AJB Care Ltd improved from Requires Improvement to Good overall, with both Safe and Well-Led rated Good, having resolved a previous breach of Regulation 17 relating to governance and medicines record-keeping. Minor issues around visit time consistency and office communication were noted but not time-critical.
Concerns (2)
minorMissed or late visits: “Some people did say they would like more consistent call times.”
minorCommunication with families: “Two people and a relative felt communication between 'the office' and themselves could be better, saying on one occasion a call wasn't returned.”
Strengths
· Medicines managed safely with clear guidance in support plans, well-maintained MARs, regular training, competency assessments and audits.
· People felt safe; staff knowledgeable about safeguarding procedures and how to report concerns.
· Robust recruitment process including DBS checks to ensure suitable staff were employed.
· Effective governance and audit systems identified issues and drove continuous improvement, resolving previous Regulation 17 breach.
· Positive culture with people feeling known as individuals and not 'just a number'; feedback mechanisms in place including annual surveys.
safe:Insufficient evidence to ratewell-led:Insufficient evidence to rate
AJB Care Ltd received a targeted inspection focused solely on Regulation 17 (Good Governance), with the overall rating remaining 'Requires improvement' from the previous comprehensive inspection. The provider was found to still be in breach of Regulation 17 due to inadequate medicines records and audit systems that failed to identify all governance shortfalls.
Concerns (4)
criticalMedication management: “Records about the support people needed with their medicines were not always up to date and some did not contain enough information to support staff to manage medicines in the most effective way.”
criticalRecord keeping: “People's medicines records did not contain enough information when staff reminded or prompted people to take their medicines. There were no records kept about what medicines staff were prompting people to take.”
criticalGovernance: “Although the provider's medicines audits had identified some areas that needed to improve, they had not identified all the issues we found with medicines records during this inspection.”
moderateIncident learning: “Systems were either not in place or were not robust enough to assess, monitor and improve the quality and safety of the service.”
Strengths
· People were happy with the support they received with their medicines and relatives raised no concerns.
· Staff were trained in medicines administration and competency was regularly checked.
· Staff understood their roles and felt well supported by management.
· People and staff had opportunities to provide feedback and were confident concerns would be addressed.
· The registered manager investigated concerns to learn from them and reduce recurrence.
Quality-Statement breakdown (2)
safe: Using medicines safelyInsufficient evidence to rate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careInsufficient evidence to rate
AJB Care Ltd was rated Good across all five key questions at its first rated inspection in July 2016, with people feeling safe, well-supported and treated with dignity by a consistent and trained workforce. Minor governance gaps were identified, including lack of formal complaint action recording, overdue policy reviews, and absence of staff team meetings, but none constituted a regulatory breach.
Concerns (6)
moderateRecord keeping: “the action taken could not always be evidenced. For example, the attitude of two staff had been identified in a complaint, but there was no evidence to support the action”
moderateGovernance: “the registered manager told us there was no formal process of analysis and action plan for the review of records returned to the office.”
minorStaff competency: “when we spoke with some staff their knowledge was limited in how this might impact them in their role [MCA/DoLS].”
minorRecord keeping: “For one person there was inconsistent information in the support staff provided with a person's eye drops.”
minorGovernance: “policies that we looked at had passed the annual review date.”
minorComplaints handling: “the complaints policy required updating to include the correct information about the procedure to follow if people remained dissatisfied after the agencies response”
Strengths
· People felt safe and expressed confidence in care staff, with all questionnaire respondents confirming they felt safe from abuse and harm.
· Sufficient staffing levels with consistent care teams providing continuity; no missed visits reported by people using the service.
· Staff received comprehensive training including Care Certificate, MCA/DoLS, medication management, and a wide range of clinical topics via an in-house training officer.
· Regular supervisions (minimum four per year) and annual appraisals were in place and confirmed by staff records.
· Strong caring relationships evidenced by overwhelmingly positive feedback from people and relatives about staff dignity, respect and kindness.
AJB Care Ltd was rated Requires Improvement overall at its February 2019 inspection, with a breach of Regulation 17 (Good Governance) due to insufficiently robust auditing of care records, MAR sheets and financial transactions. Caring, effective and responsive practices were rated Good, supported by consistent, well-trained staff and positive feedback from people and relatives.
Concerns (6)
criticalGovernance: “Audits and checks were in place but some of these were not robust in terms of care logs and financial records. Documentation and MAR's were not always brought back to the office in a timely manner.”
criticalSafeguarding: “there had been two safeguarding concerns which had occurred within the service but had not been reported to CQC.”
moderateMedication management: “the service was not always recording the time medicines were administered on the Medication Administration Record (MAR) as per their own guidance.”
moderateRecord keeping: “we found that there were gaps in completion of some medication sheets and that daily records were not always dated clearly. This should have been identified through audits.”
moderateOther: “Where the service handled money for people, there was no system to ensure financial transactions were brought back to the office in a timely manner to check that the correct procedures were followed.”
minorStaff competency: “We recommended that more comprehensive competency assessments needed to be developed in line with best practise guidelines.”
Strengths
· People and relatives reported care was safe, caring and personalised to individual needs and preferences.
· Visit times were reliable, consistent and flexible, with realistic and achievable rotas.
· Staff were experienced, well-established and had a very low turnover, enabling trusting relationships with people.
· Staff received regular training, supervision and appraisals and felt well supported.
· Complaints were handled promptly with evidence of lessons learned and actions taken.
Quality-Statement breakdown (20)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and management; learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
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Good
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support; duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; working in partnership with othersGood