regular supervision sessions, annual appraisals and spot checks on the care provided by staff.

The healthcare needs of people had been assessed and staff worked closely with healthcare professionals to meet the needs of people.

Staff encouraged people to have a healthy diet where this was part of their contracted responsibilities. They were aware that if there were significant fluctuations in people’s weight, they should alert their manager, relatives and professionals involved.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were treated with dignity and respect. Staff had received training on ensuring equality and valuing diversity and respecting the human rights of people.

The service provided people with person-centred care and support that met their individual needs and choices. People’s preferences and choices had been responded to.

The service took complaints seriously and with one exception complaints recorded had been promptly responded to. People and relatives were aware of who to complain to.

Results of recent satisfaction questionnaires indicated that people and their representatives were mostly satisfied with the care and services provided. We however, received feedback that further improvements were needed to ensure that the service provide care that was reliable, punctual and in accordance with agreements made. The service had imposed a voluntary embargo on new contracts so that they could address and rectify deficiencies identified.

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 the service was Good (published on 16 May 2018).

Why we inspected:

This was a scheduled planned comprehensive inspection.

Enforcement:

We found two breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014 in relation to safety and governance.

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 continue to monitor information we receive about the

Not everyone using Ace Homecare Services Limited receives a regulated activity. CQC only inspect the service 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.

The service had two registered managers who work full time. They informed us that they wanted to ensure that the service was well supported. Registered managers are people who have registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People and relatives of people who used the service spoke highly of care workers and informed us that they were satisfied with the care and services provided. They informed us that people had been treated with respect and they were safe when cared for by the service. There was a safeguarding adults’ policy and care workers were aware of the procedure to follow if they suspected people were being abused.

There were suitable arrangements for supporting people with their medicines. There was a policy and procedure for the administration of medicines. The medicine administration records (MAR) had been properly completed to indicate that people had received their medicines.

Risk assessments were seen in the care records of people. However, two of them were not sufficiently comprehensive as they did not describe signs and symptoms to look for. These were rectified soon after the inspection.

The service had a recruitment procedure to ensure that care workers recruited were suitable and had the appropriate checks prior to being employed. We examined a sample of six records of care workers. We noted that these records had the necessary documentation such as a Disclosure and Barring Service check (DBS), references, evidence of identity and permission to work in the United Kingdom.

The service had a training programme to ensure care workers were competent and able to care effectively for people. Certificates were seen in the records of care workers. They had the necessary support and supervision from management staff. Teamwork and communication within the service was good. New care workers had received a comprehensive induction.

Care workers were caring in their approach and able to form positive relationships with people. There were arrangements for encouraging people and their representatives to express their views and make suggestions regarding the care provided and the management of the service. Individual assessments and care plans had been prepared for people. These contained information regarding people’s cultural and religious background.

The service had a complaints procedure and people and their representatives knew who to contact if they had concerns. Complaints recorded had been promptly responded to. People and their representatives expressed confidence in the management of the service.

Audits of the service had not yet been carried out. The registered managers stated that they had only started providing care to service users. The registered manager informed us that the service was newly set up and they were in the process of arranging their audits.