Amicable Care Ltd is a domiciliary care service providing personal care to adults, including people with dementia or physical disabilities. At the time of this assessment, the service supported 26 people of whom 14 received support with personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Dates of assessment 7 November to 4 December 2024. We used an Expert by Experience to get feedback from people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The assessment was undertaken in response to the previous rating and breaches of regulation. The service has been rated requires improvement following this assessment. We found a continuing breach of regulation relating to good governance. We have asked the provider for an action plan in response to the shortfalls found at this assessment. The provider’s quality assurance systems were still not fully effective at identifying and addressing issues. For example, care records did not always contain sufficient detail about people’s individual needs, and this had not been addressed by the provider. The provider was not always effective in recording potential risks to people or how to mitigate them. There had been some improvements to medicines management, but other issues were still ongoing so further and sustained improvement was needed. Staff said they felt supported and valued by the provider. Improvements had been made to recruitment, supervision and communication processes for staff. This service has been in special measures since 18 November 2023. During this assessment the provider demonstrated that some 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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Amicable Care Ltd was rated Inadequate overall following a June–July 2023 inspection, with two regulatory breaches issued as warning notices covering unsafe medicines management (Regulation 12) and systemic governance failures (Regulation 17). Critical shortfalls were identified across risk assessment, incident recording, recruitment checks, and care planning, placing the service in special measures despite positive feedback from people about staff compassion and infection control.
Concerns (13)
criticalMedication management: “Medicines administration charts showed gaps in medication, did not always demonstrate complete courses of medications had been given and amendments were not always signed and dated.”
criticalGovernance: “An effective system was not in place to monitor and manage the quality and safety of the service and ensure regulatory requirements were met.”
criticalSafeguarding: “The provider did not have an effective system to record and investigate safeguarding issues.”
criticalIncident learning: “Systems to monitor accidents and incidents were not effective and did not promote learning. Incidents were not always recorded.”
criticalRecord keeping: “Management audits had not taken place and the provider did not have a robust system to identify errors and omissions in records.”
criticalStaffing levels: “References, qualifications and employment histories were not always requested by the provider prior to applicants starting work.”
moderateStaff competency: “An effective system was not fully in place to demonstrate all staff were competent to administer medication and monitor completion of other training.”
moderateStaff training: “Quality assurance processes did not always record whether some staff were competent to administer medication and other training they had undertaken.”
moderateSupervision / appraisal: “Staff were receiving supervision on a regular basis. However, staff did not receive an appraisal in line with the provider's appraisal policy.”
moderateCare planning: “Care plans were not completed in a way which promoted person centred care. The provider did not ensure care plans included enough information about people's needs.”
moderateMissed or late visits: “One told us, 'There's been a couple of times when nobody has turned up, because she was accidentally missed off the rota.'”
moderateConsent / capacity: “Information about people's consent to care and how this was gained was not fully recorded. Records did not always evidence a relative's legal status.”
moderatePerson-centred care: “People and their family members were not consistently involved in their care planning. Some people's care had not been reviewed for over 18 months.”
Strengths
· People felt safe and were positive about the care delivered; one person said 'I like the carers I get and feel very safe with no worries.'
· Staff maintained good infection prevention and control practices; relatives confirmed PPE use and hygiene standards.
· Continuity of care was maintained with regular small staff teams familiar with people's needs.
· Staff showed compassion and at times went above and beyond; people noted dignity and respect were upheld.
· The service worked alongside other health and social care professionals involved in people's care.
Quality-Statement breakdown (17)
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people; assessing risk, safety monitoring and management; learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionsGood
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
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
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: Meeting people's communication needsGood
well-led: Managers and staff being clear about their roles; understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood