Date of Assessment 23 to 28 October 2024. Ace Homecare London is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection 27 older people or people with dementia received personal care support from Ace Homecare London. The service was rated requires improvement at their last inspection (published 09 June 2022). This was because we identified multiple breaches in relation to the way the provider managed risks to people, care plans lacked detail to ensure peoples individual needs were fully met. Quality assurance systems were not operated effectively. We undertook this assessment to check the provider had implemented the action plan we required them to complete after their last inspection to show us they had improved. This assessment was announced on 12 December 2024 and was conducted by a single assessor on 16 December 2024. We assessed 18 quality statements related to the 3 key questions, is the service safe, responsive and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. At this inspection we found improvements had been made by the provider. This was because the provider had addressed all the concerns we identified at their last inspection. These improvements included improved and detailed assessments and care plans, detailed risk assessments and the effectiveness of how they operated their established governance systems. This meant they were no longer in breach of regulations and people were not at risk of harm. The overall rating for the service has therefore improved from requires improvement to good based on the findings of this inspection. Our overall rating for the service is good. There were good systems in place to ensure that the care being provided was of good quality. People and relatives told us staff were caring, and they felt safe. People were involved in their care planning and reviews.
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Ace Homecare London was rated Requires Improvement overall following a focused inspection in April 2022, with breaches of Regulations 9, 12 and 17 identified relating to inadequate risk management, non-personalised care plans and ineffective governance systems. Strengths were noted in safeguarding, medicines management, infection control and staff training, and the registered manager acknowledged shortfalls and had begun remedial action.
Concerns (8)
criticalCare planning: “Risk assessments and risk management plans lacked detail and did not always provide the required information to ensure that people who used the service were protected from risks.”
criticalPerson-centred care: “Care plans were not always personalised and provided care workers with the necessary information to provide person centred care to people who used the service. This was a breach Regulation 9.”
criticalGovernance: “The provider's care records checks were not effective because they had not identified that risk assessments and care plans were not being completed appropriately.”
moderateRecord keeping: “People's care plans lacked people's background...Details of how tasks should be provided were not personalised and this information was not available for staff reference.”
moderateSafeguarding: “We found that in one DBS check that the member of staff had a previous criminal conviction. However, the service did not undertake a risk assessment to ascertain if the person was safe.”
moderateConsent / capacity: “Most MCA assessments were mostly ticked...there was no detail to state how a mental capacity assessment was being undertaken.”
minorCommunication with families: “How people communicated and understood information presented to them, was only recorded in some care plans. This meant that care workers did not always have information of how to communicate with people.”
minorComplaints handling: “In one complaint the service did not record what action had been taken by the provider to improve the service.”
Strengths
· Care workers demonstrated a clear understanding of safeguarding responsibilities and how to report abuse.
· Medicines were managed safely with a clear medicines policy covering different stages of medicines support.
· Robust infection prevention and control arrangements including COVID-19 guidance and appropriate PPE.
· Accidents and incidents were documented, analysed and discussed with staff to minimise recurrence.
· Staff received induction based on the Care Certificate, regular training, supervision and appraisals.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
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: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careRequires improvement
Ace Homecare London was rated Requires Improvement overall following a January 2020 inspection, with two regulatory breaches identified: inadequate risk assessments (Regulation 12) and ineffective governance and quality assurance systems (Regulation 17). Key concerns centred on persistent missed and late visits, incomplete risk assessments for high-risk conditions, and insufficiently frequent medicine audits, while caring and effective practice were generally strong.
Concerns (7)
criticalMissed or late visits: “Out of the five records examined, all had at least ten occasions when staff did not arrive on time and stay the agreed duration.”
criticalMissed or late visits: “In one recent incident, staff did not visit a person for several days and management was unaware of this until they were informed by a care professional.”
criticalCare planning: “Where a suction machine was needed because of a debilitating condition there was no appropriate risk assessment.”
criticalCare planning: “The risk assessment of a person with diabetes was not sufficiently detailed and did not include guidance for responding to symptoms of high or low blood sugar levels.”
criticalGovernance: “No audits had been done regarding complaints, incidents, and risk assessments. Although the service had started to check the punctuality of visits and any missed visits, these checks and audits were not documented.”
moderateMedication management: “There had been a recent incident where a person had not been administered their medicines as prescribed. Medicine audits were done two monthly. This was not sufficient.”
minorRecord keeping: “The assessment of people's skin condition had not been completed. As the form was not completed, we could not be sure if the assessments were missed or not.”
Strengths
· Staff were safely recruited with appropriate DBS checks, references, identity evidence and right-to-work checks carried out prior to employment.
· Staff received comprehensive training including safeguarding, moving and handling, MCA, food hygiene and first aid, with regular supervision and annual appraisals.
· People and relatives expressed high satisfaction with staff competence, dignity, respect and cultural sensitivity.
· The service worked effectively with health and social care professionals, with three care professionals providing positive feedback on partnership working.
· People's cultural, religious and communication needs were assessed and matched with appropriately skilled staff, including language-matched carers.
Quality-Statement breakdown (25)
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
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