Annicare North is a homecare service which provides personal care to people in their own homes. It provides care to children and adults of all ages some of whom may have a learning disability or be living with dementia or a physical disability. We carried out this assessment as we had identified multiple concerns in our previous inspection, and we needed to check to see if the provider had made improvements. The assessment took place between 2 April 2025 and 13 May 2025. We visited Annicare North on 8 and 9 April 2025. We looked at all the quality statements across the 5 key questions we use to inform our assessments: safe, effective, caring, responsive and well-led. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about the services supporting people with a learning disability and autistic people and providers must have regard to it. The provider was previously in breach of the legal regulations in relation to safeguarding people from abuse, staffing and safe recruitment of staff, safe care and treatment and good governance. Improvements were found at this assessment and the provider was no longer in breach of these regulations. There were enough staff to meet people’s needs, and they were supported with appropriate training. Care was planned with people and reviewed when their needs changed. Care plans reflected people’s needs and ensured their health and well-being were promoted. Staff advocated for people to ensure they received appropriate healthcare. However, further improvements in medicine management, and ensuring the care for people at risk of developing pressure areas were needed. People were happy staff asked for consent before providing any care, but the provider had not ensured care plans fully documented when decisions to restrict people’s liberty had been made by health and social care professionals. Audits were in place to monitor the quality of care provided. They had driven the improvements since the last inspection. They ensured systems were in place to provide safe care to people. Following the inspection the provider wrote to us to inform us they were taking immediate action to resolve the concerns found
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Annicare North received a Requires Improvement rating across all five key questions at its first inspection, with enforcement warning notices issued for breaches of Regulations 12 and 17 and further breaches identified in safeguarding (Reg 13), recruitment (Reg 19), and staffing/training (Reg 18). While staff were consistently described as kind and caring and the service demonstrated strengths in infection control, end-of-life partnership working, and MCA compliance, significant failings in medicines management, risk assessment, safeguarding processes, staff training and competency, and governance systems placed people at risk of harm.
Concerns (13)
criticalMedication management: “On one occasion, the provider failed to ensure trained and competent staff were in place to support a person to receive their medicines safely.”
criticalSafeguarding: “In one incident of alleged abuse, a person sustained a significant injury while being supported with moving by staff. There was no evidence of a full investigation.”
criticalRecord keeping: “Staff members did not always have a record of their full employment history or previous employment references in place at the time of their commencement of employment.”
criticalStaff training: “4 staff members had not completed training in multiple areas, such as safeguarding. This was despite being employed at the service for over 6 months.”
criticalStaff competency: “No staff members had a recorded moving and handling competency completed and at least 7 staff members had not had a medicines competency check.”
criticalGovernance: “Quality assurance systems were not effective in identifying issues and improving the service. Medicine audits were delegated but there was not a consistent approach.”
moderateIncident learning: “There were 5 incident reports which were reviewed which did not include any actions recorded to reduce future risks.”
moderateCare planning: “Some people and relatives received a visit from office staff to assess their needs and preferences prior to the start of their care while others did not.”
moderateMissed or late visits: “The timing is not good at all. I think our 'window' is 9.30-10am, but staff have been as early as 9.15am and as late as 11am.”
moderatePerson-centred care: “[My Relative] has dementia yet we have had over 30 different carers and though they connect better with some, they struggle to cope with all the different staff.”
moderateComplaints handling: “The provider failed to respond to a relative within 21 working days of their concern, which was the timeframe outlined in the provider's complaints policy.”
moderateEnd-of-life care: “One person did not have an end-of-life care plan. Care plans also did not always include information on actions to take in the event someone deteriorated.”
minorSupervision / appraisal: “Staff had completed '1 to 1' supervisions, but these varied in quality. Relevant sections were not always filled out.”
Strengths
· Staff were kind and caring and supported people to achieve positive outcomes while maintaining their privacy and dignity.
· Staff protected people from the risk of infection and received training in infection control and PPE use.
· The provider delivered a high proportion of end-of-life care packages, working closely with healthcare agencies and charities to support dignified deaths at home.
· People's communication needs were met, including those with complex communication requirements.
· The provider worked within the principles of the Mental Capacity Act 2005.
Quality-Statement breakdown (20)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced diet
Requires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Supporting people to express their views and be involved in making decisions about their care; Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Meeting people's communication needsGood
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 candourRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement