This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of our assessment 4 people were using the service. Date of assessment: 26 November to 6 December 2024. This was an ‘assessment using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment. The rating at the last inspection was requires improvement (published 11 October 2023). At the last inspection, we identified breaches of regulations relating to person-centred care and good governance. At this assessment, we found there had been improvements and the provider was no longer breaching any regulations. The rating for this service has changed to good. We found people received safe care. Risks to their safety and wellbeing had been assessed and planned for. People received their medicines safely and as prescribed. There were enough suitable staff, and they had the training and support they needed to care for people well. People’s needs and choices were assessed so that care could be planned in a person-centred way. People consented to their care and treatment. The staff worked closely with other professionals to help make sure people’s needs were met. People were cared for by kind and supportive staff. There were effective systems for monitoring and improving the quality of the service.
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Aniis Care remains rated Requires Improvement overall for the fourth consecutive inspection, with enforcement conditions imposed for breaches of Regulation 9 (person-centred care) and Regulation 17 (good governance) due to insufficiently detailed and inaccurate care plans and ineffective quality monitoring systems. Caring was rated Good, reflecting kind and respectful staff, while medicines management, safeguarding and infection control showed meaningful improvement since the previous inspection.
Concerns (6)
criticalCare planning: “a person's risk management plans stated they required 2 staff to support them to mobilise safely, but the registered manager informed us this care was only in January 2023.”
criticalPerson-centred care: “Some people's care plans did not always provide appropriately detailed information about the care or support they required.”
criticalGovernance: “this system of checks had not been consistently effective as it had not identified and addressed the issues we found during this inspection.”
moderateCommunication with families: “a person's plan noted they were hard of hearing, wore spectacles and 'slightly blind' in one eye, but in order to meet their communication needs only stated, 'Care workers will visit me 4 times a day'”
moderateMissed or late visits: “a relative said, 'There have been occasions when the staff are running very late and we don't know if they will be coming and I have had to phone … They don't always let us know'”
moderateRecord keeping: “Records of another person's care plan review in February 2023 stated the person was 'bed-bound' with no mobility equipment in place, while also noting they needed support to mobilise with a walking frame.”
Strengths
· Medicines managed appropriately with MAR audits and staff competency assessments in place.
· Staff treated people with dignity, respect and kindness; people spoke highly of individual carers.
· Recruitment processes improved and no longer in breach of Regulation 19.
· Safeguarding awareness training in place; staff understood how to recognise and report abuse.
· Incident and accident recording improved with learning reviews implemented.
Quality-Statement breakdown (15)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
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 preferences; Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
Aniis Care made improvements since the last inspection, with effective and caring ratings improving to Good and previous breaches of regulations 9, 11, 12 and 13 no longer in place. However, the provider remained in breach of Regulation 17 (Good Governance) due to ineffective quality monitoring systems that failed to identify gaps in personalised care planning, communication needs and end-of-life care discussions.
Concerns (8)
criticalGovernance: “The registered person did not always effectively operate systems and processes to assess, monitor and improve the quality of the service and to assess, monitor and mitigate risk”
moderateCare planning: “Some people's care plans had not been updated to provide personalised information about their preferences for how they liked to be supported.”
moderatePerson-centred care: “One person's care plan stated they needed support with bathing and dressing but there was no information about their bathing or personal grooming preferences.”
moderateCommunication with families: “One person's care plan stated they were hearing impaired and used hearing aids. However, there continued to be no direction in the plan for staff on making sure the person wore their aids or how best to communicate with the person.”
moderateEnd-of-life care: “the registered manager stated staff had offered to discuss this with some people but we still found there was no record kept of this.”
minorCare planning: “a person's plan did not include guidance on how to recognise if they were becoming unwell due to their identified health condition.”
minorMissed or late visits: “the provider still did not have a formal system for recording and reviewing missed or late care visits to identify and reduce the frequency of these”
minorStaff competency: “the provider noted that some of these assessments were overdue as a result of managing the service through the COVID-19 pandemic.”
Strengths
· People and relatives reported feeling safe and that staff were caring, kind and respectful
· Improvements made to risk management and medicines administration; MARs completed appropriately and audited
· Safe recruitment processes including DBS checks and references
· Staff received training, periodic supervision and annual appraisals and felt supported
· Good infection prevention and control arrangements with adequate PPE during COVID-19
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Aniis Care was rated Requires Improvement overall following a focused inspection that found breaches of regulations 12, 17 and 19 covering unsafe medicines management, inadequate risk assessment, recruitment failings and ineffective governance. A Warning Notice was issued for the repeated breach of good governance, and people reported rushed, late and sometimes uncaring visits.
Concerns (10)
criticalMedication management: “there was no information about what medicines staff helped the person to take and no medicines administration records (MARs) to show that staff had supported the person to take them as prescribed.”
criticalCare planning: “there was no assessment in the person's risk management plans of how the risks associated with these conditions affected them.”
criticalStaff competency: “the provider had not recorded obtaining or seeking to obtain any references from the applicant's previous employers.”
criticalGovernance: “this system of checks had not been consistently effective as it had not identified and addressed the issues we found during this inspection.”
moderateIncident learning: “the manager reported they had not considered reviewing the person's risk management plans in response to these incidents to consider if their care needs had changed.”
moderateInfection control: “The provider had not completed COVID-19 risk assessments for all the people whose care records we saw.”
moderateMissed or late visits: “Most people and relatives told us they experienced late or variable care visits.”
moderatePerson-centred care: “The only criticism I've got is they wash me down as if I'm in a car wash. They're very firm but ease back if I tell them.”
moderateRecord keeping: “some of the records we saw were not always clear and legible about what care was provided.”
minorComplaints handling: “I'm not so sure if I'd recommend the company due to the way they dealt with my complaint.”
Strengths
· Staff completed training on how to provide medicines support safely and spot-checks were conducted in people's homes.
· Safeguarding policies and processes were in place and staff knew how to respond to concerns.
· Staff felt supported by managers who were always available to them.
· The provider supplied staff with PPE and gave training on infection prevention and control.
· The service worked in partnership with other health and social care agencies to provide joined-up care.
Quality-Statement breakdown (11)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Preventing and controlling infection; Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk from abuseGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
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Not rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcareNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care; End of life care and supportNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Managers and staff being clear about their roles; understanding quality performance, risks and regulatory requirements; continuous learning; duty of candourNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving care; Duty of candour
Requires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement