Archived: Allied Healthcare Hull

During our inspection on 1 and 2 December 2016, we found the provider had taken appropriate action to achieve compliance with all of the regulations previously identified as non-compliant during the comprehensive inspection in June and July 2016. The service was rated 'requires improvement' at our inspection in December 2016 as we needed to ensure the improvements we found were sustained over time. At this inspection, we found the improvements have been sustained and we have rated the service as good.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC). Like providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found staff were recruited safely and sufficient numbers of staff provided individual packages of care and support. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns. Medicines were handled safely and staff had received training in this area. We saw people had assessments of their needs prior to the provider offering them a service and senior staff completed individual risk assessments and care support plans.

Staff understood how to gain consent from people who used the service and the principles of the Mental Capacity Act 2005 were followed. People who used the service were supported by staff to eat a healthy diet and drink sufficiently to meet their individual needs, in line with their personal preferences. We found people were supported by a range of healthcare professionals to ensure their needs were met effectively.

Calls were managed by an electronic system and travel time had been introduced that ensured staff had sufficient time to travel between people’s homes and stay for the full-allocated call time. This had been supported further by the redeployment of staff into teams where calls were closer together; meaning less travelling time was required.

Staff were observed as kind and caring in their interactions with people and privacy and dignity were respected

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The registered manager and staff were responsive to people’s changing needs. Reviews of people’s care were held on a regular basis and people who used the service were involved in the initial and on-going planning of their care. Care plans were in place, which focussed on supporting people who used the service to maintain their independence and ensure their care needs were met.

The service was led by a registered manager, who understood their responsibilities to inform the CQC when specific incidents occurred within the service. We found quality assurance systems were in place that consisted of audits, daily checks and questionnaires and details of any action taken to improve the service when shortfalls were identified.

A copy of the complaints policy and procedure was provided to each person and people told us they felt able to raise concerns with staff or the registered manager.

This unannounced comprehensive re-rating inspection took place on 1 and 2 December 2016. At the comprehensive inspection of the service in June and July 2016, we found the registered provider was non-compliant with regulations 9, 11, 12, 13, 16, 17 and 18 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. This meant the registered provider was not meeting the requirements of regulations pertaining to providing person centred care, obtaining appropriate consent and following the principles of the Mental Capacity Act 2005, providing safe care and treatment, safeguarding people from abuse and improper treatment, responding and acting on complaints, utilising effective systems to monitor and improve the quality of service provision and ensuring suitable numbers of staff who had completed relevant training and were supported effectively could be deployed to meet the needs of the people who used the service.

A registered manager was responsible for the day to day management of the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At this comprehensive re-rating inspection on 1 and 2 December 2016 we found the registered provider had taken appropriate action to achieve compliance with all of the regulations previously identified as non-compliant during the comprehensive inspection in June and July 2016.

At the comprehensive inspection of the service in June and July 2016, we found that people did not always receive person-centred care this was due to 160 care plans being out of date and not accurately reflecting the care and support people required. During this inspection we found that people’s care plans were up to date, reflected their current needs and provided appropriate guidance to enable staff to deliver person centred care in line with people’s preferences. However, we also found staff failed to deliver care at pre-arranged times which meant people did not always receive support in line with their preferences.

At the comprehensive inspection of the service in June and July 2016, we found people had not always provided consent to the care and support they received. People and friends and relatives had provided consent without the appropriate authorisation to do so. During this inspection we saw consent had been gained and recorded effectively and the service was working in line with the principles of the Mental Capacity Act 2005.

At the comprehensive inspection of the service in June and July 2016, we found people did not receive safe care and treatment. Risks to people’s safety were not mitigated and staff delivered care and support that had not been planned for or risk assessed. During this inspection we saw evidence that reviews of people’s care had been undertaken, new care plans and risk assessments had been developed, which included pertinent information to ensure staff could deliver care and support safely.

At the comprehensive inspection of the service in June and July 2016, we found people were not safeguarded from abuse and improper treatment by way of neglect. This was due to the service not being able to deploy sufficient staff to deliver the care and staff leaving care calls consistently early. During this inspection we saw evidence to confirm additional staff had been recruited and call monitoring information showed staff stayed for the full duration of the care call.

At the comprehensive inspection of the service in June and July 2016, we found complaints were not always responded to and investigated appropriately and complaints were not used to improve the overall quality of the service. During this inspection we saw complaints were acknowledged, investigated and responded to in a timely way. Responses to complaints were reviewed by senior managers to ensure they covered all areas of concern and were used to drive improvement whenever possible.

At the comprehensive inspection of the service in June and July 2016, we found the registered provider’s governance systems were inadequate and not operated effectively. During this inspection we saw evidence to confirm internal systems were monitored and used to ensure specific actions had been undertaken when required, such as reviewing people’s care and support, updating care plans and delivering staff training and support. However, the system required further development to enable it to drive improvement and ensure consistency across the service.

At the comprehensive inspection of the service in June and July 2016, we found suitable numbers of staff could not be deployed to meet the assessed needs of the people who used the service. Staff were not supported effectively and had not always completed refresher training when required. During this inspection we saw evidence to confirm all staff had completed refresher training in line with the registered provider’s policy and received effective levels of supervision, appraisal and mentorship.

This unannounced inspection took place on 30 June, 4 and 27 July 2016. A lead inspector conducted the inspection over the three days and was supported by a second inspector on 4 July 2016. At the last inspection of the service in December 2014, the service was complaint with all of the regulations we inspected at that time.

The registered manager had been in post for four months at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service did not have sufficient numbers of suitably qualified, competent, skilled and experienced to deploy. The service could not cover 430 care calls between 27 June and 3 July 2016. The service also had to permanently relinquish care packages for 17 people back to the local authority commissioners, Hull City Council as they did not have the staff meet their needs. The 17 people required an accumulative total of 567 care hours per week. People who used the service were exposed to the risk of abuse by way of neglect because the registered provider failed to ensure the service could deploy sufficient numbers of staff to meet their assessed needs.

The registered provider failed to ensure plans were in place to deal with emergency situations, including staffing shortages.

Call monitoring records showed that staff consistently failed to stay for the full duration of the care call. We saw that calls commissioned for 30 minutes were delivered in 11 minutes and those for 60 minutes were delivered in 38 minutes. Care calls were not always delivered at agreed times; records showed care staff arrived over two hours early for some scheduled calls.

During the inspection, the registered manager and care delivery director informed us they became aware, in March 2016, that records had been falsified within the service. This included the dates of when care plans for 160 people had been reviewed, and when audits had taken place for log books [records of the care and support that had been delivered] and medication administration records (MARs). As well as falsified dates of staff training, supervision and spot checks records. At the time of our inspection, three months after they became of the falsified records, no action had been taken to assess who needed a care plan review most urgently or what training staff required to ensure they were delivering care and support safely and competently.

Risks were not managed appropriately as the registered provider and registered manager were unaware of the care needs for 160 people. This meant the service was delivering care and support that had not been planned for or risk assessed.

The service failed to audit 175 logs book and 99 people’s MARs. The registered provider and registered manager had not assured themselves that people had received the care and support they had been assessed as requiring or even if they had any additional needs. They had not assessed whether people received their medicines as prescribed.

Safe recruitment practices were not followed. We reviewed 10 staff files and saw that seven staff had been offered a role within the service when only one reference had been obtained. The reference was not always from their last place of employment. Disclosure and Barring Service (DBS) checks were undertaken.

Due to the falsified records, the registered provider was not aware of the staff training updates which were required and failed to take action when they became aware of the issue in March 2016. When a review of staff files was completed, gaps in staff training and supervision were highlighted.

It was not clear if the service had gained people’s consent before care and support was provided. The principles of the Mental Capacity Act 2005 were not always followed. Care plans had been signed to provide consent by people who did not have the right to do so.

People were supported to maintain their health and were encouraged to eat a healthy and nutritious diet of their choosing.

Staff were not fully aware of people’s needs and did not know their preferences for how care and support should be delivered. People's preferences were not always recorded.

People did not receive effective person-centred care because they were not provided with the opportunity to discuss their strengths, abilities and level of independence

Complaints were not always responded to appropriately and the service failed to learn from the complaints they had received to improve the level of care and support delivered.

The registered provider failed to notify the CQC of specific events that occurred within the service including the falsified care and training records and the loss of staff which resulted in 180 people not having the care and support needs met.

The registered provider disbanded its internal auditing team in 2015 and failed to review the quality monitoring processes to ensure they remained effective. No auditing had occurred since October 2015 when numerous concerns were highlighted. These included not responding or handling complaints appropriately, annual reviews not completed as required, risk assessments not undertaken, financial transactions not recorded and gaps in staff training highlighted. There was no evidence to show that any of these issues had been addressed.

The registered provider failed to ensure they had maintained accurate, complete and contemporaneous records of each person who used the service. We found some people’s care plans had not been reviewed since their creation in 2013 and 2014.

We found multiple breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 and a breach of the Health and Social Care Act 2008 [Registration] Regulations 2009. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of Inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of Inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.