AM-R-AZ LLP, a domiciliary care agency supporting 11 people, was rated Requires Improvement overall following a focused inspection in January 2023, with breaches of Regulations 12 and 17 identified in relation to unsafe medicines management, inadequate risk assessments, insufficient staff training, and ineffective governance systems. Caring and Responsive were not inspected and retained prior Good ratings from 2019.
Concerns (15)
criticalMedication management — “staff had started giving a person their 'as required' [PRN] medicine twice a day. The registered manager told us this was at the GP request. However, the GP had not changed the prescription”
critical
Medication management
— “PRN protocols were not always in place or did not contain the necessary information staff required to ensure people received PRN medicines as prescribed.”
criticalCare planning — “Care plans did not always contain sufficient information about people's health conditions. We found no information recorded when people had a diagnosis of epilepsy or multiple sclerosis.”
criticalStaff training — “AM-R-AZ LLP is registered to provide care to people with a learning disability and who are autistic; however, not all staff had received training in learning disabilities.”
criticalGovernance — “Systems and processes in place to audit medicine records were not effective in identifying the concerns we found on inspection regarding incorrect and missing information.”
criticalSafeguarding — “The registered manager told us of issues they were having with district nurses requesting staff completed tasks they were not trained to do. The registered manager had not submitted any safeguarding notifications.”
moderateCare planning — “staff told us care plans were not always kept up to date. One staff member told us, 'We have been asking them to change and update [person's] care plan as it does not contain the correct tasks'”
moderateStaff training — “All our training is online. I haven't had practical face to face training in manual handling or basic life support/first aid training.”
moderateStaff competency — “Agency staff don't know me. They can't always use the hoist and they don't always have the experience.”
moderateGovernance — “People, relatives and staff told us they were not asked for feedback on the service. One person said, 'I have never been asked.'”
moderateSupervision / appraisal — “Staff told us they did not have any 1:1 time to discuss concerns or issues.”
moderateRecord keeping — “Not all people and relatives had seen their care plan. One relative told us, 'We have been asking for a copy of the care plan for ages, we still have not seen it.'”
moderateConsent / capacity — “When the provider completed mental capacity assessments and assessed a person lacked the capacity to make a specific decision a best interest decision had not always been recorded.”
moderatePerson-centred care — “during these observations an additional member of staff watched other staff give personal care to people. This was not in line with least restrictive options or maintaining people's dignity.”
minorIncident learning — “Staff were not offered regular staff meetings to discuss any concerns, improvements or lessons learnt.”
Strengths
· Staff were recruited safely with DBS checks and references from previous employers completed before starting work.
· Effective infection prevention and control measures were in place; staff used PPE effectively and safely.
· Staff received safeguarding training and knew how to recognise and report abuse, including to external agencies.
· Care plans included protected characteristics such as pronouns, religion, culture and preferred gender of staff.
· People were supported to maintain a healthy diet and adequate fluid intake with nutrition and hydration records in place.
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: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candourGood