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Alina Homecare Specialist Care - Poole Good

We are carrying out a review of quality at Alina Homecare Specialist Care - Poole. We will publish a report when our review is complete. Find out more about our inspection reports.


Inspection carried out on 17 October 2017

During a routine inspection

This comprehensive inspection took place between 17 and 24 October 2017, in response to information of concern. CQC was aware there had been a recent large-scale safeguarding enquiry overseen by a local authority. There had been a number of allegations relating to short staffing and people not receiving the care they needed. The bulk of these concerns were not substantiated.

We gave notice a day ahead of the inspection to ensure the people we needed to speak with would be available. When we last inspected the service in September 2016, it was Good overall and in all domains except Caring, which was Requires Improvement. There were no breaches of the Regulations.

Alina Homecare Specialist Care was previously known as The Care Division – Poole. This service provides care and support to people living in a number of ‘supported living’ settings, so they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The service is also a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Its supported living and domiciliary care services are provided to people with a learning disability, across Poole, Bournemouth, Eastern Dorset and South West Hampshire.

Not everyone using Alina Homecare Specialist Care receives regulated activity. 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.

Under its conditions of registration the service is required to have a registered manager. The registered manager had left the service in September 2017. Their replacement was already in post and had applied to register as manager, as had their line 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.

There had been changes in the management team over the past year. Staff said the new manager seemed experienced, knowledgeable and supportive, and were hopeful that things would change for the better. However, the new manager had only very recently joined the service; hence the improved confidence in management was not embedded or sustained. We will review the positive impact of the manager at our next inspection.

Staffing levels had presented a challenge over the summer, as staff had left and there had been issues with the approval of annual leave that meant more staff were off work than should have been. Some staff reported that they or colleagues worked long hours. The managers had recognised staffing pressures and had a plan in place to address recruitment and retention.

Staff morale had been low in recent months. Staff were fearful that colleagues would leave. Some staff told us that recently there had been a better atmosphere at the office and that communication with the office-based staff and management team had improved. However, the improved morale and communication was a recent development and it was too early to say whether it was embedded and sustained. We will review this at our next inspection.

Staff were supposed to have regular supervision meetings to discuss their work and any issues it presented. The managers were aware these had fallen behind owing to staffing pressures and supervisory staff having to cover gaps in rotas. However, a strategy was in place to address this.

Checks were made to ensure new staff were of good character and suitable for their role. Staff had core training at induction in topics such as safeguarding, movin

Inspection carried out on 13 September 2016

During a routine inspection

This comprehensive inspection took place on 13, 14 and 15 September 2016. We gave notice a day beforehand to ensure the registered manager would be available. We last inspected the service in July 2014 and found that the service was meeting the regulations.

The Care Division – Poole provides care and support to people with learning disabilities in their own homes. Some people have domiciliary care, with staff visiting at set times during the week, and others have supported living assistance, with staff present for most, if not all, of the day and night. At the time of our inspection, there were 67 people receiving a personal care service.

The service had a registered manager, which is a condition of its registration. 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.

A manager was registered for The Care Division – Poole who no longer worked there. Following the inspection she submitted an application to cancel her registration and is no longer registered.

The ownership of the service had changed at the start of 2016. The new management team were seeking to foster an open and inclusive culture. They were finding ways of promoting people’s involvement in the service, including setting up a forum for people who used the service and producing more information in an easy-read format. Staff felt confident to share any concerns with the management team and knew how to raise whistleblowing concerns to external agencies such as CQC. Staff recruitment procedures helped ensure that only staff who were suitable for work in a care setting were employed.

People were put at the centre of their care. They were involved in developing their care plans, which reflected their preferences and individual needs. Their rights were protected because staff and management had a working knowledge of the Mental Capacity Act 2005. Staff also understood their responsibilities for safeguarding people against neglect and abuse.

Staff understood people’s care plans and provided the support they needed, including support with their health and nutritional needs. Where people had complex and specialised needs, staff had the appropriate support and training to enable them to meet these. Medicines were managed safely.

Where people’s care packages allowed, care included support to pursue interests and attend social activities. Some people reported that staff not being able to drive restricted the activities they could take part in. The service had already identified this as an issue and were seeking to incentivise more staff to drive.

There were sufficient staff to provide care safely. If support workers were not available, for example, due to sickness or leave, supervisory staff based in the office would attend. However, some people told us that support was on occasion cancelled and that their rotas were sometimes late or showed the wrong times. People also said that they were not always informed about rota changes.

Staff were well supported through effective training. They felt colleagues and the supervision process supported them. Where weaknesses in some supervision processes were highlighted, the management team had already started to make improvements.

Views were mixed about communication with the office. Most people and staff viewed this positively. They said that the on-call system generally worked and that it was usually possible to get hold of supervisory and managerial staff when they needed to. However, two members of staff said they did not always receive sufficient communication from the office, for example, to inform them that new staff would be visiting to work a shadow shift.

The senior management team had set up a quality assurance system. This gave them

Inspection carried out on 17, 18, 21, 22, 28 July 2014

During a routine inspection

One inspector carried out this inspection and the registered manager was present throughout our visits to the office. The Care Division � Poole provided a service to 57 people at the time of our inspection.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

We considered our inspection findings to answer questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found.

Is the service safe?

People�s care was planned and delivered in a way that was intended to ensure their safety and welfare. For example, we saw that care plans covered people's physical health needs, including epilepsy and swallowing difficulties, and set out how staff should support them to remain safe. Although we did not observe any intimate care, we saw that people were receiving support as specified in their care plans. For example, when we arrived to visit one person, they were tilted in bed in the position that their care plan said they needed to help drain fluid from their chest. Their care notes recorded that staff had tilted them each day in accordance with their care plan.

Where people displayed behaviours that challenged others, care plans contained behaviour guidelines that set out how they behaved when they were feeling settled and happy and how their behaviour changed when they became distressed. The behaviour guidelines were set out in language that was positive about the person and gave clear instructions for how staff should respond to different types of behaviour.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person told us they felt safe with their workers and that staff were careful with their property. The other people we met looked relaxed and happy with the staff who were supporting them. The five support workers we spoke with confirmed they received regular training in safeguarding vulnerable adults against abuse and were all aware of signs or issues that could indicate abuse.

Staff received the training they needed in order to perform their roles satisfactorily. We spoke with five support workers, who all confirmed that they received regular mandatory training. They said that staff from the office checked their training was up to date and called them in for any updates that were due.

Is the service effective?

People were provided with a choice of suitable and nutritious food and drink. Information was available for support workers about people�s food preferences and dietary needs. People�s care logs and food diaries recorded that staff had supported them to eat a range of healthy foods that were consistent with their food preferences and dietary needs. The person we spoke with told us their support workers helped them to make a menu plan every week and encouraged them to choose food they liked that was healthy.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed that a person�s support worker assisted them to sit in an upright position and supervised them while they were drinking, as their care plan specified. Another person�s care plan stated that they were able to prepare snacks and cook meals with staff support to ensure their safety. The person told us they liked cooking together with their support workers.

Is the service caring?

The person we spoke with told us their support workers were kind and polite. During our visits to people, we saw that staff interacted with them in a respectful manner. Care plans gave detail about people�s individual communication styles, including the gestures and facial expressions they used to indicate pleasure and displeasure.

Is the service responsive?

People's needs were assessed and care was planned and delivered in line with their individual care plan. The care plans we looked at reflected people's assessed needs and contained clear, detailed instructions so that support workers provided the help and support people needed. They were individualised, setting out details of people�s daily routines and reflecting their known preferences and communication styles. Staff were familiar with people�s care needs, which helped ensure that people received the support they needed. A person told us that staff followed their care plan and that they were happy with the support they received.

There were enough staff to meet people�s needs. The person we spoke with told us their support workers were �good� and said they had a regular team of staff. Records of care given for the previous three weeks for the people whose care we considered showed that people had a consistent team of support workers.

People were supported to be able to eat and drink sufficient amounts to meet their needs. Care plans set out any support people needed with preparing food and drinks and consuming them.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people receive, and to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. There was a system in place to ensure that staff followed The Care Division - Poole policies and procedures, and staff had opportunities to give their views about the running of the service. The staff we spoke with told us they received regular supervision. Records of supervision meetings showed that staff discussed their performance in their role and had the opportunity to raise any issues that they wished. Audits were regularly undertaken to check that staff and records complied with the provider�s policy and procedures. There was evidence that learning from incidents took place and appropriate changes were implemented. Incident records showed that each report had been reviewed by a senior member of staff, who had taken action where necessary. A member of staff who participated in the �on call� rota told us that the managers were �definitely� supportive if they needed to contact them.

Inspection carried out on 2, 3, 5, 8 July 2013

During a routine inspection

During our inspection we met five people who used the service, spoke with three of them and with two relatives. They were positive about the support they received. For example, they said that support workers helped them in ways they needed. Not everyone was able to tell us about their experiences so we observed how staff worked with them, examined records and spoke with the manager, nominated individual and eight staff involved in providing care.

Before people received any care they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We observed that people were supported to make choices and that their preferences were respected.

People experienced care, treatment and support that met their needs and protected their rights. People received assistance to do things they enjoyed.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider assessed and monitored the quality of the service, and assessed and managed risks to people's health, safety and welfare.

Inspection carried out on 9, 17, 22 January 2013

During a routine inspection

We carried out an unannounced visit on 8 January 2013. The service provided care for people with complex needs. On this occasion we did not meet people who use the service but spoke with three family representatives, two care workers and three health professionals on 17 and 22 January 2013.

The care provided by was person centred, which meant it was focussed on meeting people's needs according to the individual's preferences. We found that staff attitudes, training and records all reflected that the individual needs of the person and how best to meet their needs was at the centre of their work.

One relative told us "They are all absolutely first class. We cannot fault them. They understand how to look after [my relative] and their possessions and they recognise signs that they may be unwell"

Another relative said "I'm very happy. The staff are supportive, kind and helpful. They are good communicators and they understand my needs as well as [my relative's]. They are always happy with their carers".

We spoke with two staff who told us that they understood safeguarding policies and procedures and had good support from their managers. We found that staff were well supported and given specialist training relevant to people's needs as well all mandatory training.

Good record keeping systems were in place to support the work of the staff and protect people using the service from the risks of unsafe treatment.