Archived: Allied Healthcare Newcastle

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. These related to the breaches of regulations regarding safe care and treatment, consent to care and treatment and person-centred care.

We undertook a focused inspection on 26 July 2016 to check they had followed their plan and to confirm whether they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Allied Healthcare Newcastle on our website at www.cqc.org.uk.

Allied Healthcare Newcastle is a domiciliary care agency that provides personal care to adults and older people, some of whom may have a dementia-related condition. It does not provide nursing care. At the time of this inspection it was providing support to approximately 300 people in Newcastle upon Tyne and North Tyneside.

The service had not had a registered manager in post since June 2015. At the time of this inspection the registered manager from another local branch was attending the service two days per week to oversee the management of the service. We were informed they had recently applied to become the registered manager of this service as well as the one they were currently managing. We were advised this was an interim measure and a new manager had been hired and was in the process of undergoing pre-employment checks. 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.

We found that improvements still needed to be made with regard to the management of medication. The service had appointed a Medication Administration Records (MARs) monitor with responsibility for checking all MAR’s on a fortnightly basis. However, medication care plans and records we reviewed did not demonstrate that people had received their medication as prescribed. Risk assessments had not been completed for people who were self-medicating and ‘as required’ medication had not been documented in line with the provider’s policy. Care records and guidance for topical medication did not demonstrate these were being used as prescribed.

We found the provider had taken action to update the care records of approximately half of the people using the service. New care plans were comprehensive and captured full details of people’s needs and preferences as well as their consent to care and treatment. However the service did not have a robust plan in place for reviewing and updating all remaining care records in a timely manner. Care records we reviewed did not always accurately reflect the level of care people were receiving from the service. The records had not been updated in a timely manner to reflect changes in people’s care needs and care was not being reviewed on a regular basis.

We found a continued breach of regulation regarding safe care and treatment. We also found a breach of regulation in relation to the governance of the service. 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 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 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.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements. We undertook a focused inspection on 26 July 2016 to check the service had followed their plan and to establish whether they were meeting the legal requirements. During this inspection we found the provider had failed to meet the assurances set out in their action plan. We found a continued breach of legal requirements in relation to safe care and treatment and a breach of legal requirements in relation to good governance. As a result, we placed the service into special measures.

This inspection took place on 30 November and 1 December 2016 and was announced. The inspection was undertaken to establish whether the provider had made improvements following our previous inspections.

Allied Healthcare Newcastle is a domiciliary care agency registered with the Care Quality Commission (CQC) to provide personal care to people in their own homes. At the time of the inspection the service was supporting approximately 280 people living in Newcastle and North Tyneside.

The service did not have a registered manager. An acting manager had recently been recruited and had applied to become registered with the CQC. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that improvements still needed to be made with regard to medicines management. Clear and accurate records were not being kept of medicines administered. It was not possible to determine whether people had received their medicines as prescribed.

Possible risks to the health and safety of people using the service and the staff members who supported them were assessed. Action to mitigate or manage identified risks were built into care plans. However, potential risks to the overall service had not been adequately assessed. Robust plans were not in place to continue the running of the service in the event of an emergency.

The service had taken steps to safeguard people from abuse. Safeguarding and whistleblowing (exposing poor practice) policies were available for staff to refer to. These provided guidance to staff on the appropriate action to take if they suspected abuse or poor practice. Staff received safeguarding training and were aware of their roles and responsibilities in recognising and reporting any signs of abuse.

Recruitment systems were not always robust. The provider’s recruitment procedure stated it was acceptable to employ staff members where only one reference had been obtained. However, we found this was in contradiction of the terms of the contract held with one of the local authorities who commissioned care from the service. Checks were performed prior to taking on new care packages to ensure the service had sufficient staffing availability to cater for people’s needs.

With the exception of some of the office staff, we found staff had been provided with the support they needed in terms of training, supervision and appraisal to perform their roles effectively. The care co-ordinators had not received regular supervision to support them to perform their roles effectively.

We found overall the service was now working within the principles of the Mental Capacity Act 2005. New care documentation had now been introduced and implemented for all people using the service. This included a screening tool to look at people’s capacity to make decisions about their care and treatment. Information was also captured about any advance decisions people had made about their future care and treatment. Where people had appointed a representative to act on their behalf, the service liaised with them about the person’s care. People were also supported to have sufficient to eat and drink and to access other healthcare services

The majority of people we spoke with told us they received care from regular care workers. Overall people were positive about the care and support they received.

Since our previous inspection, action had been undertaken to review and update people’s care records. Staff used an electronic system to monitor review dates for people using the service and plan reviews of their care.

The service had a system for receiving and acting on complaints. Records showed action was taken to investigate complaints. The system had built in controls for a senior manager to only close complaints once they were satisfied appropriate action had been taken.

People, relatives and staff we spoke with did not feel the service was always well managed. People and their relatives told us they did not receive a rota, had little involvement with office staff and were not informed when care workers were going to be late. Similar comments had also been raised in the service’s annual satisfaction survey conducted earlier this year. This showed any action taken to address the comments had not been fully effective in resolving people’s issues.

The service had not had a registered manager in post since 2015. During this time the service had been managed for short periods of time by a number of different people. This had resulted in a lack of consistent management for staff. Office staff in particular had received limited management support during this time. Of the three care co-ordinators employed by the service we found only one had received a formal supervision session during 2016.

The service had a range of systems for monitoring and improving the effectiveness and quality of the service. We found these had not been utilised at the frequency stated in the provider’s policy. Documentation did not always clearly record areas for improvement or the remedial action taken. Audits had not also identified all of the shortfalls we highlighted during the inspection.

At the last inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures due to continued breaches in relation to safe care and treatment and good governance.

CQC is now considering the appropriate regulatory response to resolve the problems we found.