Archived: Allied Healthcare London

Updated 20 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The site visit took place on 19, 20 and 21 August 2015. It was unannounced on the first day. Five inspectors, including a pharmacist inspector, were involved in the site visit, accompanied by a specialist nursing advisor. A further five inspectors made phone calls to people who used the service, their relatives and staff. An expert by experience also made phone calls to people who used the service. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this case services for older people.

Altogether we spoke with 164 people who used the service, 26 relatives and 54 nursing and care staff. We also spoke with the two registered managers for the service.

We reviewed the information we held on the service and we examined 25 nursing and care files across all teams, eight staff files and a range of other policies, procedures and management records, including medicines administration records.

Updated 20 November 2015

The inspection took place in two parts; a three day site visit to the provider’s office base on 19, 20 and 21 August 2015, and telephone calls to people who used the service, relatives, care workers and nurses over the following two weeks. The office site visit was unannounced on the first day.

Previously, when we inspected the service in October 2014, we had lots of concerns about how the service was run and we found five breaches of the regulations covering care and welfare, assessing and monitoring the quality of service provision, staffing, management of medicines and consent to care and treatment. We issued warning notices for three of these breaches of regulation.

When we returned in February 2015 we carried out a focused inspection to see if the service had complied with the warning notices. We found the service was no longer in breach of the regulations in respect of care and welfare, assessing and monitoring the quality of service provision and staffing and had made significant changes to the way it organised the delivery of care to improve safety and reliability. At that time it was too soon to assess the impact of those changes for care staff and people who used the service.

During this August 2015 inspection we carried out a comprehensive check on all parts of the service to ensure it was meeting all the current regulations. On this occasion we found the service was no longer in breach of the regulations relating to medicines and consent to care and treatment and no further breaches were found. In contrast to previous inspections people who used the service and staff were much more content with the service. The changes had impacted upon most of them in a positive way.

There are several parts to the service; altogether approximately 900 people are supported by 350 Allied Healthcare London staff. Six teams provide domiciliary care to people in one south London borough. Each team is headed by a care delivery manager (team leader), supported by a care quality supervisor (responsible for assessment, care planning and review), a scheduler (responsible for organising care workers to visit people at agreed times) and an administrative assistant.

The seventh team supports four extra care housing schemes in two south London boroughs, as well as the night owl service for one borough. This team is led by a service delivery manager with scheme managers based on site in each of the blocks of flats. They manage the care workers who are also based there. One of them takes the lead for the night owl service which operates out of the largest of the housing schemes. A care quality supervisor is also assigned to the extra care housing team.

The night owl service provides night time cover for 53 people in one London borough. It supports people who need care during the night, and includes those with continence issues, skin care and repositioning needs, as well as people who are living with dementia and are very active during the night. Two teams of two care workers are provided with a car to travel to visits.

The eighth team, known as the specialist team, supports some people with complex needs on account of their mental health or brain injury, some people requiring 24 hour care and people who use personal budgets to pay for their care. In addition their care staff work with children and young people who require care in their family homes. The office based staff for this team comprise a care delivery manager, a scheduler and a care quality supervisor.

There is a registered manager for these personal care services, but a different person is the registered manager for nursing care. Nightingale Nursing Bureau is also based in this location. Much of their work is related to supplying the NHS with agency nurses and falls outside the scope of registration. This area of their work was, therefore, not inspected. However, they also directly support up to six children and adults with nursing needs to remain at home. This area of their work was inspected.

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.

In addition all parts of the service can request advice and support in relation to people with complex healthcare needs from a regional team of nurses, one of whom acts as the link nurse for this location.

The service had made improvements to the way visits to people who used the service were organised. Every person we spoke with had positive views about their regular care staff or nurses and praised them for their commitment and hard work. In most instances people could rely on visits from well-trained staff who knew them well. However, we found cover arrangements for regular care workers were still not as good as they should have been, particularly at weekends, nor were arrangements for visits requiring two members of staff. We saw the provider was working on a number of solutions to this problem, such as targeted recruitment, but they had not completely resolved the issues at the time of inspection.

The provider had instigated weekend working for the office staff in most teams, including managers. This ensured there were always staff on hand to deal with sudden care worker absence or emergencies involving people who used the service. Other teams had their own on-call arrangements.

Strengths of the service also included staff training, which was often followed up by competency checks; robust recruitment processes and service monitoring and evaluation. Care staff were now deployed for no more than 60 hours per week.

The service benefited from good management and leadership in many ways as managers knew their teams and the people they supported well and there was evidence of collaborative working to solve scheduling and other problems. Systems were in place to monitor and evaluate service provision. However, some staff, people who used the service and their relatives complained to us about inconsistent responses from staff based in the office.