Archived: Allied Healthcare Keighley

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children.

The last inspection was carried out in February 2017; the report was published in September 2017. At that time the service was rated ‘requires improvement’ overall. The provider was in breach of three regulations relating to person centred care, (Regulation 9) staff training, (Regulation 18) and good governance, (Regulation 17). It was the second time the provider had been in breach of the regulations relating to person centred care and good governance and we took enforcement action. The provider sent us an action improvement plan and submitted regular updates on the progress they were making in bringing about the required improvements. During this inspection we found some improvements had been made however found further improvements were needed and the overall rating remained ‘requires improvement’. This was the third consecutive inspection when the overall rating was ‘requires improvement’. However, it was the first ‘requires improvement’ rating since the introduction of our new approach to inspecting services that are repeatedly ‘requires improvement.’

The service did not have a registered manager at the time of our inspection. 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.

Over the past three years, the service has had three changes of manager. The previous registered manager left approximately six months before this inspection. The provider had appointed a new manager but they told us they were leaving at the end of April 2018. We were concerned the lack of consistent leadership was preventing the service from fully implementing and sustained the required improvements.

People told us they felt safe and comfortable with the care workers who provided their support. Staff knew how to recognise and report concerns about people’s safety and welfare. When concerns were raised the service worked with other agencies in an open and transparent way to make sure they were dealt with properly.

All the required checks were done before new staff started work. This helped to protect people from the risk of receiving care and support from staff unsuitable to work with vulnerable people. We found improvements had been made to the way staff training was provided and most people told us they were satisfied staff had the skills they needed to carry out their duties properly.

Risks to people’s safety and welfare were not always properly assessed. This created a risk people would not always receive the right care and support. People’s care records were not always up to date or detailed enough to make sure staff had the information they needed to deliver appropriate care and support.

Overall, we found people were getting the support they needed with their medicines. However, further improvements were needed to ensure people consistently received the right support with prescribed creams and lotions and that records were clear and accurate.

The service had changed the way they organised and allocated staff since the last inspection. Most people told us this had improved the service they received in terms of both the timing of calls and the continuity of staff. The provider had further improvements planned including putting an electronic call logging system in place later in 2018.

People told us staff were caring and treated them with respect and dignity. We saw people were supported to make decisions about their care and treatment. When people were not able to give informed consent decisions taken in their best interests were recorded.

People knew how to make a complaint and the majority of people we spoke with felt their concerns were dealt with properly.

There were systems in place to monitor the quality and safety of the service but they were not always operating effectively. There were processes in place to seek the views of people who used the service. We received mixed feedback from people about how well the provider used their feedback to make improvements to the service.

During this inspection we found two breaches of regulation. These were related to safe care and treatment, (Regulation 12) and governance and record keeping, (Regulation 17). This was the third consecutive inspection where we found the provider in breach of Regulation 17. We are considering the appropriate regulatory response to our findings.

Allied Health Care Keighley is registered as a domiciliary care service to provide nursing and personal care to people in their own homes.

The last inspection was carried out in December 2015. At that time we found the provider was in breach of three regulations, Regulation 9 (person centred care), Regulation 18 (staff deployment) and Regulation 17 (good governance).

Since the last inspection two managers have left the service. The new manager who took up their post in January 2017 was not registered at the time of our inspection visit but has since completed the registration process. 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.

People who used the service told us they felt safe. Care workers knew how to recognise and report abuse. We found some of the office staff were not aware of the correct safeguarding reporting procedures although they had taken action to address the concerns raised. The service had co-operated fully with the local safeguarding and commissioning teams to make sure concerns were investigated and it was noted that the quality and depth of these investigations had improved since the appointment of the new manager.

We were assured the staffing situation had improved since the last inspection. People told us there had been improvements over the past three to four months. They said there was more consistency and they were now being informed when staff were running late. However, we found there was still room for improvement with some people reporting staff still seemed under pressure to rush to the next call. The registered manager told us they had recruited more staff and were making changes to the way rota’s were organised to further improve the service.

A record was kept of missed calls and they were investigated. However, without an electronic monitoring system we could not be assured that all missed and late calls were identified.

All the required checks were carried out before new staff started work. This helped to protect people from the risk of receiving care and treatment from staff unsuitable to work in a care setting. We found new staff received comprehensive induction training and had a period of shadowing more experienced staff before working on their own. However, we found the staff training records were not up to date and the provider could not demonstrate that staff had completed all the required training. The new manager had already identified this and was working to address at the time of our visit. There were systems in place to make sure staff received regular supervision however some of the staff we spoke with told us this had not been happening in recent months.

Risks to people’s safety and well-being were assessed. However, we found the records were not always detailed enough to ensure staff had the information they needed to manage risks. When people were supported with medicines this was recorded in their care plans but the medication administration charts were not always up to date and accurate.

There was out of hours telephone support for people who used the service and staff. .

Consent to care and treatment was recorded. We saw the relatives of people who lacked capacity were consulted about decisions but the records did not always show what legal authority they had to represent people’s views.

People who were supported to eat and drink by the service told us they were happy with the support they received. We found the records did not always have detailed information about people’s likes and dislikes.

The service worked with other professionals in health and social care to support people to maintain their health and well-being.

Most people were complimentary about the care staff and said their privacy and dignity was respected. We found the service was inconsistent in taking account of people’s individual and diverse needs. For example, some people’s preferences with regard to the gender of staff providing care were respected but others were not. We also found an inconsistent approach to the annual care reviews which meant some people were missing out on the opportunity to be involved in planning their care.

We found people’s assessed needs were not always fully or clearly recorded. In addition, we found there were still inconsistences in call times and calls were not always well spaced out. This created a risk people would not receive the right care to meet their needs.

Feedback from people about the effectiveness of the complaints procedures was mixed. For some people it had resulted in an improved service but for others it had not. The new manager had identified shortcoming in the way complaints were dealt with and was addressing this.

We found that although there were systems and processes in place to monitor the quality and safety of the service they had not been working effectively. The new manager was open and honest about the challenges which the service was facing. They showed us that although they had only been in post a few weeks they had started to identify and deal with the majority of the issues we found during the inspection. These included concerns around care documentation, staff training and the management and deployment of staff.

We found the provider in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 18(2) in relation to staff training and support, regulation 9 in relation to person centred care and regulation 17 in relation to good governance. These are repeated breaches also found at the last inspection in December 2015. The Commission is considering the appropriate regulatory response to these continued breaches of regulation and will publish our actions when any appeals processes have been completed.