Assured Care Southport

Updated 18 January 2024

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.

Inspection team

The inspection was carried out by 3 inspectors and an Expert by Experience who contacted people and their relatives by telephone to gather feedback on their experiences of 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

This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing.

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 was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we received feedback from the local authority regarding difficulty contacting the service. We needed to be sure the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 31 October 2023 and ended on 9 November 2023. We visited the location’s office on 31 October, 3 and 7 November 2023.

What we did before the inspection

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

The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. Please see the well led section of the report for further details.

During the inspection

We spoke with 10 people who used the service and 5 relatives about their experience of the care provided. We spoke with 16 members of staff including the registered manager, care manager, personnel manager, care co-ordinators and care workers. We reviewed a range of records. This included 15 people's care records and multiple medication records. We looked at 9 staff files in relation to recruitment. We looked at training data and quality assurance records. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 18 January 2024

About the service

Assured Care Southport is a domiciliary care agency providing personal care to people living in their own houses, flats and specialist housing. At the time of our inspection the service was supporting 180 people with 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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Risk was not appropriately assessed, monitored and mitigated. We found widespread concerns with a lack of information regarding the management of people’s individual risks. People were exposed to avoidable risk of harm as systems to ensure the safe and proper management of medicines were inadequate. Staff were administering medicines without any competency checks being completed to ensure they had the skills to do so safely.

The provider failed to ensure the required recruitment checks were carried out on staff which significantly increased the risk of unsuitable staff caring for people.

Safeguarding systems were in place, however, not all staff had received safeguarding training in line with best practice guidance and we were not assured staff had the necessary skills and knowledge to protect people from the risk of abuse.

People were placed at increased risk of harm as staff had not received the required training to meet their needs safely and effectively. Staff who were new to health and social care were not enrolled on The Care Certificate. Relevant training was not provided to ensure staff had the required skills to support people with a learning disability and autistic people in line with right support, right care, right culture guidance.

Care plans did not effectively guide staff on how to meet people's dietary needs, preferences and risks.

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.

The provider failed to ensure care and treatment was planned for people in a personalised way. There was a lack of person-centred detail in all care plans we reviewed. People's care plans and risk assessments were not always completed, up to date and reflective of their current needs. Accessible formats of communication for people with impaired vision or cognition were not in place to aid their understanding and involvement.

Inadequate governance and quality assurance measures meant people were exposed to unnecessary risk and avoidable harm. The significant shortfalls found with risk assessments, recruitment practices, capacity and consent and person-centred care were not picked up by the registered manager's or provider's monitoring processes. The registered manager failed to have adequate oversight of the running of the service to ensure the required legal regulations were met. Multiple breaches of regulation found at the inspection showed the registered manager and provider lacked a clear understanding of their role and regulatory responsibilities.

People were generally treated with kindness by staff who delivered care. However, the shortfalls found with recruitment, training and care planning did not reflect a caring approach to people’s care and support. People told us they were well treated by staff.

Most people and their relatives told us they received support from a consistent staff team who generally arrived to their care calls on time. People told us staff mostly wore PPE and followed good hygiene practices to reduce the risk of infection spread.

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 23 October 2018).

At the last inspection, we recommended the provider reviewed their processes relating to The Mental Capacity Act 2005.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, 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.

Following the inspection, the provider sent us an action plan to demonstrate how they would improve the safety and quality of the service.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed, need for consent, person centred care and good governance 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.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.