Archived: Allied Healthcare Bury St Edmunds

The service is registered to provide personal care to people who live in their own home.

There was a registered manager in place. 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.

The manager organised staff to carry out assessments to see if the service could meet people’s needs. Careful consideration had been given to determine if the service had sufficient staff to meet individual’s needs with regard to the location of where people lived. This branch of the service had taken over the work of a recently closed branch in Clare. An active and robust recruitment campaign for new staff had been embarked upon to ensure sufficient staff were available to attend to people’s assessed needs.

An assessment of people’s needs was carried out prior to the service providing care. This included risks to the individual receiving care and environmental risks. We saw that risks reviews for people were in place and reflected the current situation.

The provider had a safeguarding policy for staff that gave guidance on the identification and reporting of suspected abuse. Staff we spoke with were aware of how to raise and concerns regarding suspected abuse because of the training that had been provided.

There were sufficient staff to support people safely and provide care. Some people told us that the service staff did not miss their call, but were sometimes late. That is they came over half an hour past the allocated time. People we spoke with told us that this had improved recently. Some people had also found that when they wanted to change the time of their visit for one day, to attend an appointment. The service was not always able to accommodate this change. When the service staff were running late or in danger of missing calls to provide care to people, the service had back-up plans in place to deliver the care to people. We were also told that the service tried to ensure that when a person specified the gender of the staff member to care for them, the service usually was able to accommodate the request. If it could not then service staff did inform people in advance. The service had been able to recruit more staff in the past few months and hence was in a better position to provide the gender of staff of people’s choice and also to arrange visits within the allocated time.

All people we spoke with had a care plan and they considered it was accurate. We saw that the plans were organised into a structure which identified what the staff were required to do at each visit. We also saw that at each visit the staff had written in the notes what had been achieved. The plans were person-centred and emphasis had been placed upon how to address the person and who to contact in an emergency. The service had undertaken a considerable piece of work to introduce a new care plan format in April 2015. The individual’s care plans were reviewed as required to ensure they reflected the needs of the person.

Training records informed us staff had received training to provide medication safely and the service had medication procedures in place which had been reviewed. The service had an equipped training facility and staff had received training in mental capacity and various subjects so that they could provide support to people with regard to their needs such as diabetes.

People and their relatives gave positive feedback about the staff that provided care. The service provided supervision and spot checks to support the staff. The service had policies and procedures in a place and staff told us that they had been given time at their induction for important information to be explained to them. Staff we spoke with considered they were well supported especially as they could raise matters as they happened with the service senior staff.

People and their relatives told us they were involved in the planning of their care and support. They felt that the service listened to their views. They told us that when they contacted the service their calls were always answered and staff tried to support and help them. At the time of our inspection the service informed us there were no outstanding complaints.

The service had systems in place to monitor the quality of service and had worked with people using the service and members of staff when improvements had been identified for them to be implemented. There was an on-call service available for staff and people using the service to contact to request support or raise a matter of concern.

During this inspection we visited the service's offices and looked at a sample of records held there. During the course of the inspection we contacted eight people who used the service or their relatives. We also spoke with seven staff including the registered manager, recruitment officer and care staff.

This is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff. People we spoke with told us that they were always treated with respect, given choices and never discriminated against.

Systems were in place to make sure that staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

Risk assessments had been undertaken and safe systems of work developed. This reduced risks to people who used the service and staff.

Procedures were in place for staff to respond to concerns or allegations of abuse. The service ensured staff were aware of their responsibilities in respect of whistleblowing.

Care records identified the level of support people needed. Staff who supported people with their medication needs had received appropriate training. This helped to ensure that people were kept safe and their needs were met.

The service had a policy for the Mental Capacity Act 2005 (MCA). Staff training included specific training on MCA. Staff inductions included dementia care which covered consent and best interest decisions for people.

Staff were able to explain how they would report concerns to the provider and said that these were acted on.

Is the service effective?

People's health and care needs were assessed. Nutritional needs, mobility, medication and equipment needs had been identified in people's care plans where required.

People's care needs were taken into consideration when the staff supported them. People's daily records showed the support people received during their visits.

Is the service caring?

People were supported by kind and attentive staff. One person's relative said, 'They (staff) are excellent. Could not do without them." A person that used the service told us about staff, "They are lovely. I couldn't ask for more."

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service had a robust system for the interrogation and learning from all significant events, involving three layers of checks within the organisation. We saw records confirming regular quality checks were undertaken in respect of care staff and the recording maintained in people's homes. This showed us that the service responded appropriately to any areas where improvement was required.

Is the service well-led?

Staff felt supported in their roles through training, staff meetings and supervision.

The service had an effective quality assurance system in place which included audits of records and supervision and training of staff.

The service had a good induction program which had recently been changed and improved further. Staff received all their mandatory training before they started work. They were paired up with a mentor to support them whilst they were learning what their role entailed and were introduced to people who used the service.

You can see our judgements on the front page of this report.

Before the inspection we received information of concern. The concerns related to poor record keeping. They suggested records did not show what care and support people had been provided. They told us that care calls were not scheduled around people's needs and were not provided at a time of their choosing. They told us the service was short of care staff.

We identified concerns with staffing levels and found that, particularly at weekends, the service had less staff to cover calls. This resulted in people not receiving their call at their preferred time and two people told us they had calls missed. We saw from the records kept by the provider that any missed calls had been recorded and investigated and reasons recorded. The service raised a safeguarding alert to ensure other agencies were aware when they had been unable to fulfil their contractual arrangements. This meant that the provider monitored missed calls and took actions to reduce the likelihood of this happening again.

We looked at care records, and care plans and found these to be of a high standard. We saw that the provider had introduced regular record audits and was able to show us what actions were taken if shortfalls in record keeping were identified. This meant the provider had ensured that the records were fit for purpose and showed how people's needs were being met.

We had received an action plan from the provider telling us they were not compliant and had taken action to address concerns we had on risk assessments for pressure area care. However we found at this inspection that no progress had been made. We found that care plans were not currently being reviewed with vital documentation missing. One person did not have a care plan for two months.

We found that 13 care staff had left employment with the service. Three care co-ordinators were no longer working in the office. The service had been recruiting new staff to replace these people and staffing matters were set to improve.

We inspected how complaints were handled and found they were not being appropriately managed.

At this follow up inspection we found that a team of people had been based at the agency in order to make improvements. We found that the provider had made progress to review care plans and improve the information in medication administration charts. We were told by managers that reviews had been completed on 40 care plans and 60 medication administration records. We sampled 11 care plans and found that progress had been made to review nine of these and the other two were in progress. We spoke with four care staff who told us matters had improved with care plans and medication charts being up to date.

We visited three people in their own homes and asked them about their care. They were positive about the care they received. One person told us "I receive the roster of what staff are coming to support me in good time now. There are no gaps on it like there used to be. My care plan is here, but I like to talk the new staff through my care needs. The office staff are courteous and helpful to me."

We found that there were clear plans in place to state when people would be visited, for how long and what tasks would be completed in that time. One person who used the service told us, "They are here on time". Another person told us "They are pretty reliable. I have got a copy of the plan and they have stuck to it". Most people experienced care, treatment and support that met their needs and protected their rights.

Some peoples care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare in respect of assessment and planning for pressure area prevention.

There were enough qualified, skilled and experienced staff to meet people's needs. Three people we spoke with told us that they had a regular group of people who supported them. That they arrived on time and would telephone if they were to be late for any reason. One person told us, "I have my regular group of people that I can have a laugh with. I treat them like friends. They are lovely girls and I trust them". Another person told us, "I like all the staff. They are very pleasant".