Access Support Services – SADACCA Ltd was rated Requires Improvement across all five key questions at its July 2018 inspection, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance), the latter resulting in a warning notice. The decision to outsource all care staffing to Watoto Enterprise Ltd had created significant gaps in oversight, training, care planning, medication management, and recruitment, leaving the registered provider unable to demonstrate compliance with its own Statement of Purpose.
Concerns (12)
criticalCare planning: “One person who had been using the service for two months did not have risk assessments or a care plan in place.”
criticalMedication management: “There was no medication administration record (MAR) for us to check if people had received their medication as prescribed.”
criticalGovernance: “The checks completed by the manager and the director to assess and improve the quality of the service provided gave them insufficient oversight.”
moderateStaff training: “Only two out of seven Watoto staff had completed infection control training.”
moderateSupervision / appraisal: “We were unable to determine whether staff were being supported to deliver care and treatment safely...unable to access supervision and appraisal records for staff employed by another company.”
moderateComplaints handling: “There was a complaints process, but the three people using the service did not have a copy of it in their homes.”
moderateRecord keeping: “We could not establish if the care plans had been reviewed as there were no records.”
moderateMissed or late visits: “One person's lunch call was delivered at 3pm on the 1 and 2 July 2018. This person had also experienced four missed calls week commencing 1 June 2018.”
moderateSafeguarding: “There was no systems in place for staff to record financial transactions to protect people from financial abuse.”
moderateStaff competency: “There were no records to show the competency of Watoto staff had been checked for the administration of medicines.”
moderateLeadership: “This decision to outsource the staffing at the service was not meeting the registered providers 'Statement of Purpose'.”
minorConsent / capacity: “The manager told us they would need to undertake further training to complete [mental capacity] assessments.”
Strengths
· People felt safe in their homes and were treated with dignity and respect by staff.
· People were supported to have maximum choice and control of their lives.
· The service enabled people to maintain community links through access to the SADACCA day centre.
· A social worker provided positive feedback about a Watoto staff member who had built up a good relationship with a person using the service.
· The director and manager demonstrated a good knowledge of the people being supported.
Quality-Statement breakdown (15)
safe: Risk assessmentsRequires improvement
safe: Medication managementRequires improvement
safe: Recruitment proceduresRequires improvement
safe: Staffing levelsGood
safe: Financial safeguardingRequires improvement
effective: Staff trainingRequires improvement
effective: Supervision and appraisalRequires improvement
Access Support Services - SADACCA Ltd achieved an overall Good rating at this September 2019 inspection, having addressed previous breaches of Regulations 12 and 17 identified in July 2018. Safe remained Requires Improvement due to risk assessments lacking sufficient detail and person-centredness, and minor gaps in staff recruitment records.
Concerns (4)
moderateCare planning: “one person's risk assessment stated they received medication when they didn't. People's risk assessment needed to be more detailed and person centred.”
minorRecord keeping: “staff recruitment records required improvement to ensure all the relevant information was kept within the staff member's individual file.”
minorConsent / capacity: “We noticed one person had not signed all their consent forms. We shared this information with the director.”
minorStaff training: “a new staff member had completed a range of training, but they had not been enrolled to undertake the Care Certificate.”
Strengths
· Medicines were managed safely with MAR records regularly checked and staff competency verified.
· Sufficient staffing levels with staff who knew people well; person told us they received regular calls from staff who knew them really well.
· Safeguarding procedures were robust and staff were knowledgeable about their roles in keeping people safe.
· Staff received equality and diversity training; care records included preferences on race, religion and sexual orientation.
· Quality assurance systems improved since last inspection; director regularly reviewed daily and financial records.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
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
Access Support Services - SADACCA Ltd was rated Requires Improvement overall at its first inspection in April 2017, with three regulatory breaches identified covering recruitment (Reg 19), staffing/supervision (Reg 18), and governance (Reg 17). The service demonstrated genuine strengths in caring practice and person-centred support, but lacked the formal documented systems needed to evidence safety, staff oversight, and quality assurance.
Concerns (6)
criticalStaff training: “Staff were not provided with appropriate training and supervision as is necessary to enable them to carry out the duties they are employed to perform.”
criticalSupervision / appraisal: “records of supervisions/ meetings with staff had not been recorded. This meant the managers could not evidence they were providing formalised support to staff”
criticalGovernance: “most of this was not recorded but carried out in an informal way...there was no written evidence of this. quality assurance systems were not robust”
criticalStaff competency: “full information regarding each person had not been obtained prior to the person starting work. No written references from previous employers had been obtained”
moderateRecord keeping: “audits of accidents and incidents and spot checks of staff were not recorded in writing to evidence they had been completed.”
moderateCare planning: “further information about how the risk could be eliminated or reduced were not recorded in a risk assessment format.”
Strengths
· People consistently reported feeling safe and well cared for, with no missed visits recorded.
· Medicines management was appropriate with MAR sheets in place and staff competencies checked.
· Care was person-centred, respecting individual preferences, routines, and cultural/religious needs.
· Staff treated people with dignity and respect; relatives praised professionalism and kindness.
· Complaints policy was clear and accessible; no complaints received since service commenced.
Quality-Statement breakdown (14)
safe: Recruitment checksRequires improvement
safe: Safeguarding proceduresGood
safe: Medicines managementGood
safe: Staffing levelsGood
effective: Staff supervisionRequires improvement
effective: Staff trainingRequires improvement
effective: Mental Capacity Act complianceGood
effective: Nutrition and hydration supportGood
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: 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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: The provision of accessible informationGood
responsive: End of life care and supportGood
well-led: Continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staffGood
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
caring: Dignity and respect
Good
caring: Person-centred approachGood
responsive: Care planning and reviewsGood
responsive: Complaints handlingGood
well-led: Governance and auditRequires improvement