Archived: Agincare UK Bridport

The inspection took place on 27, 28, 30 April 2015 and was announced. We gave the service a short notice of 48 hours as we wanted to be sure staff were in the office when we visited.

The service provides personal care and support to people in their own homes in the area of Bridport. At the time of inspection the service was being provided to 120 people, including older adults, some living with dementia and younger adults with physical disabilities or long term conditions. The service also provided care and support service for a small number of younger adults with learning disabilities. Approximately 60 people had their care plans arranged through local authority social care teams. Other people arranged and paid for the service directly with Agincare UK Bridport. The service is well established with over 1100 hours of care and support delivered weekly.

The service was required to have a 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 2008 and associated Regulations about how the service is run. At the time of inspection a registered manager was no longer in post as they had changed role to senior carer in December 2014. A replacement manager had been appointed who had been in post four months at the time of inspection. However during the inspection they were in the process of handing over to a new manager who had been in post for two days. The new manager told us they were in the process of submitting an application to become a registered manager. We spoke with both managers during the inspection.

At the last inspection on 5 December 2013, the service was not meeting the standard relating to the safe handling of medicines and not meeting the standard for how the quality of the service was assessed and monitored. At this inspection we found there had been improvements in how medicines were handled. People’s medicines were handled safely as there was a system for recording, administration and checking to detect errors and for corrective action to be taken if required. Although there had been some improvement in how the quality was checked, there were still shortfalls in the area of assessing and monitoring quality.

People told us they felt safe with the service. We observed that staff reported their concerns promptly to the office. There had been a number of safeguarding investigations carried out within the service over the last year. The service had been working with the local authority over the last six months to address concerns found as part of these investigations and shortfalls in meeting contractual standards, found during their contract monitoring visits in June and August 2014. Concerns and issues found related to risk management and accidents, the quality of individual care plans and specialist training for staff relating to learning disability. These areas had been addressed; however some actions relating to care plans were in progress.

The service was not meeting the legal requirements of the Mental Capacity Act 2005 as the guidance was not fully understood and applied by the service. Although policies and procedures were in place relating to people who did not have mental capacity to give consent to their care plan, they were not being followed. This meant the service could not be sure the care and support being delivered was the least restrictive option to keep people safe, in accordance with the law and relevant code of practice.

People expressed mixed views about their service, with some telling us their experience was very positive and others stating concerns about timing of visits, communication or sometimes the skills and understanding of the care worker who visited. Some people wanted more consistency of care worker so they could know what to expect and build up a relationship with their carer. People who experienced some dissatisfaction with certain aspects of their service told us there had been gradual improvement over the last three months. One person told us, “we are very happy with care. We couldn’t do without it. The carers who come to us are very kind.” Another person told us, “girls I have are very good, the regular ones.” Another person said, “the carers keep checking we are happy with everything. They provide good care.” Another person told us, “I get very anxious about the way the care is delivered to me.” We raised this with the manager who quickly responded to rectify this with the person. We observed examples of people being treated with respect by care staff and we saw office staff treating people with respect and consideration when they contacted the service by phone.

People told us that when they raised issues with their care that the office tried to respond and deal with it. For example, one person said they were, “always apologetic, and most times they do something about it, but sometimes they forget.” Some people told us they were aware that it could be difficult when care had to be arranged when someone was sick. However some people did raise concerns about not always being notified beforehand if there were going to be changes.

The system for allocating visits took account of people’s wishes and needs and where possible regular care staff were arranged who had the right experience to meet these needs. Office staff responsible for planning the service knew about people’s individual requirements and tried to meet these by deploying staff who were suitably qualified. However the service acknowledged this could be constrained by availability of staff, which was affected by recruitment, and sickness, and were aware this affected people’s experience of care. There was no system for the routine monitoring of the actual timings of visits against the planned times or for keeping track on how many different care workers went in to each person so performance in these area could be measured.

Some people relied on help from the service to eat and drink and we found that the most of the care plans we looked at described this support in detail and reflected people’s wishes, however some were not as detailed. We found people who had been helped to eat a balanced diet. However the time allocated for this was limited for some people which affected staff’s ability to always provide this consistently. The manager also acknowledged that some staff would benefit from more specific training in this area. Two staff told us they would have liked more time to prepare meals. Some people told us they would like more time for meal preparation however that their social worker was unable to arrange extra time for this.

People’s needs were assessed before they received a service and written care plans contained a good level of information about each person and their preferences, the risks associated with their care needs and when a review was due. The new manager showed us a format which was being introduced to enhance care planning with people, to make it more person centred and give easy to follow guidance to staff about understanding people’s wishes and preferences.

The service liaised with community social and healthcare professionals to ensure people had access to healthcare when required or to notify other relevant professionals of changes in people’s circumstances. Staff were recruited safely. Staff received an induction and on-going training to carry out their duties. Most training was done online or through workbooks

Some people or their relatives told us the quality of their care could be improved in relation to the meeting more complex needs. The manager acknowledged gaps in areas of more specialist training for staff in areas such as dementia and other long term conditions such as Parkinson’s. Staff told us they felt generally supported to do their job however some staff expressed a wish for practical training to help them meet individual needs confidently, such as moving and handling and catheter care.

The manager kept a record of feedback about concerns reported by people and staff and any action taken. This demonstrated people’s issues were being addressed and their experience was taken into account in improving the service. Some staff told us the communication between the office and people and care workers had improved over the last few months, however that further improvement was required. The manager had visited some people at home to discuss their service, which people told us they greatly appreciated.

We found there were two breaches of regulation in relation to mental capacity and governance.