Access Dignity Care Limited Also known as Access Dignity

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We did not look at all quality statements for Effective at this assessment. The service was not always effective. This rating uses some scores from the previous inspection. This showed a decline since the last inspection. Assessments completed by the service were insufficiently detailed to enable effective, good quality care planning. This included failure to assess the impact of specific health conditions. There was a lack of understanding by staff and leaders about capacity and consent. There were no mental capacity assessments for people living with dementia who might not be able to consent to all aspects of their own care and treatment. Where people made decisions which could be considered unwise, there was no evidence of support or further information provided by staff. During our assessment of this key question, we found concerns about consent and capacity, which resulted in a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified concerns relating to the competency of staff, resulting in a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Assessments completed by the service at the time of inspection were insufficiently detailed to enable effective, safe, good quality care planning. This put people at risk of their needs not being met. This had not been identified by the provider’s own audits. Although the provider reacted to feedback given during the CQC site visit, and sent 3 people’s updated care plans for review, these records were still not detailed enough and did not show user involvement. The registered manager told us they would complete a phased re-assessment of everyone using the service, to ensure all care plans were safe, accurate and good quality before accepting any new admissions into the service.

Feedback from staff and the registered manager showed they lacked the skills and understanding of people’s assessed needs and conditions, which had put people at risk. A person using the service was assessed to require support with all of their meals and drinks, as they were unable to independently mobilise. Staff were not providing this support, and the registered manager and assessment manager confirmed they were aware of this, but had not taken any action. This is despite believing the person was consuming no food, contrary to their assessed needs. Staff could not explain how they supported people's wellbeing, as there was very limited information recorded as assessment of people's interests. The poor standard of assessments had not been identified by the management team, showing a lack of oversight. Following our feedback, the registered manager took action to re-train staff responsible for completing assessments.

There were concerns raised by people about the assessment process, which did not result in care which reflected their values, preferences, and needs. A person’s relative said, “[Access Dignity Care Limited] came and did a care plan and sold the service to me but they haven’t lived up to expectations.” Another person said, “[Access Dignity Care Limited] came and did an assessment and put the plan in a folder. They didn’t ask me what I wanted, and they didn’t ask me if I minded male care workers, but they send them in, and I don’t want them.” We also received feedback that visit timings agreed at assessment were not always followed. A person's relative told us, “They did an assessment and I was asked about times, but they don’t stick to the times I asked for.”

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Processes in place were not effective to ensure consent to care and treatment underpinned all areas of people’s care and support. This put people’s human rights at risk where they lacked capacity to give informed consent to their own care and treatment. People were not supported to access resources they might need to facilitate informed decision making. The lack of mental capacity assessments had not been identified by the provider or its compliance team. Following our feedback, the local authority safeguarding team offered to provide training to the service in the Mental Capacity Act.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. The service was not working within the principles of the MCA. Communication barriers meant staff could not always effectively seek consent before providing support, and we received feedback staff did not always have the skills to provide care to people living with dementia in a person-centred way. A person said, “The care workers don’t speak good English. I can’t understand them.” Another person’s relative said, “[My person] gets very upset because [care workers] do not understand them. But on a positive note [the care workers] are very nice people, caring and good humoured.” However, we also received feedback from a person's relative who said, "The care workers always say what they are doing and ask, 'Would you like us to...?’. They are polite and respectful.”

Leader’s own lack of understanding impacted on their ability to ensure effective care plans were in place and hampered the monitoring of staff practice. There was a lack of understanding at management level about fluctuating capacity, for example when experiencing an infection, and the need for decision-making to be time and decision specific. There were no mental capacity assessments provided on request for anyone using the service. This included for people who may not have capacity to consent to all aspects of their own care, for example, due to living with advanced dementia. This meant there was no evidence actions were taken in the person’s best interests in providing care and treatment.