The inspection was completed on the 28 and 29 November 2017, 12 December 2017, 10 and 22 January 2018 and was announced. At the time of this inspection there were 45 people receiving a service from Allied Care & Nursing Ltd.This service 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 for older adults living within Southend on Sea. The domiciliary care agency office is in close proximity to all major bus and train routes.
At the last inspection on the 5 and 6 December 2016 and 11 January 2017, the service was rated ‘Requires Improvement ’. A breach of regulatory requirements was evident for Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance], Regulation 18 [Staffing] and Regulation 19 [Fit and proper persons employed]. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-Led’ to at least good. The action plan was received detailing the improvements they intended to make. At this inspection, we found the service remained rated ‘Requires Improvement’. This is the second time the service has been rated ‘Requires Improvement’.
The registered provider was also the registered manager. The registered provider had delegated the day-to-day running of the service to the newly appointed care manager. The latter was previously the care coordinator. 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.
Staff recruitment practices required significant strengthening as not all records had been sought. Newly employed staff had not received a comprehensive induction. This included induction for staff where they had been promoted to a different role. Not all staff had received mandatory training or other specialist training to meet people’s needs. Staff had not received regular formal supervision and where this was in place, staff did not feel it was ‘fit for purpose’.
Effective robust arrangements were not always in place to assess and monitor the quality of the service. Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements required to achieve compliance with regulatory requirements and the registered provider’s own policies and procedures.
Although there was no impact to suggest that people’s care and support needs were not being met, not all risks to people’s health, welfare and safety had been identified. Improvements were required to guide staff in the steps they should take to mitigate risks to ensure people’s safety and wellbeing.
Although people told us that staff provided care and support that was kind and caring, not all arrangements were as effective as they should be and if not monitored carefully, could potentially impact on the delivery of care people received. This referred specifically to the deployment of staff not always being appropriate and staff attending to people on their own despite the person using the service being assessed as requiring two members of staff.
Suitable arrangements were in place to keep people safe. Policies and procedures were followed by staff to safeguard people and staff understood these measures. People were protected by the registered provider’s arrangements for the prevention and control of infection despite not all staff having attained training in this subject. Arrangements were in place for learning and when things go wrong.
People’s nutritional and hydration needs were met. People received appropriate healthcare support as and when needed and staff knew what to do to summon assistance. The service worked together with other organisations to ensure people received coordinated care and support. People were supported to have choice and control of their lives. However, staff understanding and knowledge of the key requirements of the Mental Capacity Act (MCA) 2005 required improvement.
Staff had a good knowledge and understanding of people’s specific care and support needs and how they wished to be cared for and supported. People confirmed they were treated with respect and dignity and were able to maintain their independence wherever possible.
Support plans were in place to reflect how people would like to receive their care and support, and covered all aspects of a person's individual circumstances. Information about how to make a complaint was available and people’s representatives told us they were confident to raise issues or concerns.
We have made recommendations about the management of risk and the deployment of staff within the service to meet people’s care and support needs.
You can see what action we told the provider to take at the back of the full version of the report.