Allfor Care Alpha Care Recruitment West and Home Care Service Limited

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.

Enforcement

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.

Follow up

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.

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, 97 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

Records had not always been updated when people's needs changed. Therefore, staff did not always have the most up to date information about how to care for people, or the risks associated with their care. We discussed this with the registered managers and reviewed information of care provided and feedback from stakeholders. Whilst information suggested people's needs were being met, failure to keep accurate and clear records meant there was an increased risk of staff providing inappropriate or incorrect care.

The provider's systems for auditing how medicines were being managed were not always operated effectively. Staff completed records to show when they had administered medicines and any problems associated with this. However, the management team did not regularly check these records and therefore could not identify if any improvements were needed.

People using the service and their relatives told us they were happy with the care they received and were cared for by the same familiar staff who they had good relationships with. People who had raised concerns felt these had been dealt with well and they were happy with the outcome.

Risks to people's safety and wellbeing had been assessed and planned for. These assessments and plans had been regularly reviewed and updated since the last inspection.

The provider had systems to make improvements when things went wrong. For example, following accidents and incidents, they had reviewed what had happened, discussed this with the staff involved and provided information for all staff to learn from these.

People's needs were recorded in care plans. They had been involved in developing these, and their preferences formed part of the planned care. There was evidence the provider had liaised with other professionals who supported people, such as doctors and schools for the children. Records of care provided by staff showed care plans had been followed and people's needs were being met.

The provider had effective systems to capture the views of people using the service and their families. They regularly contacted them and obtained detailed feedback. Where people had expressed concerns, we saw the provider had acted on these and made improvements. The majority of people had given positive feedback and were happy with the service they received.

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). At our last inspection we found the provider was breaching two of the Health and Social Care Act 2008 (Registration) Regulations 2009 because they had failed to send us notifications of all significant events and had not clearly displayed their CQC rating on their website.

We also identified breaches of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, person-centred care and good governance. We issued warning notices telling the provider they must make improvements to these areas.

At this inspection, we found improvements had been made. However, further improvements were needed, and the provider was still breaching the regulation relating to good governance.

Why we inspected

We undertook this targeted inspection to check whether the warning notices we had served in relation to Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on warning notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected and found that although there were still concerns relating to some areas, there had been improvements so we widened the scope of the inspection to assess all of the key question of well-led and were able to award a rating to this key question. But we have not reviewed the rating of other key questions and therefore, not overall.

Enforcement

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 monitor the service.

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Allfor Care Alpha Care Recruitment West and Home Care Service Limited is a domiciliary care service providing personal care and support for people in their own homes. The service supports younger people with autism and complex physical impairments. The majority of people receiving support had their care funded by a local authority. At the time of the inspection the service provided support for approximately 93 people.

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

The provider did not record and investigate when an incident and accident occurred involving a person receiving support so lessons were learnt to prevent reoccurrence of similar incidents and accidents.

When a risk had been identified during an assessment of a person’s needs a risk management plan had not always been developed to provide care workers with adequate information to reduce the risks. Risk management plans for some people had not been regularly reviewed to ensure these were up to date.

Improvements had been made in the monitoring of how medicines were recorded but issues were still identified in relation to the guidance provided for care workers to make sure they had all the necessary information to support people with their medicines safely.

Records relating to people using the service were not always clear about the care and support they needed, so staff had all the information they needed to care for people.

The provider had a range of audits in place, but these were not effective as they had not always identify areas where improvement were required so these could be addressed.

People told us they felt safe when receiving care. The provider had a process in place for the receipt, recording and investigation of complaints so people and relatives can be confident their complaints would be taken seriously.

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

The provider operated safe recruitment processes and there were enough care workers allocated to meet people’s care needs. Staff received the training and supervision they required to equip them with the skills to provide care in a safe and effective way.

An assessment of people’s care and support needs was completed before they started to receive care from the service.

People using the service, relatives and care workers felt the service was well run.

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 19 March 2019) and there were multiple breaches of regulation which included regulations in relation to person centred care, the need for consent, safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made in relation to supporting people to consent to their care (regulation 11), but the service was still in breach of the other regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider still needs to make improvements. Please see the Safe, Responsive and Well Led sections of this full report. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified repeated breaches of regulations in relation to safe care and treatment, 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.

The provider had not sent notifications to the CQC relating to two incidents that involved the police as required by law. This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We are considering our regulatory approach regarding this breach of regulation.

The provider was not displaying their rating on their website. This was a breach of regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering our regulatory approach regarding this breach of regulation.

Follow up

We will request an action plan from 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.

• Allfor Care Alpha Care Recruitment West and Home Care Service Limited is a privately owned domiciliary care agency providing personal care to people who live in their own homes in the London Boroughs of Ealing and Hounslow and surrounding areas. At the time of our inspection the agency offered a service to 36 people. Some of the people were older adults with associated health and personal care needs and some were younger adults with learning disabilities or mental health needs. The provider had two other registered locations providing domiciliary care services one located in the London Borough of Harrow and one in the London Borough of Kensington and Chelsea.

• The administration of people’s medicines was not always recorded accurately to confirm they were taken as prescribed.

• Risk management plans were not always in place to provide care workers with the information to enable them to mitigate identified risks when providing care.

• When incidents and accidents occurred, they were not investigated to identify appropriate actions which could be taken to reduce the risk of reoccurrence.

• Care workers were not always deployed appropriately to ensure there was additional staff to cover visits during period of annual leave or sickness.

• 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; the policies and systems in the service did not support this practice.

• Information was not always provided in an appropriate format to enable people to be involved in decisions about their care.

• Records did not always provide up to date information relating to people’s care.

• The provider had quality assurance processes in place but these were not robust to provide adequate information to identify areas requiring improvement.

• People told us they felt safe when they received support from the care workers in their own home. The provider had a process in place to respond to concerns relating to the care provided.

• People were happy with the care they received, they felt the care workers treated them with dignity and respect as well as helping them maintain their independence whenever possible.

• Care workers received training and appropriate equipment to help manage risks associated with the spread of infection.

• People were supported to eat and drink where required.

• People told us they knew how to raise concerns about their care.

Improvement action we have told the provider to take:

• The service has been rated requires improvement and we have identified four breaches of regulations. These were in relation to person-centred care, need for consent, safe care and treatment and good governance. Please see the action we have told the provider to take in the section towards the end of the report.

Rating at last inspection:

• The last inspection took place on 23 June 2016. At this inspection we rated the service good overall and for all of the key questions we ask. (Report published 15 July 2016)

Why we inspected:

• This was a scheduled inspection based on the previous rating

Follow up:

• We will be requesting an action plan from the provider identifying how they are going meet the regulations and improve the service to at least a good rating. We will also continue to monitor the service.

The last inspection of the service was on 31 January 2014 when we found no breaches of Regulation.

Allfor Care Alpha Care Recruitment West and Home Care Service Limited is a privately owned domiciliary care agency providing personal care to people who live in their own homes in the London Boroughs of Ealing and Hounslow and surrounding areas. At the time of our inspection the agency offered a service to 21 people. Some of the people were older adults with associated health and personal care needs and some were younger adults with learning disabilities or mental health needs. The provider had one other registered location providing domiciliary care services located in the London Borough of Harrow.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People who used the service were happy with the care they received. They said that care workers were kind, caring and polite. They felt their needs were being met and the care workers arrived on time. People felt involved in planning their care and told us the agency was responsive to their concerns and feedback.

The staff received the support, training and information they needed to care for people safely and meet their needs. There were appropriate procedures for recruitment which meant that only suitable staff were employed. The staff had opportunities to meet with the manager and discuss their views and experience.

There were clear and appropriate systems for assessing the quality of the service. These included asking people who used the service for their opinions and regularly checking that they were happy with the service. The manager and senior staff knew the service well and had a good knowledge of individual people who used the service, their needs and the staff who cared for them. They had improved systems for coordinating and monitoring the service and were looking at ways for continued improvements. They liaised with the local authorities who purchased the care and other providers to keep themselves up to date with changes in good practice guidance and legislation.

People told us that they felt respected by staff. One person said, 'I feel respected and valued always".'

The agency ensured people using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent this from happening.

Staff were aware of their role in safeguarding.

Staff we spoke with told us that they were supported by the agency in their work. Comments from staff included, "We feel supported, adequate training and support is available".

We found that the agency had good systems in place to assess and monitor the quality of service provision.

We looked at the care records of people and found there was a system in place to ensure people consented to their care. People had an assessment of their care needs before they started using the service. A care plan was then implemented to ensure staff knew how to deliver care safely and effectively.

The service had suitable staff arrangements to ensure people's needs were met. The staff had been appropriately trained and therefore knew how to identify and report any concerns of abuse.

We looked at the provider's complaints system and found people were able to make complaints if needed and these were dealt with appropriately.