About the service:

Personal Assistance Care Agency Ltd. is a domiciliary care service registered to provide personal care to people living in their own homes. Not everyone using Personal Assistant Care Agency Ltd. receives a 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 14 people were using the service.

People’s experience of using this service:

Quality assurance systems were not effective. The service manager was assessing and monitoring the quality of care delivered. An improvement plan was devised and was based on their assessment which included care planning. Although the improvement plan was recently introduced this had yet to be embedded into practice.

There were people receiving personal care who were at risk of potential harm. The daily notes showed people’s individual risks included mobility needs, people who experienced severe epilepsy and choking risks. However, risk assessments on how risks were to be mitigated were not available at the agency office.

The staff told us risk assessments were developed for some people. However, their comments indicated where risk assessments were in place they were not read by the staff and were in need of reviewing.

Risks assessments for the property were not in place. This meant the registered manager could not be certain that staff were working in a safe environment.

Customer details and comprehensive assessments were in place for some people. However, care plans were not developed from these assessments. There was no evidence that people’s care needs had been reviewed.

Records of daily visits documented by staff lacked their signatures and times of visits. There was little evidence on how staff had met people’s agreed outcomes.

People told us staff supported them with taking their medicines. The staff lacked an understanding on effectively recording the support they provided with medicines administration. For example, prompting and removing medicines from the packaging. This meant staff were not maintaining accurate records of medicines they had administered. Copies of medicine administration records were not available at the agency office for auditing. Comments from staff indicated that good practice guidance for medicines was not followed, NICE guidelines (National Institute for Health and Care Excellence).

Recruitment of staff was not well managed. Copies of application forms were not always fully completed. Applications forms did not always give the names of the most recent employer. There was no evidence that references had been sought for all staff.

Disclosure and Barring Services (DBS) checks had taken place for all staff. A DBS check allows employers to check whether the applicant has any convictions or whether they have been barred from working with vulnerable people. Where DBS checks were returned with convictions there was no evidence that the registered manager had assessed with the staff the learning from these episodes. This meant the registered manager had not gained reassurances that these incidents would not be repeated.

Recruitment was ongoing and a team leader had been appointed. The registered manager and the service manager told us the appointment of the team leader would assist with the monitoring of staff practice, undertaking care plan reviews and updating records.

There was support for staff through staff meetings. The most recent team meeting was well attended and all areas of the staff’s role and responsibilities were discussed.

People told us they felt safe while staff from the agency were present. The staff told us they had attended safeguarding of adults training. These staff knew they types of abuse and how to report any concern. There were three safeguarding referrals made before the inspection by CQC in respons

We undertook an announced inspection at Personal Assistant Care Agency Ltd. On 20 December 2018. We gave the service 24 hours’ notice that we would be visiting. This was because the location provides domiciliary care services and we wanted to make sure someone would be available to support our inspection. This was the first inspection for the service at their new registered address.

Personal Assistance Care Agency Ltd. is a domiciliary care service registered to provide personal care to people living in their own homes. Not everyone using Personal Assistant Care Agency Ltd. receives a 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, 20 people were using the service.

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.

Medicines were managed safely but some administration records required more detail, such as prescription guidance. People were protected from the risks associated with infection control.

Risk assessments were in place for people’s home environments. Not all personal risk assessments were in place although staff knew how to support people appropriately and safely.

There were sufficient numbers of suitable staff on duty to meet people’s needs and staff benefited from one to one supervision support from their manager.

Staff were knowledgeable about their responsibilities to report any concerns and knew how to identify abuse and what to do about it.

Although staff were knowledgeable about the Mental Capacity Act (2005), there were no recorded mental capacity assessments where there were doubts about people’s capacity.

Staff training was behind schedule and most required refreshers. New staff followed an induction process which was aligned to the Care Certificate.

People’s choices and preferences were detailed in their support plans. People and their relatives had been involved in developing and reviewing the plans. People were supported to attend activities, day services and maintain hobbies and interests.

The service worked collaboratively with health and social care professionals to develop appropriate support plans and make changes when required. Staff followed guidance given by specialists to support people using best practice methods.

Feedback received from people, their relatives, and visiting professionals was very positive about how caring the service was. Staff promoted people’s privacy and dignity and were respectful in their approach and methods.

The service was developing new ways of recording and documenting care plans, daily records and people’s care information. This was in the early stages of implementation. This meant that not all records were organised or up to date. However, a new service manager was being recruited. They would work alongside the registered manager and take over the day to day running of the service.