About the service:

Acquire Care Ltd is a domiciliary care agency that was providing personal care to 86 people at the time of the inspection.

People’s experience of using this service:

We identified five breaches of regulations. These were in relation to safe care and treatment, safeguarding procedures, mental capacity, good governance and the registered managers responsibilities.

People were satisfied with the day to day support they received from the staff that visited them. However, their call times were not always planned in line with their wishes. This impacted negatively upon peoples’ wellbeing.

The overall governance of the service was not robust and had failed to ensure that people received a service that was in line with their wishes. It had failed to ensure that issues were not only dealt with but that subsequent improvements were sustained.

People were not always supported to have maximum choice and control in how they wanted their support to be delivered.

Staff received adequate training and support. People were confident in the ability of staff to provide the support that they needed.

More information is in the detailed findings below.

Rating at last inspection:

Good, report published 25 September 2018

Why we inspected:

We undertook an unannounced responsive inspection of Acquire Care Ltd on 19 February 2019. This inspection was carried out in part following concerns that had been raised by the public surrounding the standard of care delivered by Acquire Care Ltd.

Enforcement:

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly. We have requested an action plan from the registered provider as to how they plan to address breaches in regulation and make improvements to the service.

We undertook an announced inspection of Acquire Care on 12 and 13 July 2018. This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults. On the day of our inspection 68 people were being supported by the service.

At our last inspection on 30 March 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). Staff were not always deployed effectively and the provider did not have effective systems in place to monitor the quality of service.

At this inspection we found the service had made significant improvements to address these concerns. People told us and visit schedules confirmed staff were deployed effectively to meet people’s individual needs. The service had established effective systems to assess the quality of care the service provided. Learning was identified and action taken to make improvements which improved people’s safety and quality of life.

However, at this inspection we found that the registered manager and the management team did not fully understand the Mental Capacity Act (MCA), this meant that the service did not always apply the principles of the act in its work. The MCA protects the rights of people who may not be able to make particular decisions for themselves.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safe. The service had safe, robust recruitment processes. Staff understood their responsibilities in relation to protecting people from the risk of harm. People told us they benefitted from caring relationships with the staff.

Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicines as prescribed.

People were treated as individuals by staff committed to respecting people’s individual preferences. Care plans were person centred and people had been actively involved in developing their support plans. People told us they were confident they would be listened to and action would be taken if they raised a concern. We saw a complaints policy and procedure was in place.

Staff spoke positively about the support they received from the registered manager. Staff told us the registered manager was approachable and there was a good level of communication within the service.

People told us the service was well managed. People knew the managers and staff and spoke positively about them. The service sought people’s views and opinions and acted upon them.

We undertook an announced inspection of Acquire Domiciliary Care Agency (DCA) on 30 March 2017. We told the provider two days before our visit that we would be coming.

Acquire Care provides personal care and live in care services to people in their own homes. At the time of our inspection 61 people were receiving a personal care service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staffing rotas indicated there were sufficient staff to meet people's needs. However, the service did not always deploy staff effectively and this had a negative effect on people’s wellbeing.

The registered manager understood the Mental Capacity Act (MCA) 2005. However, not all staff we spoke with understood the act and applied its principles in their work. Since our last inspection the service has made improvements in relation to its understanding and working within the principles of the MCA. However, further work was needed to fully embed this within the service. The MCA protects the rights of people who may not be able to make particular decisions themselves.

Some people and relatives we spoke with told us how language could sometimes be a barrier when people were being supported by staff whose first language was not English.

Systems that were in place to monitor the quality of service were not always effective.

People told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with the staff who had a caring approach to their work. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe. Where people needed support with their medicines, they were supported by staff that had been appropriately trained.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision.

The service sought people's views and opinions and acted upon them. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

We carried out an announced inspection on 5 March 2015.

Acquire Care provides personal care services to people in their own homes. At the time of our visit the service was supporting 76 people.  At our last inspection on 30 July 2013 the service was meeting the regulations inspected.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Staff were knowledgeable about the needs of the people they supported and provided personalised care. Care plans detailed the support people needed. People felt involved in making decisions about their care and their decisions were respected. People told us they were supported by caring staff who treated them with dignity and respect.

People felt confident to make a complaint, but this was rare as people told us they were happy with the service. Complaints received were dealt with and resolved to the person's satisfaction.

People were referred to health professionals appropriately. The management team liaised with health professionals to achieve the best outcomes for people. Health and social care professionals told us the management team were responsive when contacted.

The registered manager promoted a caring culture. Staff felt valued and listened to. There was a monthly award scheme to recognise staff achievements. Staff were encouraged and supported to develop. Staff told us the management team were approachable and responsive.

The registered manager had implemented changes to the staffing structure to enable them to spend more time developing improvements to the service. A new computer system was being implemented to improve the quality assurance systems.

Records relating to people's capacity did not follow the principles of the Mental Capacity Act. We could not be sure that people's capacity had been fully considered.

We have made a recommendation about the Mental Capacity Act.

During this inspection we followed up one compliance action made at the last inspection.

People that we spoke with by telephone told us they were involved in making decision about their care and were complimentary about the level of care received.

We saw detailed information recorded in the person-centred care plan about the person's needs and how they were to be met. Records seen of visits included time of the care workers arrival and department and care provided.

We saw evidence of effective recruitment and selection processes in place. For example we saw that the agency had a detailed checklist in each file to ensure that the recruitment policy and procedure had been adhered to.

All care workers received an induction. The length of the induction training and shadowing was extended until a care worker felt confident in their role.

The manager had undertaken an internal quality monitoring exercise that included the reviewing of all documentation, policies and procedures.

The agency had a complaints procedure and a complaints policy. People were aware of the procedure to take if a complaint had been raised with them.

We saw that the manager and senior staff had reviewed all people's assessments, care plans, risk assessment and daily records. We found these to be of a good standard. We looked at staff personnel files and these contained all the information required. We looked at policies and procedures and many of these had been updated or reviewed.

Some people spoke about the high quality of care they received. People told us that they knew who to contact within the agency if they had a problem and that staff were well trained and knowledgeable about their care needs. Comments included ' Acquire has given me so much help and confidence that the care of my dying husband has been and will be carried out exactly as he and I would want it to be ' my only complaint was acted upon immediately' '99% of the ladies that call on us are efficient, friendly and careful that when they leave he is comfortable and peaceful' 'i think Acquire carry out a brilliant and so necessary service- long may it continue'

People told us that they had a choice in who provided their care and were able request a change in the type of care they received, if care was not being given in the way they wanted. We saw some examples of this recorded in the files we looked at.

People told us that their care was regularly reviewed by the service provider and that if there were problems they were confident that the agency would investigate them. People told us that they were listened to and that action was taken if they had a complaint or concern over the care they received. We noted that the agency did have a formal process for complaints, but most issues were resolved informally. 'Acquire responded to our concerns to our satisfaction'.