About the service:

¿ Ambley Care Limited is a domiciliary care agency registered to provide personal care for people who require support in their own home. Ambley Care Limited is a wholly owned subsidiary company of Medway Community Healthcare (MCH) C.I.C.

¿ Not everyone using Ambley Care Limited receives regulated activity; CQC only inspects the service being

received by people provided with 'personal care'; help with tasks related to personal hygiene and eating.

Where they do, we also take into account any wider social care provided. At the time of our inspection, they were supporting 47 people who received support with personal care tasks.

People’s experience of using this service:

¿ The service had improved since we last inspected it. Everyone we spoke with was positive in their feedback. Comments included; “I had a massive operation and they’ve been great”; “I feel very safe, and I have lifeline” and “I feel safe, I haven’t seen or heard anything, but I would feel confident to raise any issues.”

¿ Care plans contained risk assessments, which was appropriately linked to their support needs.

¿ Processes were in place to identify and reduce any environmental risks to people and care workers.

¿ The service was working according to the Accessible Information Standard (AIS) and its requirements during our inspection. This meant that people were able to communicate effectively with care workers or understand what was going on and involved in decision-making.

¿ People’s needs were assessed prior to receiving a service including the protected characteristics under the Equalities Act.

¿ Staff were skilled in carrying out their role. Trained staff were employed to meet people’s needs. Staff said they were supported by the manager.

¿ People were encouraged to raise any concerns they had or make suggestions to improve the service they received. One person said, “When I had that complaint, I did not call the office, but I told the carer who came the following night. She contacted the office, and someone rang me, and I explained my complaint. The office acted on it immediately and resolved my complaint.”

¿ Staff felt there was an open culture where they were kept informed about any changes to their role. Staff told us the manager was approachable and listened to their ideas and suggestions.

¿ The service had effective systems in place to assess, monitor and improve the quality and safety of the services provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

¿ Requires Improvement (Report published 23 May 2018).

Why we inspected:

¿ At our last inspection on 03 April 2018, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to our findings, that the provider failed to carry out, collaboratively with the relevant person, an assessment of the needs and preferences for care and treatment of the people who used the service. Further, the provider failed to act in accordance with the Mental Capacity Act (2005), people's capacity to consent to care and support had not been assessed and recorded within their care plans. The provider also failed to assess the risks to the health and safety of service users receiving the care or treatment. The provider had also failed to operate effective quality monitoring systems and failed to provide appropriate support, professional development and supervision as is necessary to enable them to carry out the duties they are employed to perform.

¿ We asked the registered provider to take action to meet the regulations. We received an action plan, which stated that the registered provider would take action to meet the regulations by July 2018. The action plan was continually updated up until 22 March 2019.

¿ At this inspection, we found that improvements had been made in relation to the requirements made above.

Follow up:

¿ We will continue to

The inspection was carried out on 03 April 2018, and was an announced inspection. The provider was given 48 hours’ notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us.

Ambley Care Limited is a domiciliary care agency registered to provide personal care for people who require support in their own home. Ambley Care Limited is a wholly owned subsidiary company of Medway Community Healthcare (MCH) C.I.C. Ambley Care Limited was established in July 2016 to provide personal care and enablement to residents of Medway aged over 18. They provide enabling services to assist service users to regain independence. This could be after discharge from hospital to home or within community rehabilitation units. Services are provided for a short time period of six weeks. However, in some instances, the service provided had lasted up to four months.

Not everyone using Ambley Care Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. This was the first comprehensive inspection since the agency was registered on 09 May 2017. At the time of our inspection, they were supporting 101 people who received support with personal care tasks.

There was no registered manager at the service. The last registered manager left in January 2018 and the provider was in the process of registering a new manager with the commission. 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.

The provider had not carried out appropriate risk assessments when they visited people for the first time. There were no care related risk assessments identified for people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider did not understand their responsibilities under the Deprivation of Liberty Safeguards. People’s capacity to consent to care and support had not been assessed and recorded within their care plans.

Staff [Enablers] had not received regular supervision as is necessary to enable them to carry out the duties they are employed to perform.

People’s needs had not been properly assessed by Ambley Care prior to receiving support from the service. Care plans had not been developed with people by Ambley Care on how to meet their needs. Care plans did not contain information about people’s likes, dislikes and personal histories.

The provider did not have adequate processes in place to monitor the delivery of the service.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. We have made a recommendation about this.

The provider had not managed medicines safely. Staff had not been trained in medication administration which would have equipped them for prompting medicine administration. We have made a recommendation about this.

The provider had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the service’s whistleblowing policy. They were confident that they could raise any matters of concern with the management, or the local authority safeguarding team.

The provider provided sufficient numbers of staff to meet people’s needs and provide a flexible service.

All staff received induction training at start of their employment. Refre