Background to this inspection
Updated
20 August 2021
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 Care Act 2014.
Inspection team
This inspection was carried out by one inspector and one Expert by Experience. 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 and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 29 June 2021 and ended on 5 July 2021. We visited the office location on 29 June 2021.
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. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.
During the inspection
We spoke with 18 people who used the service and six relatives about their experience of the care provided. We spoke with six members of staff including the registered manager, assistant manager, and care workers. The nominated individual were not available at the time of the inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures and training records were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
20 August 2021
About the service
Assured Care (Stockport) Limited is a domiciliary care agency providing personal care to 214 people at the time of the inspection.
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
The provider had not always ensured detailed individual risk management plans were in place to guide staff on how to provide care to people with specific needs in the safest way possible. Care documentation was not always reviewed in a timely way to reflect people’s current care needs.
The provider had not ensured staff had the necessary, up to date training in place before providing care and support to people. Also, the provider had not satisfied themselves on an ongoing basis that staff providing care and support were competent to do so.
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. However, we found concerns regarding legal safeguards around decision making for people in the form of Lasting Power of Attorney (LPA).
We have made a recommendation around the lawful use of LPAs.
We received mainly positive feedback from people who used the service about the care they received and about the care staff. People felt safe and they told us staff read their care plan and staff always wore personal protective equipment (PPE) when visiting them.
Policies, procedures and audits were in place. However, they had not always been followed and audits had not identified the concerns we found on this inspection. Staff mostly felt supported in their role and felt they could report concerns to the senior staff.
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 18 July 2019).
Why we inspected
The inspection was prompted due to concerns received about the management of and escalation of people’s individual risks to their health, staff training levels and non-notification of safeguarding incidents. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 Assured Care (Stockport) on our website at www.cqc.org.uk.
Enforcement
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 continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to the management of people’s individual risks, staff training and governance of the service.
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 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.