Archived: Allcare Nurses Agency Limited

The service were last inspected on the 16 August 2014 when they met all the regulations we inspected.

The service did not have a registered manager. The current manager had applied to the Care Quality Commission (CQC) to become registered and was awaiting an interview. A service cannot be judged as good in this domain if there is no manager registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were aware of and had been trained in safeguarding procedures to help protect the health and welfare of people who used the service.

Risk assessments for health needs or environmental hazards helped protect the health and welfare of people who used the service but did not restrict their lifestyles.

Plans of care were individual to each person and showed staff had taken account of their wishes. Plans of care were regularly reviewed.

People who used the service had complex needs and staff were trained in how to support each individual. We saw details in the plans of care for how staff should support people to take sufficient food and fluids.

People who used the service had access to a range of activities they enjoyed and included exercise to keep healthy.

The agency asked for people’s views around how the service was performing and we saw evidence that the manager responded to their views.

There was a suitable complaints procedure for people to voice their concerns. There had not been any major concerns since the last inspection.

We observed a good rapport between people who used the service and staff. We saw that staff appeared to know people well and understand their needs. This included the complex communication needs of people who used this service.

Staff were recruited using current guidelines to help minimise the risk of abuse to people who used the service.

Staff were trained in medicines administration and supported people to take their medicines if it was a part of their care package. Some staff received training to give medicines for epilepsy when required.

Staff received an induction and were supported when they commenced work to become competent to work with vulnerable people. Staff were well trained and supervised to feel confident within their roles. Staff were encouraged to take further training in health and social care topics.

Management conducted audits to ensure the service was performing well or devised an action plan for any area they found lacking.

The office was suitable for providing a domiciliary care service and was staffed during office hours and there was an on call service for people to contact out of normal working hours.

People who used the service thought managers were accessible and available to talk to.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The registered manager audited any incidents and used the information to improve the service. This reduced the risks to people and helped the service to continually improve. One person who used the service said, "I have no complaints and feel able to make it very clear if I had any worries". A family member said, "There were a few problems when we first started using the service like there always is but they responded well and the service is now very good".

The care agency had proper policies and procedures in relation to the Mental Capacity Act (2005). Staff had been suitably trained to meet the needs of individuals with mental health problems or dementia..

We looked at staff files and saw that people were recruited safely. Suitable checks had been made prior to new staff working at the home. This helped ensure suitable staff were employed at the care agency to work with children and adults.

We saw that the electrical equipment had been serviced and maintained in the office. There was a system for any equipment used by people who used service to be maintained or repaired. The fire system was checked regularly and fire extinguishers were serviced to keep them in good working order.

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in developing their plans of care. One person who used the service told us, "They talk to me regularly about my care although I don't feel I need to read the care plan again". A family member said, "I read the care plan every day and would let them know if it was not accurate. We have regular meetings to discuss how things are going".

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as specialist feeding equipment or mobility aids.

The manager and other key staff audited the effectiveness of the systems they used. This included care plans and spot checks to assess the competence of staff and the care they gave. The information was used to improve the service.

Staff were trained in all the mandatory topics such as health and safety, infection control, fire safety, food hygiene, medication administration, first aid, mental capacity, deprivation of liberties and moving and handling. There were other training opportunities in care specific to each person such as for epilepsy or special feeding needs.

Was the service caring?

People were supported by kind and attentive staff. One person who used the service told us, "The staff are pleasant and because I get the same staff I now know them. They go to great efforts to ensure I am well looked after". A family member said, "I have a good relationship with staff and think they are very good. I think they are well trained".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

Was the service responsive?

People completed a range of activities with support from the service regularly. Each person's known likes and dislikes were recorded and their possible limitations in attending some activities. Risk assessments protected people from possible harm when using transport, going out and attending events or school.

The registered manager or senior staff held regular meetings with people who used the service and staff. Meetings were held which included all relevant professionals. We looked at the results from quality assurance surveys which were positive and included comments such as, "Overall care is brilliant and I am really happy with the care package and nurses provided for my son", I have no problems with the service provided. Thank you" and "You provide an excellent service". Where comments were not as positive like "We should be told about any staff inductions with our child and we should be asked after the induction if it is OK for them to come again" the registered manager changed the system to be more acceptable.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way by working together when necessary. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the registered manager. The records were stored securely and readily available for inspection.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

They told us their care workers provided sensitive and flexible support and they were well cared for. A person spoken with told us, 'They are very good. They let me do what I can and they are very patient with me'.

We looked at three support plans. We saw records in place to ensure their consent was gained in relation to the care provided. People told us, 'They always ask me what I want' and 'We have to sign to agree to the service they provide'.

People told us they had no concerns about the care being provided and they felt safe and protected from potential harm. One person told us, 'They always make sure I'm safe and well. I have their number in case of an emergency'.

We looked at staff records and saw evidence they had received supervision and were provided with training relevant to their role. People spoken with said, 'The staff do a very good job' and 'They are very well mannered'.

We found risk assessments that were required to be kept to protect the safety and wellbeing of people were accurate and up to date to ensure people's needs were fully met.

We noted that the agency policies and procedures had not been reviewed since our last inspection. These procedures are required to ensure good working practices and protect people who may be at risk.