Archived: Allied Healthcare Bridlington

The service provides personal care to people who live in their own homes in the Bridlington, Driffield Hornsea and Scarborough areas. At the time of the inspection there were 173 people receiving care and support services from Allied Healthcare Bridlington.

There was a registered manager in place who was registered with the Care Quality Commission (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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our previous inspection on 09 and 10 May 2016, we found systems and processes to manage medicines in a safe way for people were ineffective. Accurate and complete records had not been maintained and the registered provider had not robustly assessed, monitored or mitigated the risks relating to the health, safety and welfare of people using the service. This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we checked the management and administration of medicines for people who received a service and we found that actions implemented as a result of our previous inspection meant the registered provider was compliant with Regulation (12)(2) (g) and we found people’s medicines were managed and administered safely.

The registered provider had assessed, monitored or mitigated the risks relating to the health, safety and welfare of people using the service. This meant risk to individuals and the service were managed so people were protected and had their freedom supported.

During our previous inspection on 09 and 10 May 2016, we found systems and processes for the deployment and cover of care workers and the allocation of calls were ineffective and care workers often did not spend the full amount of time with a person. This was a breach of Regulation 18(1) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found the provider had implemented changes and as a result they were not in breach of Regulation 18(1). Calls were managed electronically and travel time had been introduced that helped to ensure staff had sufficient time to travel between people’s homes and could stay for the full duration of the agreed visit.

During our previous inspection on 09 and 10 May 2016, we found there was limited or sometimes no evidence to suggest people had been involved in planning or agreeing to the care and support provided. This was a breach of regulation 11(1) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found the registered provider was compliant with the previous breach of regulation 11. We found that people or their representatives had signed their agreement to the care and support they received and where one person had been unable to sign their care plan information confirmed why this was the case.

During our previous inspection on 09 and 10 May 2016, we found the registered provider did not have systems and processes in place that ensured where a person might be unable to make decisions for themselves (where they lacked mental capacity), that they had documented mental capacity assessments or a best interest decision to provide care and support. By not documenting mental capacity assessments and best interest decisions, we could not be certain that people’s rights were protected in line with the MCA.

At this inspection, we checked and found the registered provider was following legislation under the MCA. We saw that assessments of people’s capacity had been completed that recorded if people had the capacity to make their own decisions. The registered manager told us there was no one receiving a service who was being deprived of their liberty.

During our previous inspection on 09 and 10 May 2016, we found care plans were not always up to date. Information was not consistently recorded on the summary sheet and was not always reflective of people’s individual needs despite recent reviews. This was a breach of Regulation 17 (2) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found the registered provider was not in breach of Regulation 17. Care records had been reviewed and updated. A new format was being introduced that provided staff with easy to read information about people’s individual needs and preferences and staff told us they had access to written records for people.

During our previous inspection on 09 and 10 May 2016, we found audits and other quality assurance checks were in place but these checks were inconsistent and did not always bring about improvement. We found that training and deployment of staff, management of medicines and care planning were being audited but we had concerns about these areas of practice. Records for people were not always accurate or up to date. This meant that staff did not have access to up to date and complete records in respect of each person using the service, which potentially put people at risk of harm. Where surveys had been completed, actions from feedback were still outstanding and care workers and staff voiced their concerns about the overall communication within the service. This was a breach of Regulation 17 (2) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As a result of the changes implemented by the registered provider we found, during this inspection, they were not in breach of Regulation 17. The registered manager had revised the way the main office was staffed which had improved communication. Systems and processes that led to improvement were implemented and electronically managed to ensure they were effective in their purpose. Records of people’s care had been reviewed and updated and staff had access to up to date and completed records in respect of each person using the service.

People were encouraged to provide their feedback on the service they received. Regular ‘customer telephone quality reviews’ were completed and the registered manager showed us the outcome of an annual survey dated June 2016. Feedback had been analysed and actions implemented which helped to improve the service for people.

People were protected from avoidable harm and abuse. Staff had received training in safeguarding adults from abuse and systems and processes were in place to record and investigate any concerns that helped keep people safe.

Staff were recruited safely with appropriate checks and safeguards in place that helped ensure only people deemed suitable to work with vulnerable people had been employed.

We saw staff had completed induction training and other training that was provided to ensure care workers had the appropriate skills and knowledge to meet people’s individual care and support needs. Systems and processes were in place to support staff in their roles and provide them with feedback and training opportunities should they wish to progress in the organisation.

There was sufficient detailed guidance for care workers to provide people with their food likes and dislikes and their nutritional requirements.

All the people we spoke with told us they received their care and support from care workers who were caring, thoughtful and understood their individual needs. Care workers we spoke with had a caring approach with the people they supported. It was clear from our conversations that care workers worked with the same people and had a clear understanding of their needs.

People we spoke with told us they knew how to complain and who to speak with if they had any concerns. Care plans in people's homes included a welcome booklet containing information for people to use if they had concerns or needed to complain. This meant the registered provider had systems and processes in place to actively responded to concerns and compliments and that people's concerns were listened to with actions and outcomes recorded.

The service provides personal care to people who live in their own homes in the Bridlington, Driffield Hornsea and Scarborough areas. At the time of the inspection there were 208 people receiving care and support services from Allied Healthcare Bridlington.

There was a registered manager in place who was registered with the care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from abuse by care workers who had received training in safeguarding adults and understood the signs of abuse to look out for and how to report any concerns including whistleblowing if appropriate.

The registered provider undertook risk assessments to keep people and others safe whilst in their home. We saw that this information was not well documented or in sufficient detail to ensure care workers had adequate information to mitigate and manage risks to people.

Employees were recruited into the service with appropriate checks on their suitability. Care workers received a robust induction process and the registered provider put new staff through training in line with the care certificate to ensure they understood the fundamentals of delivering care and support. Mandatory training was well managed and some additional training was provided to meet people’s needs. However, we saw that care workers worked with people with specific needs and at times, they had not received appropriate training to meet those needs. Deployment of care workers and the allocation of calls meant care workers often did not spend the full amount of time with a person and arrived late. Cover provided when care workers were away was not effective for people and we saw care workers did not always understand people’s needs. This was a breach of Regulation 18(1) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

People received assistance with their medication; the amount of assistance they received was dependant on their assessed needs. Care workers received appropriate training and competency checks. The registered provider had an audit procedure to check medication was well managed. However, despite this medication was not well managed or recorded and we saw a number of errors and recordings where it was not clear if a person had received their prescribed medication. This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care workers received training in the Mental Capacity Act 2005 (MCA) during their induction and had a basic understanding of the principles. We saw the registered provider worked with the Community Mental Health team where they had concerns. Care plans identified where a person had fluctuating capacity but we saw that systems and processes that had been established by the registered provider did not contain sufficient detail regarding people's capacity to ensure care workers worked within the requirements of the Act.

The registered provider was in the process of updating care plans for people. Despite this process, we saw that care workers did not always have sufficient information available to them in care plans to provide person centred support and did not have access to important information about the person’s individual needs and preferences. The information documented was not always transposed to the summary sheets and some areas had not been completed.

Communication between people, care workers and the agency office staff was not well managed and employees raised this as a concern.

Quality assurance systems and audits were in place and feedback from people had been sought using a questionnaire. However, despite the systems in place we found that these were not always effective in driving improvement or in managing risks for people using the service and employees. This was a breach of Regulation 17 (2) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was limited or sometimes no evidence to suggest people had been involved in planning or agreeing to the care and support provided and people's ability to make decisions was not clearly recorded. This was a breach of Regulation 11 (1) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

The registered provider had an effective process and systems were in place to monitor and respond to complaints and compliments. We saw these were handled effectively and led to improvement in people’s care and support.

Communication between people, care workers and the agency office staff was not well managed and employees raised this as a concern.

Quality assurance systems and audits were in place and feedback from people had been sought using a questionnaire. However, despite the systems in place we found that these were not always effective in driving improvement or in managing risks for people using the service and employees.

We identified four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.