Ashley Care is a domiciliary care agency, at the time of our assessment they were supporting approximately 150 people with a regulated activity. The assessment took place from the 23 April to the 24 April 2024. The assessment was completed to follow up on the last inspection to see if improvements had been made. We found improvements had been made at the service since they had been taken over by a new provider. There was a strong management and governance structure in place and staff were supported with the skills they needed to care for people.
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Ashley Care, a domiciliary care service in Southend-on-Sea, received an overall rating of Requires Improvement following a focused inspection in September 2022, having improved from Inadequate. While significant progress was made on staffing and safe care, a continued breach of Regulation 17 (Good Governance) was identified due to ineffective quality monitoring systems failing to address persistent late call delivery and inadequate oversight of care scheduling.
Concerns (7)
criticalGovernance: “We were not assured the current governance arrangements were robust enough and effective in identifying or taking action with regard to staffing shortfalls and issues with the deployment of staff.”
moderateMissed or late visits: “From 01 September 2022 to 22 September, people's care visits were not delivered at the time they were scheduled.”
moderateMissed or late visits: “The majority of their morning calls were carried out between 7am and 8am instead of 8am and 9am. The majority of their lunch time calls were between 11am and 12pm instead of 12pm to 1pm.”
moderateMedication management: “For one person, staff removed medicines and left on their table for person, this is recorded as 'medication to be prompted', then in their 'All about me' document, states...medication to be administered.”
moderateStaffing levels: “On the days their regular carer(s) were off, the timing of their visits became erratic particularly at the weekend. One relative told us, 'weekend people are often the office staff and they are just in and out.'”
moderateRecord keeping: “The auditing process had failed to identify people were not receiving their care calls at their scheduled time as stated in their care plan and where improvement was needed.”
minorCare planning: “One person who had a catheter in situ had a generic catheter care leaflet in their care plan...with no guidance as to what assistance was required.”
Strengths
· Significant improvements made since last inspection; service exited Special Measures and is no longer rated Inadequate overall.
· Safe recruitment practices in place including references and DBS checks.
· Risks to people were assessed, recorded and reviewed.
· Effective infection prevention and control measures in place with adequate PPE supply.
· Staff understood safeguarding responsibilities and how to report abuse.
Ashley Care was rated Inadequate overall and placed in special measures following continued breaches of Regulations 12, 17 and 18, with widespread missed and late calls, inadequate risk assessments, gaps in COVID-19/infection control training and ineffective governance. A previous Warning Notice on good governance had not been complied with, although some improvements were noted in medicines records and recruitment.
Concerns (17)
criticalMissed or late visits: “Clients have been left without calls or their medication.”
criticalMissed or late visits: “The timesheets for one person demonstrated 36 occasions over a 47 day period whereby staff did not stay for the required time they should.”
criticalCare planning: “Risks relating to people's health and wellbeing, for example where a person had a catheter or stoma fitted...had not been considered or recorded.”
criticalStaffing levels: “We are so short staffed, that's why everyone is getting late and missed calls.”
criticalInfection control: “Staff told us they had not always been made aware where people using the service had tested positive for COVID-19.”
criticalGovernance: “The quality assurance and governance arrangements in place were not reliable or effective in identifying shortfalls in the service.”
criticalLeadership: “widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalOther: “the provider had failed to notify the Care Quality Commission without delay of incidents...seven safeguarding adult concern forms had been raised...but a statutory notification was not submitted.”
moderateStaff training: “Not all staff had up to date mandatory training, with many courses seemingly completed over a one or two-day period.”
moderateStaff competency: “Not all staff had been trained to provide safe catheter and stoma care.”
moderateInfection control: “Not all staff had received specific training relating to COVID-19 or 'donning and doffing'.”
moderateMedication management: “Where people continuously refused their medication, records did not show that staff had taken any action in response to this such as referring this to a healthcare professional.”
moderateIncident learning: “When things go wrong, lessons were not always learned to support improvement, and this was evident from our findings at this inspection.”
moderateCommunication with families: “people told us they were not always contacted by Ashley Care if staff were running late or where there was a change of carer.”
moderateSafeguarding: “Where safeguarding concerns were raised, and an internal investigation undertaken, not all investigations completed by the registered manager were robust.”
moderateRecord keeping: “the risk assessments for three people recorded these were last completed in October 2019, December 2019 and August 2020.”
moderatePerson-centred care: “People told us their care could be rushed and meant staff did not have the time to chat with them.”
Strengths
· Improvements noted relating to some aspects of medicines management and completion of MAR charts
· Improvements in staff recruitment practices, no longer in breach of that element of Regulation 18
· Staff had a good understanding of safeguarding and how to escalate concerns
· Staff had sufficient supplies of PPE and were observed using it effectively by people and relatives
· Service was working in partnership with the Local Authority and other healthcare professionals
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and management; Using medicines safely; Preventing and controlling infectionInadequate
safe: Staffing and recruitmentInadequate
safe: Learning lessons when things go wrongInadequate
safe: Systems and processes to safeguard people from the risk of abuseNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Continuous learning and improving care; Duty of candourInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate