Archived: Allied Healthcare - Middlesbrough Also known as Nestor Primecare Services Limited

The inspection was announced which meant that we gave the provider 48 hours’ notice of our visit. This was because the location provides a domiciliary care service and we needed to ensure that suitable management would be available.

This inspection had been brought forward because we had received a number of safeguarding concerns which had been raised about the service following the closure of their Redcar branch. When this branch was closed, all staff and care packages were moved to the Middlesbrough branch. Concerns included missed calls, care workers not knowing people’s care needs and rotas not being issued in a timely manner.

Allied Healthcare Middlesbrough is a domiciliary care agency which provides personal care to people living in their own houses and flats in the community. This includes children, younger adults and older adults. Not everyone using Allied Healthcare Middlesbrough receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care,’ help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of the inspection there were 168 people using the service, 153 people were living within the Middlesbrough area and 15 people were living within the Redcar area. We looked at all records relating to both areas during this inspection.

We last inspected the service on 26 April 2017 and rated the service to be Good. At this inspection we found the service had deteriorated and rated the service as requires improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the time of the inspection the service had a registered manager who was currently absent from their work. 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 and their relatives told us they did not think the service was consistently well led and raised concerns about how the standard of the service had deteriorated over recent months.

The provider had a range of quality monitoring audits in place but these had not been undertaken effectively over recent months to identify issues within the service and act upon them to make improvements. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations.

Medicines records were not being managed safely and did not always keep people safe. We found records completed by care workers were not always accurate and up to date. Audits of medication administration records (MARs) had not been undertaken to identify if people were receiving their medicines as prescribed.

Best interest decisions were not always recorded to reflect the process had taken place and who was involved when best interest decisions were made for people.

Individual risk assessments were not always in place where specific health issues had been identified in care plans. This meant that care workers were not always provided with the information to enable them to mitigate these risks when providing care to people.

The provider had safe recruitment and selection procedures in place and most checks had been undertaken before staff began work. We found some gaps in people’s employment history had not been recorded prior to the person commencing their employment.

People were supported by enough people to meet their needs safely.

People told us that they felt safe when they received support from care workers in their own home. Care workers understood safeguarding, what their responsibilities were and could tell us what action they would take if they had any concerns about the way people were supported. Care workers received training in both safeguarding of adults and children.

People told us they felt care workers were kind, caring and treated them with dignity and respect when providing care. People and their relatives knew how to raise a complaint. Policies and procedures were in place to investigate and respond to complaints appropriately.

The provider told us that they had a training programme in place for all care workers which included mandatory and refresher training. Care workers told us they received training in all aspects of their role. However, records provided were not always up to date to evidence care workers training.

Although care workers had not consistently received regular supervision they gave us positive feedback and told us they were supported by management and could approach them at any time.

At the time of our inspection nobody was receiving end of life care. However, with the support of other health care professionals people could remain at the home at the end of their life and receive appropriate care and treatment.

People’s nutrition and hydration needs were met and they were supported to maintain a healthy diet. Where needed records to support this were detailed.

People were supported by person centred approaches this means peoples preferences and choices are respected when planning and receiving care and support.

Notifications of significant events were submitted to us in a timely manner by the manager.

Partnership working was in place with other professionals, including; health care professionals, or specialist consultants including community nurses and physiotherapists were Involved in people’s care as and when this was needed and care workers supported people with any appointments.

Evidence was available to show that all accidents and incidents were responded to appropriately by the registered manager and used as a learning opportunity.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach relates to risk management and good governance of the service. You can see what action we told the provider to take at the back of the full version of this report.

Allied Healthcare Middlesbrough is a domiciliary care service that provides personal care to people in their own homes. The service supports people in the Middlesbrough area. At the time of the inspection 226 people were receiving personal care from the service.

The service was last inspected in January and February 2016. During that visit we identified breaches of our regulations. Risk assessments were not regularly reviewed which meant that risks to people using the service were not regularly assessed. Care plans were not always regularly reviewed to ensure they met people's up to date support needs, and people's consent to care was not always recorded. We took action by requiring the registered provider to send us action plans setting out how they would make improvements. When we returned for out latest inspection we found this action had been taken and improvements had been made.

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.

People told us the service kept them safe. Risks to people were assessed and regularly reviewed. Accidents and incidents were monitored and emergency plans in place to provide a continuity of care in situations that disrupted the service. People’s medicines were managed safely. Policies and procedures were in place to safeguard people from abuse. Staffing levels were sufficient to support people safely. Recruitment procedures were in place to reduce the risk of unsuitable staff being employed.

People’s rights under the Mental Capacity Act 2005 (MCA) were protected and their consent to care obtained and recorded. Staff received a range of mandatory training to help them support people effectively. Staff spoke positively about the training they received and said they would be confident to request additional training if they felt they needed it. Staff were supported with regular supervisions and appraisals. Some people received support with food and nutrition. Where this was the case people’s plans contained information on their support needs and how they would like to be assisted. Staff worked effectively with other healthcare professionals to monitor and improve people’s health.

People and their relatives spoke positively about staff at the service, describing them as kind and caring. Several people we spoke with described how staff worked above and beyond what was expected in delivering care. People told us staff always maintained their dignity and treated them with respect when delivering support. Procedures were in place to support people to access advocacy services where needed.

Support was planned and delivered based on people’s assessed needs and preferences. Care plans were regularly reviewed to ensure they reflected people’s current support needs and preferences. Procedures were in place to investigate and respond to complaints.

Quality assurances processes were in place to monitor and improve standards at the service. Feedback was sought from people who used the service and from staff. Staff spoke positively about the culture and values of the service. We received positive feedback about the registered manager and the improvements they had made. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

Allied Healthcare Middlesbrough is a domiciliary care service which provides personal care to people in their own homes. The service supports people in the Middlesbrough area. At the time of the inspection 260 people were using the service.

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.

Risk assessments and care plans were not always regularly reviewed to ensure they met people’s current needs.

People’s consent to care was not always recorded on their care plan.

Procedures were in place to reduce the risk of safeguarding incidents occurring, and staff could discuss the types of abuses that can occur and how they would respond if they had concerns.

Staff told us there were enough staff to support people safely. People said their care teams were stable which meant they were supported by staff they knew.

A number of checks were carried out before staff were employed to ensure they were suitable to work with vulnerable people.

People were supported to safely manage their medicines. People were responsible for ordering their own medicines, but staff assisted some people with administration. Where this was done, staff understood how to gain people’s consent and accurately record administration.

Staff received training in a number of areas that they thought helped them to support people effectively. Staff felt confident to request any additional or specialist training.

Staff were supported in regular supervisions and appraisals, and felt they could raise any issues or support needs they had.

Some people received support with food and nutrition, and where this was done they said they always had a choice of what they wanted to eat. People’s meals were recorded so that, if necessary, their food intake could be monitored.

People were supported to maintain and promote their health and wellbeing by accessing external professionals. The registered manager and staff were able to describe how people could be supported to access specialist services if required.

People and their relatives said staff maintained their dignity and treated them with respect. They said staff delivered support in a kind and caring way, and talked about the positive impact this had on their lives. People said staff helped them to maintain their independence.

No one at the service was using an advocate, but the registered manager was able to describe how this would be arranged if needed.

People and their relatives were involved in planning their own care, and felt they had a say in how care was delivered.

Some people received support with social activities, and where this was the case care plans contained details on how this could best be carried out.

There was a complaints policy in place, and where issues had been raised they had been investigated and outcomes sent to the people involved.

Quality assurance checks were carried out, though these did not always take place as regularly as staff told us they should.

People and staff said they were asked for feedback on the service, though we did not see any records in relation to this.

Staff felt supported by the registered manager, who they described as approachable and helpful. Staff and the registered manager understood their role and responsibilities.

There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and good governance. You can see what action we took at the back of this report.