Archived: Allied Healthcare Redcar

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, younger adults with a physical or mental health disability, and children. At the time of the inspection, 111 people were using the service and were supported by 53 active staff members.

Not everyone using Allied Healthcare Redcar received the regulated activity of personal care; At this service CQC only regulates and inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where people were not in receipt of such care, the Commission takes into account any wider social care provided.

The service was last inspected by CQC in August 2016, at which time the provider was found to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During that inspection we found the provider did not ensure the proper and safe management of medicines. Risk assessments did not reflect people’s needs and people's risks had not been regularly reviewed. Staff did not always act upon risks when they were identified. Care records did not always match people’s needs. We found they were not regularly reviewed. We also found that not all staff had received the appropriate training and supervision support.

At this inspection we found improvements had been made and the provider had completed each of the improvement actions necessary. Care records had been improved and of the records we reviewed we found they were accurate and up to date. Training of staff had been addressed in relation to safeguarding and the Mental Capacity Act 2005 and improvements had been made. In addition to the above, staff now received regular supervision and checks on their competency. We saw that for those people with clinical needs such as pressure area care, risk assessments could be further improved and more detail was needed to ensure staff members were following safe infection control practice. We have made a recommendation about risk assessments.

The service had a registered manager in place. 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.

We found the arrangements for medicines management kept people safe. We looked at the medicine records of nine people who used the service. We spoke with staff about medication and reviewed the provider's medication policies.

People who used the service told us they felt safe and relatives said they had confidence in the ability of staff to keep people safe. Staff had received training in safeguarding and understood their responsibility to protect vulnerable adults from harm and improper treatment. There was an out-of-hours phone line through which people could seek assistance from the service in case of unforeseen circumstances. People reported they had not experienced any missed calls recently.

Risks were assessed by an area supervisor when someone first started using the service, and reviewed thereafter. Pre-employment checks for new staff members, including Disclosure and Barring Service checks, were in place.

There were sufficient numbers of staff on duty to meet the needs of people who used the service. People we spoke with told us staff stayed their allocated time and they were usually informed if their care worker was running late. A new electronic rota system using mobile phones had been recently implemented and we were told this helped prevent missed calls and meant staff were allocated in a more systematic way.

New staff received a seven-day induction, as well as shadowing opportunities. We found mandatory training covered a range of core topics, such as: safeguarding, infection control, dementia awareness, first aid and nutrition. The registered manager ensured staff completed refresher training.

Staff liaised regularly with external healthcare professionals and ensured their advice was incorporated into care planning.

Staff were supported through annual appraisals and a number of supervisions and observations throughout the year.

People who used the service and relatives consistently told us staff were caring, patient and upheld people’s dignity. People confirmed staff encouraged them to retain their independence on a day-to-day basis.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they were encouraged to contribute to their own care planning and review, and felt partners in the process.

People who used the service and external professionals told us staff were accommodating to people’s changing needs and preferences.

People who used the service knew how to complain, and who to. This information was shared with people in a welcome pack. Complaints were thoroughly investigated and responses given and feedback about lessons learnt was shared with the staff team.

The registered manager and care staff were described in positive terms by people who used the service and relatives. The registered manager had worked to make improvements since our last visit and feedback from people and staff was that the service had improved. Auditing and quality assurance systems were in place to enable the provider to identify trends.

The culture of the service was in line with the goals of the statement of purpose, meaning people who used the service were supported to maintain their independence from care staff who demonstrated a good understanding of people’s needs and individualities.

At the time of inspection, Allied Healthcare Redcar provided care and support to 174 older people living in their own homes in the Redcar and Cleveland area. This included people living with a Dementia, mental health difficulties and physical health difficulties. The local office in Redcar was centrally located for staff.

The registered manager had been registered with the Commission since 30 June 2016. 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.

Risk assessments did not reflect people’s needs and people's risks had not been regularly reviewed. Staff did not always act upon risks when they were identified.

Medicines were not managed safely. Risk assessments for medicines had not always been completed. No action was taken by staff when people did not take their medicines as prescribed. There were gaps in medicine administration records (MAR).

Staff had not always recognised safeguarding concerns. This meant safeguarding alerts had not always been made when needed.

Robust recruitment procedures were in place. The service sought two references from previous employers for each person and a ‘Disclosure and barring services’ (DBS) check before an offer of employment was made. DBS checks help employers make safer decisions and prevent unsuitable people from working with vulnerable client groups.

We heard mixed reviews about staffing levels. The number of missed calls had reduced since the registered manager started at the service. Staff told us they didn't always have the time needed because travel time, staff sickness and people's complex care needs impacted upon the time allocated during each call. People told us staff provided the care they needed, but it could be rushed at times.

Information about ‘Do not attempt resuscitation’ (DNAR) certificates was not up to date. This meant staff did not know which people had a certificate and whether it remained valid.

Staff carried out mental capacity assessments even when people had capacity. These assessments should only be carried out when there are concerns that people may not be able to give their consent.

There were gaps in supervision and appraisal records. Records did not show if these meetings had been completed or if there were any areas where further action was needed.

Training in all areas was not up to date. There were no records to show whether staff had received training in the Mental Capacity Act (2005), Deprivation of Liberties Safeguards and dementia care.

All staff were supported through an induction programme which included training, shadowing experienced staff and attending reviews.

People told us they were supported with their nutrition and hydration. They confirmed staff always made sure they had a drink and a meal before they left.

Staff supported people with their healthcare needs. We saw staff taking the action needed when people became unwell.

Care records did not always match people’s needs. We found they were not regularly reviewed. Care records were not always updated when changes in people's needs had been identified.

A small number of complaints had been made. Records were available to show the action which had been taken to resolve the complaint and the outcome.

Some audits had been carried out; however there were gaps within them. We also noted a lack of action plans in place to make the required improvements.

There were gaps in all records looked at during inspection. These had not been highlighted during the registered provider’s quality assurance processes.

Staff told us the registered manager was accessible and they felt supported by them. People told us the quality of the service had improved since the registered manager came into post. People spoke positively about the service.

Staff had access to regular meetings and were kept informed of changes which were occurring at the service. Staff told us they felt able to voice their opinions and concerns at these meetings.

People we spoke with told us they were happy with the care they received and had a good relationships with the staff who provided care to them.

People told us their privacy and dignity was maintained. They told us staff gave them the time they needed whenever care and support was carried out.

People told us they were involved in their care and staff sought their consent before and care and support was carried out.

We found four breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the premises and equipment and records. You can see what action we told the provider to take at the back of the full version of this report.