Archived: Allied Healthcare Brighton & Hove

At the last inspection on 15 July 2014, the service was rated Good. At this inspection we found the service remained overall Good. However, we did find some areas of practice which needed improvement which had not been consistently maintained. This was in relation to the maintenance of the review of people’s care and support plans. People told us there was not always good communication when there were changes to the times care was provided. These are areas in need of improvement.

Staff spoke of a difficult period since the last inspection where another two of the provider’s care at home services had been merged in with Allied Healthcare (Brighton and Hove.) This meant the service now covered East and West Sussex as well as Brighton and Hove. Staff we spoke with were at different stages of working through this process. Paperwork being used was not consistent and at times difficult to navigate through. They told us staffing changes had led to some delay in reviewing care and support plans, but senior staff demonstrated a robust action plan they had followed to address these issues.

Systems had been maintained to keep people safe. People and their relatives told us they felt people were safe with the care provided. They knew who they could talk with if they had any concerns. They felt they could raise concerns and they would be listened to. Assessments of risks to people had been developed. Robust recruitment practices continued to be followed to ensure enough staff had been recruited to meet people’s care and support needs. Staff told us they had continued to receive supervision, and be supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. One member of staff told us they had, “Regular supervision and supervisor will come and check work on spot checks.”

People's individual care and support needs had been identified before they received a service. Care and support provided was personalised and based on the identified needs of each individual. Detailed care and support plans were in place. Where people were unable to make decisions for themselves this had been considered under the Mental Capacity Act 2005, and appropriate actions continued to be followed to arrange meetings to make a decision within their best interests. Staff had a good understanding of consent. One member of staff told us when they provided care they, “Always ask even if routine.” A relative told us, “They will encourage him to turn over onto his side by himself, so that they can apply his creams, I hear them telling him what they are doing and saying is that ok.”

People were supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. One person told us, “Yes I am quite happy with everything, they are kind and gentle with me.” Another person told us, “They are absolute angels I would not want to change a thing.” A third person said, “All very kind and caring I have no complaints.”

If needed, people were supported with their food and drink and this was monitored regularly. One person told us, “I’ve got a list of my food in the freezer, I discuss it with them and choose daily and they cook it for me.” One member of staff said when they supported people with their food and fluid intake they would try a, “Different approach and make sure likes and dislikes catered for.” A further member of staff told us they would, “Make food they like. Nice presentation. If weight loss or poor appetite will give choice of foods and call office.”

People continued to be supported to maintain good health. One person told us, “If I am feeling unwell I let them know like now I have a sore tendon, they will check how I am and write it in the book.” Another person told us, “They noticed that I had a sore leg and called the doctor.” A third person said, “If I feel unwell they will call a

Doctor or we discuss what to do.”

People and staff told us the service was well led. Senior staff carried out a range of internal audits, and records confirmed this. People and their relatives were regularly consulted by the provider about the care provided.

Further information is in the detailed findings below.

During our inspection we spoke with a regional manager, branch manager, two field care supervisors, five care workers and a care coordinator. We accompanied field care supervisors on two monitoring visits. We conducted telephone interviews with 17 people who used the service and two relatives. We looked at the latest contracts monitoring report by the local authority and the providers last two customer satisfaction surveys to provide additional evidence. We viewed 10 people's care records to help us understand how care was planned and delivered to people who use the service.

We found that people who used the service were involved in the planning and review of their care and support plans. One person said, 'We have a review every three months, someone comes to visit so we are fully involved with it all.'

People's privacy and dignity were upheld. One person reported, 'They are polite and courteous and have good standards.' However, not everyone had their preference in relation to the gender of care workers respected. A person told us, 'There are men and ladies that come. I would prefer females as it's so intimate but I have not been asked.'

People who used the service had their needs assessed and had care plans that contained sufficient information for their health, safety and welfare to be maintained. People were satisfied with the service provided by care workers. One person told us, 'I see the same person nearly every day. She is very helpful and very caring. Anything I want or need her to do she'll do and we do get on quite well. She knows me well and I've got no complaints.' A relative said, 'He's very good; does everything he should do. He looks after dad really well and is polite and friendly. Dad can talk and chat to him and they get on well. He does everything he should on the plan.'

We found that systems for supporting staff and people who used the service out-of-hours were adequate. We saw evidence that showed that the incidence of missed and late calls had significantly decreased. However, some people still found that late calls were an issue for them. A relative told us, 'On the whole the carers are consistent but it's a problem when the carers get held up and you don't know what's happening. Dad gets upset and worried when it happens. There doesn't seem to be a mechanism to deal with these situations."

Staff told us they found the managers approachable and supportive. A care worker said, 'I can offer good quality care because I've got good people behind me now'. Staff received regular supervision. A care worker told us, 'It feels 100% better now we have regular supervision. I feel listened to.'

The provider was seeking the views of people who used the service and was addressing the issues they raised via their improvement plan. However, some people we spoke with felt the branch office did not always respond to their concerns. One person told us, 'When they don't come on time I get frightened of fainting. I have phoned the office about it and told them I'm annoyed about them coming at different times. The office people can be helpful but they don't let me know what's happening.'

We found all statutory notifications had been made by the provider and managers were aware of their responsibilities in relation to these.

People told us they were not always involved in making decisions about their care and support. One told us, 'They wrote the plan for me and that was it.' Some people felt they were treated with respect but others felt their dignity was not maintained. One person said their carer was, 'Very respectful and caring,' but another said, 'I just feel like a lump of meat.'

People's needs were assessed but their care plans were insufficiently detailed to guide care workers to support people in their preferred way. A care worker told us, 'Allied doesn't cover all care issues and has minimum care plans at the moment.'

We found that late and missed visits especially at weekends, were a recurrent issue. This was having a negative impact on the care and welfare of people who used the service and people we spoke with gave us many examples of this. One typical comment was, 'There's always confusion, they're late, don't always let me know and sometimes just forget about me altogether.'

Staff received training in safeguarding people from abuse and they knew how to recognise and report abuse if they suspected it was happening.

Staff received adequate induction, training, appraisal. However supervision arrangements were not effective; for instance two care workers we spoke with did not know the name of their supervisor. Staff told us they did not feel supported by the provider and that communication could be improved. A care worker said, 'We need better management, as there is a blame culture.'

The provider had systems to gather the feedback from people who used the service, their relatives and staff. There were also systems to spot check the quality of care delivered. However, despite risks to people's safety and welfare being identified, risks were not adequately managed and feedback was not appropriately responded to.