Date of assessment: 18 June to 30 June 2025. Almond Tree Care Ltd is a care at home service providing support to older people, younger adults, and people living with dementia, a sensory impairment and/or a physical disability. There were 51 people receiving the regulated activity of personal care at the time of the inspection. At our previous inspection completed in August 2022, the provider was found to be in breach of the legal regulations in relation to safe care and treatment, consent and governance. Improvements were found at this inspection in relation to safe care and treatment and consent and the provider was no longer in breach of these regulations. However, improvements in relation to governance were not found at this inspection and the provider remains in breach of this legal regulation. An additional breach of legal regulation was found in relation to displaying the CQC rating on the provider’s website. Whilst the care delivery was good and care staff supported people in a compassionate, kind and person-centred manner, the culture within the serve was poor which had impacted on staff wellbeing. Staff told us they did not feel valued or supported and were overworked; they told us they were treated with a lack of respect and compassion. Staff told us they were fearful of raising concerns due to repercussions. A poor working environment had been found at our previous inspection completed in August 2022 and the provider had failed to rectify this meaning the negative culture remained at this inspection. However, the people who used the service, their relatives and health and social care professionals told us the service, at the point of delivery, was consistently good. People told us they were supported by staff who were invested in them, conscientious and kind. They told us their needs were met in a person-centred manner and the records we viewed confirmed this. We found that improvements had been made in relation to risk management and consent and that people’s needs had been reviewed to ensure the service was meeting them. We have asked the provider for an action plan in response to the concerns found at this inspection.
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Almond Tree Care Ltd, a domiciliary care agency serving 26 people, was rated Requires Improvement overall at its first inspection, with breaches of Regulations 11, 12 and 17 identified relating to consent, safe care and treatment, and governance. While staff were praised for their kindness and medicines were managed safely, significant shortfalls in risk assessment, care planning, Mental Capacity Act compliance, and leadership oversight placed people at potential risk of harm.
Concerns (10)
criticalCare planning: “There were not always appropriate risk assessments and care plans to guide staff on how to provide care to people in a safe way and meet their needs.”
criticalSafeguarding: “The provider had failed to recognise when risk assessments were needed to ensure people's care was safe and this put people at risk of harm.”
criticalConsent / capacity: “The provider did not demonstrate a good understanding of when a Mental Capacity Act assessment should be carried out.”
criticalGovernance: “Their quality assurance system was insufficient and did not include checks on records such as care plans to identify potential omissions or required changes.”
moderateRecord keeping: “One care plan stated a person's intake was poor and fluid needed to be recorded and encouraged. However, it did not state what the fluid target should be.”
moderateStaff competency: “Only one of the four staff we spoke with could tell us about risks to people they cared for and how these were managed and mitigated.”
moderateEnd-of-life care: “Whilst staff had undertaken training in supporting people coming to the end of their life, there was no end of life care planning in place.”
moderateLeadership: “Some staff raised concerns about the negative working environment and how they were treated by the provider and senior managers.”
moderateIncident learning: “There were insufficient governance systems in place which meant the service had not been able to independently identify the shortfalls we found.”
minorPerson-centred care: “Care plans were brief, and task focused. We recommend that these could be developed further to include more about people's preferences.”
Strengths
· Medicines were managed, monitored and administered safely, with a system in place to monitor medicines records and staff competency.
· Staff received appropriate training and had their competency assessed periodically to ensure training had been effective.
· People told us that care staff treated them with kindness and respect and that they were kind, caring people.
· Sufficient staff were deployed to meet people's needs and people benefitted from a regular group of care staff who knew them well.
· Appropriate recruitment checks, including DBS checks, were carried out to ensure staff were of the right character and background.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
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 law
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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
responsive: Meeting people's communication needsRequires improvement
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: How the provider understands and acts on the duty of candour, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement