Agincare UK Notts County was rated Requires Improvement overall at its March 2015 inspection, with recurring failures in medicines record-keeping, missed/late visits, inconsistent care records, and failure to embed learning from complaints. Caring and effective practice by staff was noted as a strength, but governance systems were insufficiently robust to drive consistent service improvement.
Concerns (7)
critical
Medication management
: “if a medicine was not administered, the reason and any action taken as result were not consistently recorded and there were gaps in the records.”
moderateMissed or late visits: “No one came at all one day last week, and They are sometimes around 20 minutes late.”
moderateRecord keeping: “a person had been assessed as at risk of falls and in need of a falls risk assessment but in another section of the record this was not reflected.”
moderateCare planning: “We saw in all the care plans that we looked at that there were incomplete sections which meant that staff would not be fully aware of people's care needs.”
moderateComplaints handling: “Although the provider was addressing individual complaints, they were not implementing learning from the complaints to improve the experience of people using the service.”
moderateGovernance: “feedback was not provided to people and changes had not consistently improved the service.”
moderatePerson-centred care: “people had raised concerns about the lack of consistency of staff as they were concerned that staff would not know how to care for them.”
Strengths
· Staff were trained in safeguarding, understood risks and followed guidance; incidents were recorded and reported appropriately.
· Comprehensive pre-employment checks including DBS were carried out for all staff.
· Staff received induction, ongoing training and professional qualifications support; supervisions and spot checks had increased.
· People were treated with dignity and respect; staff were described as kind, friendly and responsive to individual needs.
· Mental Capacity Act 2005 was followed and best interest assessments were in place where people lacked capacity.
Quality-Statement breakdown (13)
safe: Medicines managementRequires improvement
safe: Safeguarding and risk managementGood
safe: Staffing levels and recruitmentGood
effective: Staff training and supportGood
effective: Consent and mental capacityGood
effective: Nutrition and healthcare accessGood
caring: Dignity and respectGood
caring: Person-centred approach and communicationGood
responsive: Care planning and record keepingRequires improvement
responsive: Complaints handling and learningRequires improvement
responsive: Visit timing and staff consistencyRequires improvement
well-led: Quality assurance and governanceRequires improvement
Agincare UK Notts County was rated Good across all five key questions at its announced inspection in July 2016, with 300 people receiving safe, caring and well-managed homecare in Nottinghamshire. The sole area for improvement was that care plans did not always capture sufficient detail about people's specific medical conditions and their implications for care.
Concerns (1)
minorCare planning: “care plans did not always contain such detailed information about any specific medical conditions people may have and the implications of this for the support being provided.”
Strengths
· People felt safe with care workers and received accurate rotas on time, contributing to a sense of security.
· Sufficient staffing levels maintained with ongoing recruitment; staff assigned to regular routes for continuity.
· Medicines managed safely with MAR sheets checked monthly and action taken on any errors.
· Staff well-trained with classroom-based induction, shadowing, regular supervision and annual appraisals.
Agincare UK Notts County was rated Good overall at its March 2019 inspection, with Safe requiring improvement due to punctuality issues with staff visits and inaccuracies in medication recording charts. All other key questions were rated Good, with particular strengths in staff training, person-centred care, and an open leadership culture.
Concerns (4)
moderateMissed or late visits: “It is like 'hit and miss', you don't know if they are coming or not. Sometimes they miss calls and I have to ring them.”
moderateRecord keeping: “We identified concerns with the accuracy of the medication recording charts in people's care plans.”
minorCare planning: “Some risk assessments needing updating to reflect changes in people's conditions.”
minorComplaints handling: “Records showed that the previous registered manager had not always investigated and responded to complaints in a timely manner.”
Strengths
· Staff demonstrated care, compassion and respect towards people, with people reporting positive experiences of dignity and privacy.
· Robust recruitment processes including DBS checks, references and employment history verification were in place.
· Staff were well trained, with regular refresher training and a structured induction programme including shadowing.
· An electronic call monitoring system was introduced and resulted in a significant reduction of late and missed visits.
· Person-centred care plans were developed with involvement of people and relatives, reflecting individual needs and preferences.
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongGood
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 dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting 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: Planning and promoting person-centred, high-quality care and support with opennessGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood