ACS

ACS is a domiciliary care agency providing personal care to adults in their own homes. 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. At the time of our inspection 66 people were receiving support with personal care.

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

People received safe care and support in their homes. Staff were trained in safeguarding and there were effective processes in place to report abuse if required. Risk assessments and care plans included information about known risks to people care such as falls, frailty and skin integrity so staff had sufficient information to provide safe care.

Safe recruitment practices were followed to ensure staff were suitable for their roles. Staff were usually reliable and arrived at people’s homes within a window of time. Staff completed all tasks required to support people as per their agreed care plans, and people were usually supported by regular staff.

People were supported safely with their medicines. Staff used personal protective equipment (PPE) when supporting people with personal care in accordance with good infection prevention and control practices.

Accidents and incidents were recorded and followed up appropriately. Lessons were learned when things went wrong, and measures put in place to reduce the risk of the same thing happening again.

People’s capacity to make decisions was assessed under the Mental Capacity Act (MCA). Staff knew how to support people make choices about their daily care. 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.

An open and positive culture was embedded in the service. People, relatives and staff spoke positively about the approach and availability of the registered manager and the management team.

The registered manager and management team had effective oversight of people’s care, facilitated by effective staff handovers and communication. The registered manager had identified some areas where quality assurance processes could be strengthened and had already started to take action to improve these systems.

People and their representatives were involved in people's care and had opportunities to provide feedback. Feedback was acted upon when areas for improvement were identified.

Staff were supported through supervisions including one to ones and practice observations in people’s homes. Positive feedback was received about good teamwork amongst staff which benefited everyone using the service.

The staff team worked in partnership with health and social care professionals involved in people's care and treatment, to support people achieve good outcomes. Feedback from healthcare professionals was extremely positive.

The registered manager was aware of their legal responsibilities and worked in an open and transparent way.

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 7 October 2017).

Why we inspected

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

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

The service had a registered manager. The provider was also the registered manager. 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 and associated Regulations about how the service is run.

At the last full comprehensive inspection of ACS Care Services on the 16 June 2016 the service was rated as requires improvement. We found that that the registered provider had failed to ensure systems or processes were in place to assess, monitor and improve the quality and safety of the services provide. In addition the registered provider had not consistently gained and acted upon feedback from people for the purposes of continually evaluating and improving services. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On 05 December 2016 we completed a focused inspection and found that the breach of regulation had been met. At this inspection we found the improvements that had been made had been sustained and ACS Care Services is now rated as good.

Sufficient travel time was not always factored into staff schedules, having the potential to jeopardise the safety of people using the service and the staff.

People felt safe when staff came to their homes. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were risk management plans in place to protect and promote people’s safety. Staffing numbers were appropriate to keep people safe. There were safe recruitment practices in place and these were being followed to ensure staff employed were suitable for their role. People’s medicines were managed safely and in line with best practice guidelines.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs. They were well supported by the management team and had regular one to one supervision and annual appraisals.

Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation. Where the service was responsible people were supported by staff to access food and drink of their choice to promote healthy eating. If required, staff supported people to access healthcare services.

People were treated with kindness and compassion by staff; and had established positive and caring relationships with them. People were able to express their views and to be involved in making decisions in relation to their care and support needs. Staff ensured people’s privacy and dignity was promoted.

People received care that was person centred and met their needs. Their needs were assessed prior to them receiving a service. This ensured the care provided would be appropriate and able to fully meet their needs. People’s care plans were updated when there was a change to their care needs. The service had a complaints procedure to enable people to raise a complaint if the need arose.

The service had quality assurance systems in place, which were used to good effect and to continuously improve on the quality of the care provided.

During our inspection in June 2016, we identified that the registered provider had failed to ensure that systems or processes were in place to assess, monitor and improve the quality and safety of the services provided and to mitigate the risks relating to the health, safety and welfare of people using the service. In addition the registered provider had not consistently gained and acted upon feedback from people for the purposes of continually evaluating and improving services.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stating that improvements would be achieved by November 2016.

We undertook this announced focused inspection on 5 December 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ACS Care Services Ltd on our website at www.cqc.org.uk.

A registered manager was in post. 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.

We reviewed the quality assurance systems in place, and found that these had been strengthened. The processes in place were more robust and we saw that more regular quality assurance checks were taking place to ensure that people’s feedback was gathered and acted upon to make changes.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for well led at the next comprehensive inspection.

This was the second comprehensive inspection carried out at ACS Care Services Limited.

ACS Care Services provide personal and practical help that includes all aspects of personal care, meal preparation, domestic assistance including shopping, pension collection, accompanying people on appointments and other trips. ACS Care Services also provides a 'sitting service' keeping a person company whilst their main carer takes a break. There were 151 people using this service when we visited.

There was a registered manager in post. 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. We found the registered manager only visited the service on average once every two weeks which meant there was no consistent management oversight at the service.

Inconsistencies in the recruitment process meant that the service was not able to ensure staff were suitable to work with vulnerable people.

We found that although potential safeguarding concerns and incidents of concern were not sent to the Care Quality Commission (CQC).

The quality assurance systems needed to be improved to ensure that it is effective in all areas of the service including gaining feedback from people, relatives and staff.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to use the whistleblowing procedure. Staff were knowledgeable about the risks of abuse and reporting procedures. There were appropriate numbers of staff employed to meet people’s care needs. People had their medicines managed safely, and received their medicines in a way they chose and preferred.

Staff received appropriate support and training and were knowledgeable about their roles and responsibilities. They were provided with on-going training to update their skills and knowledge to support people with their care needs. People’s consent to care and treatment was sought in line with current legislation.

People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity. People were involved in making decisions about their own care and support.

People received personalised care that was responsive to their needs. The care plans met people’s needs and preferences and provided them with good support. The service had an effective complaints procedure in place.

We identified that the provider was not meeting regulatory requirements and was in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.

We found that the provider assessed people's needs and provided them with the care they required. We also found that the provider had taken suitable steps to ensure staff were aware of their safeguarding responsibilities and suitable checks were completed on new staff. We found that complaints were handled appropriately but we did identify concerns with the way the provider monitored the service that it provided.