Date of assessment: 5 to 13 September 2024. This assessment was carried out to follow up from our previous inspection to identify if improvements had been made. The service had made improvements and is no longer in breach of regulations. However, further improvements were needed to how risks were assessed and planned for. Some people had risks identified in relation to their health and there was no guidance for staff on how to manage these risks. Staff recruitment practices were not consistently safe, and the policy was not in line with good practice. Assessment and care planning systems were in place but these lacked detail about people’s needs and preferences. There was no consideration of end-of-life care or future wishes for people. Governance arrangements in place were not always effective in identifying areas of concern and driving improvements. Improvements had been made to the systems for responding to complaints and there was a system in place to ensure these were investigated and learning was drawn from these. Safeguarding procedures were now in place, understood by staff and followed to ensure people were safe. Staff were caring and responsive to people’s needs. People received support which was person centred and were supported to maintain their independence and make choices about their care.
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A & A Services West Midlands was rated Inadequate overall at its first inspection in September 2023, with breaches of Regulations 13, 16, 17 and 19 identified covering safeguarding, complaints handling, governance, and safe recruitment. Widespread failures in oversight, medicines management, incident recording, and staff monitoring placed people at significant risk of harm, resulting in the service being placed in special measures.
Concerns (12)
criticalSafeguarding: “we saw documented on body maps people had unexplained bruising and people had missed calls, no further action was taken. This meant people had experienced potential abuse.”
criticalGovernance: “There were no quality checks or audits being completed or recorded and subsequently no oversight of the care people received. This placed people at increased risk of harm.”
criticalStaff competency: “One staff member did not have evidence of a Disclosure and Barring Service (DBS) check in their files. The provider was not aware of this.”
criticalMedication management: “Medicines administration records were not consistently completed...dosages were not always recorded. We also saw signatures were missed by staff.”
criticalIncident learning: “There were no incidents and accident forms in place despite daily records identifying concerns. This meant no action had been taken to resolve these incidents.”
criticalComplaints handling: “We saw 3 complaints in a file. These had not been responded to in line with the providers policy...the complaints were not dated, no acknowledgement had been sent.”
moderateStaff training: “There were no systems in place to monitor staff training or competency. This included in medicines. Staff did not receive supervision to ensure they were proving safe, effective care.”
moderateSupervision / appraisal: “Staff did not receive supervision to ensure they were proving safe, effective care. This placed people at risk of being supported by staff who did not have the training or skills.”
moderateCare planning: “Most of the care plans and risk assessments we viewed were not dated, it was therefore unclear if these were being reviewed or completed when needed.”
moderateMissed or late visits: “There were no systems in place to monitor people's calls, including if they were on time, the length of them and if they had taken place.”
moderateRecord keeping: “There were no systems in place that monitored people's calls...When people had missed calls, there were no records of this in the office and no action taken.”
moderateLeadership: “The nominated individual told us they had been absent from service and on return had identified that improvements were needed, however no action had been taken.”
Strengths
· Staff were kind and caring towards people; people felt safe and were left comfortable after visits.
· People and relatives were happy with staff who supported them and felt they knew them well.
· Infection control procedures were in place and followed; staff had access to PPE.
· Referrals and appointments were made on behalf of people when health support was needed.
· Staff encouraged people's independence, supporting them to do as much for themselves as possible.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Medicines managementInadequate
safe: Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
responsive: Improving care quality in response to complaints or concernsInadequate
responsive: End of life care and supportNot rated
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement