Archived: Allied Healthcare Leicester

Allied Healthcare Leicester is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

At the time of our inspection there were 70 people using the service, who resided within Leicestershire. The provider had a contract with Leicestershire commissioners to provide a service as part of the local authorities ‘Help to Live at Home’ strategy.

Allied Healthcare Leicester had a registered manager. 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.

This is the second time the service has been rated Requires Improvement.

People and family members we spoke with raised concerns as to the time keeping, continuity of care, poor communication and poor assessment systems of their needs. Some conversations reflected people’s concerns as to their experience of commissioners who referred them, which included when being discharged from hospital and the commencement of support packages by Allied Healthcare – Leicester.

The Provider Information Return (PIR) and our discussions with staff in a range of roles within the service identified improvements were needed. This included the recruitment of staff along with improvements to the reliability of the service to ensure people’s needs were met and that they experienced positive outcomes.

Systems to assess risk did not cover all potential areas. Environmental risks external and internal to people’s homes were not considered and therefore steps to minimise risk were not put into place. Assessments identifying potential risk in the delivery of people’s care had been undertaken and information provided within people’s records were in place, which was adhered to by staff.

People using the service and family members said they felt safe when staff were assisting them. Systems were in place, which were understood by staff that were aware of their responsibility in reporting any potential concerns, which may affect a person’s health of welfare.

People received the support they needed in taking their medicine and where people were unwell, staff liaised with health care professionals on their behalf. Staff supported people in the shopping of groceries, and the preparation of meals where required. People in the main spoke positively about the attitude and approach of staff, stating their privacy and dignity was respected.

People using the service and family members spoke of a shortage of staff, which meant they could not rely upon the service to meet their needs in a timely manner. People told us staff did not arrive at the agreed time and that in some instances staff failed to arrive. Staff we spoke with stated there was insufficient staff to meet the needs of people. People using the service and family members told us the weekly rotas they were provided with, which detailed the name of the member of staff who would be providing their care and the time they were scheduled to arrive could not be relied upon.

The process for the assessment and referral of people to the service were not regularly applied, which meant people experienced a service that was not consistent with their expectations and wishes. People using the service and family members expressed concern as to the assessment of their needs when undertaken by commissioners, as the assessment did not always accurately the service they received. Representatives of the service said assessments were not always provided by commissioners to them in a timely manner prior to a person commencing the service.

People told us they were supported to have maximum choice and control, some people told us how receiving the service meant they were able to remain at home, whilst others said it helped them to maintain their independence. The policies and systems in the service supported this practice.

People’s involvement and understanding of the system to contribute to the development and reviewing of their care plan was mixed. The care plans we viewed provided information as to people’s needs and had been signed by the person or a family member. People expressed dissatisfaction with the service they received, as it did not meet their needs. The main concerns for people were the unreliability of the service, with people experiencing late or sometimes missed calls. People also raised concerns as to the frequent changes in the staff that cared for them.

People were aware of how to make a complaint and told us they were confident to do so. A number of complaints had been made about the service, a significant number were related to missed or late calls. People told us they had raised concerns, some people were satisfied and had noted improvements; whilst others said, they had not noted any changes to their care because of issues raised.

There was a governance structure in place, which meant people from a range of departments within the organisation held key areas of responsibility. Meetings were regularly held across all departments and action plans were developed to improve the services. However, people continued to experience late or missed calls.

People’s views about the service were sought by the provider. There was a system for collating people’s views; however, the outcome of consultation and any action proposed to address people’s concerns was not shared with them. People expressed concerns about poor communication from staff based in the office and raised concerns about the day-to-day management of the service and its effect on the care they received.

Staff told us they did not believe their work was valued by the service, but they felt people using the service appreciated their care and support. Staff were frustrated that they could not influence the service provided to people. Systems were in place to regularly meet with staff, which included staff meetings, and on-going assessment of staff performance through supervision and training. The provider had consulted with staff and as a result had developed an action plan to address the issues they had raised.

We identified the provider was in breach of four of the Regulations 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.

At the time of our inspection there were 55 people using the service, who resided within Leicestershire. People receiving a service at the time of our inspection had recently transferred from other domiciliary care providers as part of Leicestershire local authorities ‘Help to Live at Home’ strategy and had been receiving a service from Allied Healthcare for four weeks. This inspection has focused on this four week period of time.

There were twelve staff employed to provide personal care and support to people, some of whom had transferred from other domiciliary care providers when people who used the service had moved to Allied Healthcare Leicester.

The service had a registered manager. 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.

Safety and welfare of people had been risk assessed, however the documentation detailing the areas considered and how the outcome had been arrived at were not in place. The information available to staff on how to mitigate risk was limited, which had the potential for people’s care and support not to be provided in a way that promoted their safety.

People’s safety and welfare was promoted by staff that understood and had received training on their role in protecting people from potential harm and abuse. People using the service had been provided within information, to raise their awareness about the types of abuse, and how abuse may affect them and what action they could take.

Staff recruited by the Allied Healthcare had their application and references validated and were checked as to their suitability to work with people, which enabled the provider to make an informed decision as to their employment. We found staff recruitment records for staff that had transferred their employment from other domiciliary care agencies did not contain all the relevant information. This meant the provider could not be confident that people were safe as robust employment checks could not be evidenced.

The provider was in the process of recruiting staff to provide personal care and support and in the interim was using agency staff to ensure there were sufficient staff to meet people’s needs safely.

Staff underwent a period of induction and training, and staff that had transferred their employment had been scheduled to undertake training so that the provider could be confident that all staff had received training. Records showed staff had their competency to undertake personal care and support assessed, which was confirmed by staff we spoke with.

People’s agreement and involvement in their care and support had been sought. People’s care plans had been signed by them or their representative, such as a family member to record their involvement in its contents. People’s records included signed agreements by them or their representative consenting to their consent to care and support, which included the sharing of information about them with other professionals, to promote their health, safety and well-being.

People we spoke with were in the main positive about the attitude and approach of staff, telling us staff were caring and attentive. People commented they had found it difficult to develop relationships with the staff, as they were not being supported by a consistent group of staff. People were aware that agency staff were being used and this was a contributory factor which impacted on the consistent approach to the care and support they received.

Information about people’s care and support needs had been shared between the domiciliary care agencies involved in people’s care, and had involved representatives of staff from commissioners within Leicestershire, local authority. Those involved confirmed the process of transferring domiciliary care providers had been challenging, which had impacted on people’s care and support.

People had and continued to experience missed or late calls, which was acknowledged by the registered manager. People told us they had noted improvements, which had had a positive impact on them. The registered manager had recorded the concerns and complaints received and the action taken.

We found a commitment by the registered manager and managerial staff for transparency and openness with people who used the service. A letter had been sent to all those using the service by the care delivery director, which acknowledged the disruption the transition of services, had had on people’s care. The letter contained reassurance that an improvement plan had been developed and that they continued to work in partnership with Leicestershire local authority to bring about improvements to people’s experience of the care and support they received. Quality assurance systems and tools were being used to monitor and further develop the service, which included timescales for improvement that were reviewed.