Alas Healthcare

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated inadequate.

This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulations in relation to safe care and treatment as people’s risks had not always been assessed and their medicines were not always managed safely. The service was also in breach relating to fit and proper persons employed due to unsafe staff recruitment. Failure to protect people from abuse. The provider had also not notified CQC of required incidents and was in breach of the regulation in relation to notifications.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not consistently promote a proactive and positive culture of safety based on openness and honesty. Staff did not always recognise, investigate, record, or report safety concerns and incidents appropriately. As a result, the provider did not always identify learning opportunities or embed improvements to promote good practice.

The registered manager told us they had only experienced one incident and had taken appropriate action in response. However, we identified other incidents which had not been identified as safety incidents, recorded, reported or investigated to ensure people and staff practice remained safe. This limited the provider's ability to identify themes, learn from events, and reduce the risk of recurrence.

An effective system was not in place to ensure the provider received safety alerts from the government, local authority and CQC which informed them of upcoming risks along with themes and trends to ensure they could take appropriate action to mitigate these risks. The provider had therefore not acted on a national safety alert relating to the known fire risks associated with flammable emollient creams used by people with skin conditions to ensure people would be kept safe.

The provider did not consistently work with people, their representatives, and healthcare partners to establish and maintain safe systems of care. The provider did not always assess, manage, or monitor risks to people's safety effectively.
The service did not always complete comprehensive assessments when people returned home following a hospital admission. This meant people’s care arrangements had not been reviewed to determine if the support provided remained appropriate. Staff also did not always have up-to-date information about people's needs and risks to support safe care delivery.
One relative told us their family member was discharged from hospital and received support from Alas Healthcare. However, no member of staff visited to assess their needs or develop a care plan. The relative said, "Mum was discharged from hospital with help coming from Alas but no one had come out to speak with Mum about her needs."
The relative also told us they contacted Alas Healthcare after their family member returned home from hospital and spoke with a person they believed to be the manager. They explained there was no information available in the person's home to guide staff about their care and support needs. The relative told us no action had been taken following this conversation, and they had not been contacted again. This showed the provider had not always responded effectively to concerns or ensured people had appropriate assessments and care planning in place following discharge from hospital.

The provider did not consistently work with people and healthcare partners to understand what being safe meant to them or how to achieve this. The provider did not focus on protecting people from abuse, discrimination, avoidable harm, and neglect, or on promoting people's right to live safely. The provider did not identify, escalate, and share safeguarding concerns in a timely and appropriate way.
During our review of daily care records, we identified potential safeguarding concerns that the provider and staff had not recognised or escalated. We shared these concerns with the local authority and the provider. Following our feedback, the provider told us they would take immediate action to protect people and reduce the risk of harm. This demonstrated that the provider did not always identify, monitor, and respond to safeguarding concerns to ensure people's safety.
Feedback from the local authority indicated the provider had not always worked effectively with them in relation to several safeguarding concerns prior to our inspection. The provider had not notified us of all these safeguarding concerns through the appropriate statutory abuse notification process. The provider must submit notifications without delay and provide updates when further information becomes available to enable CQC to monitor whether appropriate action has been taken
However, records showed the provider had investigated some safeguarding concerns and had implemented actions to address identified issues. The provider had also shared some learning and required improvements with staff during meetings.

The provider did not identify, assess, and manage risks. Staff did not always provide safe, person-centred care that met people's needs and supported them to achieve outcomes that were important to them.

All risks relating to people’s care had not been considered during assessments, including those relating to personal care, moving and handling, environmental safety, medicines and people's health conditions. Risk management plans were therefore not in place to ensure staff would know how to recognise all risk to people and what action to take to keep people safe. Relatives and staff also raised concerns about the lack of accurate and comprehensive information regarding people’s risks and care. This placed people at risk of receiving unsafe care.

Although the provider had completed some risk assessments, these often-contained generic information and did not clearly describe individual risks or the actions staff needed to take to keep people safe. For example, one person required a highly clinical approach to their care. However, records did not explain how staff should meet their needs or what control measures they should follow to reduce risks. This sits outside of the regulated activity of personal care and we saw no evidence of professional oversight, delegation or appropriate staff training. We had to seek additional information from staff to understand how they provided care and support. Following the inspection, this person no longer received a service from the agency.

Care plans for people living with diabetes did not contain sufficient information about how their condition affected them or how staff should support them safely. For example, information did not specify whether diabetes was managed through medicine, diet, or a combination of treatments. When we asked the registered manager, they told us they did not know because a nurse managed the person's diabetes care. Training records also showed staff had not received diabetes-specific training, which increased the risk staff may not have had the skills and knowledge required to support people safely.

We identified similar shortfalls in information for people with urinary catheters, who had pets in their homes, were cared for in bed, living with dementia, and people at risk of skin damage. Care plans did not describe these risks or the measures staff should take to reduce associated risks and maintain people's safety.

However, people told us they felt safe and supported by the staff who regularly provided their care. The provider informed us they would review their risk assessment process.

The provider did not identify, assess, and control risks within the care environment. The provider did not always ensure equipment, facilities, and systems supported the safe delivery of care.
One relative told us they lacked confidence in some staff members' moving and handling practices and did not believe staff had received sufficient practical training. They said, “I saw them physically lean over the chair with a footrest, the reclining ones, and lift him up out of there in one go which isn’t the right technique.”
During the inspection, we asked the registered manager whether any people using the service required moving and handling equipment, such as hoists, to support safe transfers. The registered manager told us no one using the service required this equipment. However, our review of daily care records identified staff used a hoist to transfer one person. Care records and risk assessments did not reflect this support need and did not provide staff with guidance on how to use the equipment safely for this person. This placed people at risk of receiving unsafe care.
Training records showed staff had completed moving and handling training. However, the provider had not completed competency assessments to assure themselves staff applied this training safely and effectively in practice. In addition, records did not consistently demonstrate that equipment had been checked to ensure health and safety requirements had been met and equipment was safe to use.
The provider had completed some environmental risk assessments to identify and reduce some risks within people's homes. However, these assessments were not always comprehensive or robust. For example, people who used topical emollient creams associated with an increased fire risk did not have individual risk assessments that considered the level of risk or identified the precautions required to keep them safe.
Environmental risk assessments also lacked important information about people’s individual fire safety. Fire risks within people's homes had not been comprehensively assessed and did not include information how people would evacuate in an emergency, or the location of gas, electricity, and other utilities that may require isolation during an emergency situation.
For people with reduced mobility, assessments did not always describe the support required to safely move around their home or what equipment they used, such as walking sticks or other mobility aids and any associated risks. This meant staff did not always have the information they needed to support people safely and reduce the risk of injury.
We discussed these concerns with the registered manager during the inspection. In response, they told us they would complete environmental risk assessments for all people using the service. These concerns demonstrated that the provider had not consistently identified, assessed, and mitigated environmental and equipment-related risks placing people at risk of harm.

The provider failed to operate effective recruitment processes to assess whether newly recruited staff had the necessary experience, competence and suitability to carry out their roles.

Recruitment records did not always contain full employment histories, and the provider had not always obtained satisfactory evidence of applicants' conduct in previous health and social care roles. The provider's recruitment audit processes had not identified these omissions, which meant they could not be assured that all staff were suitable to work with vulnerable people.

Staff received supervision; however, records did not always demonstrate when these sessions had been completed and agreed, as associated documents had not always been signed by staff. Staff completed mandatory training through a combination of face-to-face and e-learning methods. The provider also carried out spot checks of staff practice. However, where these checks identified areas for improvement, records did not consistently detail the actions required, timescales for completion, or arrangements for follow-up monitoring.

Staff had received moving and handling and medicine training. However, the provider failed to identify some people required hoisting and records showed some staff needed improvements on how they supported people with manual handling. For people who required support with medicines the provider had not completed any competency assessments to ensure staff were working in accordance with the provider’s policy. Staff practice and knowledge shortfalls had therefore not always been identified to ensure prompt development support would be provided when needed.

Most people told us they were satisfied with the punctuality of their care visits. However, some relatives raised concerns about the quality and oversight of care provided. One relative told us they felt staff did not always remain for the full duration of scheduled visits and said there were additional tasks staff could have undertaken to support their family member around the home.

Another relative told us they did not have access to information about the care their family member received. They said there was nothing available for them to check which staff had attended, the times of visits, or the care and support provided. This meant the provider did not always ensure people and their representatives had clear information about the staff delivering people’s care and the tasks that had been completed.

The provider did not consistently assess and manage the risk of infection. The provider did not always identify, monitor, and control the risk of infection spreading or share concerns with relevant agencies in a timely manner.
Care plans did not provide staff with sufficient guidance on infection prevention and control. For example, daily care records and feedback confirmed that one person used a urinary catheter and catheter bag as part of their care and support. However, care records did not include information about catheter care, the associated risks of infection and how to reduce these, or the action staff should take if they identified signs of infection or other concerns. This meant staff did not always have the information they needed to support people safely and reduce the risk of avoidable harm.
We received mixed feedback from people and their relatives about infection prevention and control practices. Some people told us they were satisfied with how staff managed infection risks. However, others reported concerns about staff practice. They told us staff did not always wash their hands, wear uniforms, or use appropriate personal protective equipment (PPE) when providing care and support.
The provider had undertaken spot checks to observe staff’s IPC practice. For those staff where improvements were required, records did not show what action had been taken to support staff to improve their practice. These concerns demonstrated that the provider had not consistently ensured staff had clear guidance and oversight to manage infection prevention and control risks effectively and protect people from the risk of infection.

The provider did not consistently ensure medicines and treatment were managed safely or in a way that met people's needs, preferences, and outcomes. The provider did not involve people appropriately in planning and reviewing the support they required with their medicines.

Throughout the inspection, the registered manager stated that staff did not provide medicines support to any people using the service. As a result, the provider had not established appropriate systems, records, or oversight arrangements for the safe management of medicines.

However, people, relatives, and staff gave conflicting information. People and their relatives told us staff provided support with medicines. Staff also told us they prompted people to take their medicines. Records we reviewed showed staff either prompted or administered medicines for some people. Despite this, the provider had not completed medicines risk assessments, maintained Medicines Administration Records (MARs), or kept accurate records of the medicines people were prescribed. This meant the provider could not assure themselves that staff supported people with medicines safely and consistently, increasing the risk of people experiencing avoidable harm.

Staff had completed medicines training; however, the provider had not carried out practical competency assessments to ensure staff could apply their training safely and in line with legislation, best practice, and national guidance. When we asked staff how they identified which medicines people were prescribed, one staff member told us they referred to the person's blister pack. This demonstrated that staff did not have access to formal medicines records to guide and monitor medicines support. Care staff must be able to identify the individual medicines before they administer them.

Records for people who required topical creams to manage skin conditions, maintain skin integrity, or reduce the risk of pressure damage did not provide sufficient guidance for staff. Care records did not consistently identify where creams should be applied, the frequency of application, or the quantity required. The provider had also failed to maintain topical medicines administration records in line with best practice. This meant the provider could not demonstrate that people received their prescribed treatments safely and as intended.

Care plans contained inconsistent and unclear information regarding medicines support. Records included generic medicines sections with multiple options but did not clearly state whether people required support with medicines, the level of support needed, or who was responsible for managing medicines. This increased the risk of staff misunderstanding people's needs and providing inconsistent care.

Effective medicines management relies on accurate, complete, and up-to-date records. The provider had not maintained sufficient medicines records to protect people or provide staff with clear guidance on how to support people safely.

During our inspection feedback, the registered manager acknowledged that staff did support people with medicines. They told us they would implement appropriate medicines management processes, records, and oversight arrangements to ensure people received safe support with medicines in line with national guidance, legislation, and best practice.