Date of assessment: 29 September to 31 October 2025. Anco Care Limited is a domiciliary care agency providing personal care to people living in their own homes, including those with complex health needs, learning disabilities, autism, dementia, and physical disabilities. At the time of inspection three people were receiving care and support from the agency. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. An assessment has been undertaken of a specialist service that is registered for use by autistic people or people with a learning disability. At the time of the assessment, the service was not used by anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. This assessment was undertaken to follow up on concerns found at the last inspection which led to an overall rating of Inadequate being awarded. At the last assessment we reviewed all the quality statements in the key questions of Safe and Well-Led. However, we could not review all the evidence categories under each quality statement due to there being insufficient evidence available. The scores for the areas we were able to assess were combined with scores based on the rating from the last inspection, which was Inadequate. Though the assessment indicated areas of improvement since the last inspection, our rating for the key questions remained Inadequate. This assessment was comprehensive covering all the quality statements, we found the improvements seen at the last assessment had been sustained and the service has been rated Good overall. The registered manager had robust oversight of key areas such as care documentation, recruitment and people’s care calls. There were appropriate systems to monitor the service, to provide a clear oversight of risk and to improve outcomes for people. The registered manager ensured consistent staff attended care calls at the time they were expected, people were kept informed of any necessary changes to their call times. Staff had appropriate knowledge and skills to undertake their job roles and felt listened to and supported by the registered manager. The registered manager and staff understood their duty and roles in safeguarding people from the risk of harm or abuse. Staff followed infection prevention and control procedures. People’s dietary needs were well supported. Medicines were not always safely managed, the registered manager took action to make improvements where required. There had not been any safeguarding concerns, accidents or incidents, transitions between services or equipment/environment concerns to test out some of these processes. However, clear systems were in place to manage such incidents, and the registered manager and staff were able to explain how these would be deployed in practice. This service has been in Special Measures since 5 May 2023. The provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
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Anco Care Limited received an overall Inadequate rating following a focused inspection in June 2023, with continued breaches of Regulations 12 and 17 relating to unsafe medicines management, unassessed risks, ineffective safeguarding processes, and persistently failed governance — the fifth consecutive Inadequate rating for well-led since 2019. While staff were described as caring and reliable by people and relatives, the provider could not assure safe care delivery due to systemic failures in oversight, record-keeping, and quality assurance, resulting in the service remaining in Special Measures.
Concerns (11)
criticalMedication management: “No recording of 1 person's medicines administration took place and at the time of inspection staff administered their medicines 3 times per day.”
criticalMedication management: “One person was prescribed morphine, a strong pain killer, but there was no guidance for staff to ensure it was given correctly and safely.”
criticalGovernance: “Under this provider, this is the fifth occasion a rating of 'Inadequate' has been awarded in the key question of 'well-led' since 2019.”
criticalSafeguarding: “Due to a miscommunication care staff had not visited to support a person with their morning routine...but the local authority were not notified.”
criticalCare planning: “Some people were at increased risk of choking, pressure wounds or falls and there were no risk assessments in place.”
criticalIncident learning: “Accident and incident reporting processes were not always effective. There was no record of some incidents.”
criticalConsent / capacity: “Documentation put in place was not completed fully or effectively...People remained at risk of having decisions made which were not in their best interests.”
criticalRecord keeping: “MAR being completed on days which didn't exist, for example 29th to 31 February, or being signed by staff who were different to those on shift.”
moderateStaff training: “Records of staff training contained gaps and were undated so there was no easy reference system to know whether training remained in date or had lapsed.”
moderatePerson-centred care: “People's care records did not contain detailed information about their routines, needs and day to day preferences.”
moderateLeadership: “The registered manager was also the nominated individual and provider...there were no other persons involved or accountable for strengthening the oversight.”
Strengths
· Safe recruitment practices were followed, ensuring staff had the right character and experience.
· Staff were reliable, usually arrived on time and stayed for the full length of the scheduled visit.
· Staff used PPE such as masks and aprons to reduce the risk of infection spread.
· People and relatives reported staff were caring, kind, attentive and treated people with dignity and respect.
· Staff worked effectively with health and social care professionals including district nurses and GPs.
Quality-Statement breakdown (18)
safe: Using medicines safelyInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Learning lessons when things go wrongInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
Date of assessment 3 June 2024 to 13 June 2024. This assessment was undertaken to follow up on concerns found at the last inspection which led to an overall rating of Inadequate being awarded. We reviewed all of the quality statements in the key questions of Safe and Well-Led. However, we could not review all of the evidence categories under each quality statement due to there being insufficient evidence available. The scores for the areas we were able to assess have been combined with scores based on the rating from the last inspection, which was Inadequate. Though the assessment indicated areas of improvement since the last inspection, our rating for the key questions remains inadequate. A new registered manager started in December 2023. One person recently started to receive support and their care needs were limited. They provided brief feedback, which was positive. There was 1 member of staff who undertook all care visits who was also the company director. This meant there was limited evidence available for us to gather and base our judgement on. There was now a range of risk assessments in place to support the provision of safe care. Medicines support started recently so processes needed to be embedded. New documentation, processes and audits had been introduced by the registered manager. There had not been any safeguarding concerns, accidents or incidents, transitions between services or equipment/environment concerns to test out some of these processes. This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.
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Anco Care Limited, a small domiciliary care agency in Milton Keynes, has been placed in special measures after a fifth consecutive 'Requires Improvement' rating, with breaches of Regulation 12 (medicines management) and Regulation 17 (governance) identified. While people and families reported positive experiences of care delivery, significant failures in MAR completion, MCA documentation, incident recording, and leadership oversight undermined safety and governance.
Concerns (8)
criticalMedication management: “MARs submitted to CQC did not detail the level of support a person required or the role of staff. This meant we could not be sure the medicine had been administered safely.”
criticalMedication management: “Information in relation to allergies was also missing from the MARs. The provider's own policy stated the records must be written clearly, with known allergies identified.”
criticalGovernance: “Systems and processes had not been operated to ensure robust governance and oversight of the service. This was a breach of Regulation 17 (1).”
criticalConsent / capacity: “We could not be assured that a best interest decision had been taken or that an MCA assessment was in place for the use of bedrails at night for a person whose capacity fluctuated.”
moderateRecord keeping: “One person's moving and handling risk assessment stated the person was independent on one page, when in fact the person was unable to mobilise independently.”
moderateIncident learning: “The process for the reporting and the following up of accidents or incidents was not always clear...actions taken and follow up actions were not being recorded on these.”
moderateLeadership: “The registered manager, who was also the provider told us they had been focusing on providing hands on care to people...This had led to a lack of oversight of the service.”
minorSupervision / appraisal: “Staff had received supervision, though this had been sporadic. The registered manager said there was only a small number of staff and they all worked together.”
Strengths
· Sufficient staffing in place; person and relatives confirmed staff were always punctual and never rushed care.
· Staff recruited safely with all required checks including DBS.
· Staff trained in safeguarding procedures and knew what action to take to protect people from harm.
· Effective infection control practices with consistent PPE use reported by all.
· Positive feedback from people and relatives about the kind and caring approach of staff.
Quality-Statement breakdown (15)
safe: Using medicines safelyRequires improvement
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: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement