15 October 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
The inspection was carried out by two inspectors and an Expert by Experience carried out telephone interviews with people receiving support and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. Inspection activity started on 22 July 2021 and ended on 30 July 2021. We visited the office location on 22 July and 27 July 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with the registered manager and the office manager. We received feedback from four care workers. We reviewed a range of records which included the care plans for seven people. We looked at the records for five care workers in relation to recruitment and supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
Following the inspection we spoke with one person who used the service and seven relatives about their experience of the care provided .We continued to seek clarification from the provider to validate evidence found. We looked at audits and information relating to visit times recorded on the electronic call monitoring system.
15 October 2021
About the service
Allfor Care Alpha Care Recruitment West and Home Care Service Limited is a domiciliary care agency providing personal care and support to people living in their own homes. The provider offered a service to adults with disabilities as well as children and young people with autism and/or disabilities. At the time of our inspection 77 people were using the service.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Risk management plans had not always been developed to provide care workers with appropriate guidance on how to manage associated risks when a specific issue had been identified in relation to a person’s health and wellbeing.
The provider had a process for the administration of medicines, but this was not always followed to ensure accurate information was provided and people received their medicines as intended.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Care plans did not always reflect people’s support needs in a person centred way. People’s communication needs were not always accurate. The end of life care wishes were not always identified for people receiving support.
The provider had developed a range of quality assurance processes but these were not always robust enough to help enable them to identify where there were issues and when improvements were required.
Safeguarding concerns were recorded but lessons learned following an investigation were not always documented. The provider had a recruitment process but appropriate references were not always requested to enable the provider to assess an applicant’s previous experience and knowledge. Care workers had access to personal protective equipment and had completed infection control training.
People were supported to access healthcare and other support when required. Care plans identified people’s nutritional and hydration support needs. Care workers had completed training the provider had identified as mandatory to ensure they had the appropriate skills to meet people’s care needs.
Complaints were responded to in a timely manner. Most relatives felt that the service was well run but some felt there were issues with communication with the office staff. The provider worked in partnership with healthcare providers and local authorities to help ensure people received safe care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 29 April 2020) and there were multiple breaches of regulation. A targeted inspection was carried out in December 2020, which also looked at the whole well-led key question. The service was not rated at this inspection but the rating for the key question of well led did improve from inadequate to requires improvement. They had also made improvements to meet breaches of regulations except for the regulation in relation to good governance. At this inspection we found the provider was still in breach in relation to good governance and was now in breach of regulations in relation to safe care and treatment, need for consent and person-centred care.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 22 July and 27 July 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, effective, responsive and well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Allfor Care Alpha Care Recruitment West and Home Care Service Limited on our website at www.cqc.org.uk.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, consent to care, person centred care and good governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.