Ace Care Agency required improvement overall due to safeguarding concerns not being reported to the local authority, a regulatory breach for failing to submit statutory notifications to CQC, inconsistent communication with people using the service, and gaps in accident analysis and quality assurance. The service performed well in effective, caring, and responsive domains, with skilled and compassionate staff delivering person-centred care.
Concerns (8)
criticalSafeguarding: “They did not report concerns about people to the local safeguarding authority as required.”
criticalGovernance: “This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 Notification of other incidents.”
moderateMissed or late visits: “"You don't know who's coming or if they're coming. It makes me feel terrible." "If they're going to be late, they don't bother to tell you"”
moderateStaff competency: “Where information of concern was received that required further investigation or risk assessment, this had not always been completed and recorded.”
moderateIncident learning: “There was no central record of accidents and no overall analysis of these events was completed.”
moderateCommunication with families: “"No one ever comes (from the office). I've never seen anyone", "It's important to talk to someone sometimes… say what you think of things".”
minorRecord keeping: “They were not keeping a record of any complaints received verbally or informally.”
minorCare planning: “Not everyone was aware of their care plan and felt involved in its development.”
Strengths
· Staff could recognise signs of abuse and were confident in reporting and whistleblowing procedures.
· Medicines administration was well managed with MAR checks and patch rotation recording in place.
· Staff were well trained, supervised, and received regular one-to-one meetings and appraisals.
· People consistently praised the caring attitude of staff, who respected privacy, dignity, and independence.
· Mental Capacity Act assessments were completed and best-interest decisions documented appropriately.
Ace Care Agency was rated Good overall at its May 2017 inspection, with staff providing safe, caring and responsive support to 29 people in their own homes. The Well-led domain was rated Requires Improvement due to gaps in governance systems, including the absence of overarching monitoring of accidents, incidents and complaints, inconsistent completion of audit forms, and insufficient staff practice observations.
Concerns (6)
moderateGovernance: “there were still no systems in place to monitor accidents, incidents and complaints.”
moderateIncident learning: “the registered manager acknowledged they did not keep any overarching record which would identify trends or patterns in the types of concerns”
moderateRecord keeping: “one person's moving and handling risk assessment had not been dated or signed. We also found one person's medicines assessment was out of date.”
moderateGovernance: “no action plan had been put into place to show how the registered manager would address this identified action.”
minorSupervision / appraisal: “the registered manager told us these [six monthly observations of practice] had not been completed as often as they would have liked.”
minorMissed or late visits: “They are supposed to be here 7.15am, but this occasion it was nearly 9am and no one rang to let me know.”
Strengths
· People felt safe with staff and risks were assessed with plans in place to minimise harm.
· Staff completed appropriate pre-employment checks including DBS and references.
· Staff received training including medication support, MCA, and manual handling.
· People were supported by regular, familiar staff enabling positive relationships and continuity of care.
· People's dignity, privacy and independence were respected by staff.
Ace Care Agency is a small domiciliary care provider rated Good across all five key questions at the November 2019 inspection, with well-led improving from Requires Improvement at the previous inspection. Minor gaps in care plan detail and absence of end-of-life preferences were identified but promptly addressed by the registered manager during the inspection visit.
Concerns (3)
minorCare planning: “We identified one care plans that did not contain enough detail in relation to a person's care needs and associated risks.”
minorEnd-of-life care: “People's end of life wishes, and preferences were not recorded in their care plans. We discussed this with the registered manager who said he would explore this with people.”
minorRecord keeping: “We identified one gap in one staff members employment history, this was addressed during our visit by the general manager.”
Strengths
· New quality monitoring systems put in place by the registered manager were working effectively.
· People felt safe and staff demonstrated good knowledge of safeguarding processes.
· Medicines were managed safely and in line with good practice guidance.
· Staff treated people with kindness, compassion, dignity and respect, with a strong person-centred culture.
· Well-led improvement from 'Requires improvement' to 'Good' since last inspection.