Background to this inspection
Updated
8 December 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on between 20 October and 2 November 2017 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us. We visited the office of the service on 20 October and 2 November, and also carried out telephone interviews with people using the service and care workers on 24 and 26 October 2017.
The inspection team consisted of one adult social care inspector, a pharmacist inspector and three experts by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who used this type of care service. The experts in this case had experience in caring for older people, people living with dementia, people with physical disabilities and people with mental health needs.
Before our inspection we reviewed all the information we held about the service. We examined the previous action plans sent to CQC by the provider and notifications we had received. Notifications are changes, events or incidents that the provider is legally obliged to send us within the required timescales. We spoke with two staff from local authority commissioning and safeguarding teams. We spoke with the local Healthwatch. Healthwatch are a consumer group who champion the rights of people using healthcare services. We used this feedback as part of our inspection planning process.
We asked the provider to complete a Provider Information Return (PIR). This is a document wherein the provider is required to give some key information about the service, what the service does well, the challenges it faces and any improvements they plan to make. This document had been completed and we used this information to inform our inspection.
During the inspection we reviewed eight people’s care information, nine people's medicine records and looked at a range of staff records, policies, procedures, auditing, rota information, survey information and IT systems. We spoke with 42 people who used the service and three relatives. We also spoke with 11 members of staff which included the registered manager, two care co-ordinators and eight care staff.
Updated
8 December 2017
The inspection took place on 17, 24, 26 October and 2 November 2017 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to assist us.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, younger adults with a physical or mental health disability, and children. At the time of the inspection, 111 people were using the service and were supported by 53 active staff members.
Not everyone using Allied Healthcare Redcar received the regulated activity of personal care; At this service CQC only regulates and inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where people were not in receipt of such care, the Commission takes into account any wider social care provided.
The service was last inspected by CQC in August 2016, at which time the provider was found to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During that inspection we found the provider did not ensure the proper and safe management of medicines. Risk assessments did not reflect people’s needs and people's risks had not been regularly reviewed. Staff did not always act upon risks when they were identified. Care records did not always match people’s needs. We found they were not regularly reviewed. We also found that not all staff had received the appropriate training and supervision support.
At this inspection we found improvements had been made and the provider had completed each of the improvement actions necessary. Care records had been improved and of the records we reviewed we found they were accurate and up to date. Training of staff had been addressed in relation to safeguarding and the Mental Capacity Act 2005 and improvements had been made. In addition to the above, staff now received regular supervision and checks on their competency. We saw that for those people with clinical needs such as pressure area care, risk assessments could be further improved and more detail was needed to ensure staff members were following safe infection control practice. We have made a recommendation about risk assessments.
The service had 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.
We found the arrangements for medicines management kept people safe. We looked at the medicine records of nine people who used the service. We spoke with staff about medication and reviewed the provider's medication policies.
People who used the service told us they felt safe and relatives said they had confidence in the ability of staff to keep people safe. Staff had received training in safeguarding and understood their responsibility to protect vulnerable adults from harm and improper treatment. There was an out-of-hours phone line through which people could seek assistance from the service in case of unforeseen circumstances. People reported they had not experienced any missed calls recently.
Risks were assessed by an area supervisor when someone first started using the service, and reviewed thereafter. Pre-employment checks for new staff members, including Disclosure and Barring Service checks, were in place.
There were sufficient numbers of staff on duty to meet the needs of people who used the service. People we spoke with told us staff stayed their allocated time and they were usually informed if their care worker was running late. A new electronic rota system using mobile phones had been recently implemented and we were told this helped prevent missed calls and meant staff were allocated in a more systematic way.
New staff received a seven-day induction, as well as shadowing opportunities. We found mandatory training covered a range of core topics, such as: safeguarding, infection control, dementia awareness, first aid and nutrition. The registered manager ensured staff completed refresher training.
Staff liaised regularly with external healthcare professionals and ensured their advice was incorporated into care planning.
Staff were supported through annual appraisals and a number of supervisions and observations throughout the year.
People who used the service and relatives consistently told us staff were caring, patient and upheld people’s dignity. People confirmed staff encouraged them to retain their independence on a day-to-day basis.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People told us they were encouraged to contribute to their own care planning and review, and felt partners in the process.
People who used the service and external professionals told us staff were accommodating to people’s changing needs and preferences.
People who used the service knew how to complain, and who to. This information was shared with people in a welcome pack. Complaints were thoroughly investigated and responses given and feedback about lessons learnt was shared with the staff team.
The registered manager and care staff were described in positive terms by people who used the service and relatives. The registered manager had worked to make improvements since our last visit and feedback from people and staff was that the service had improved. Auditing and quality assurance systems were in place to enable the provider to identify trends.
The culture of the service was in line with the goals of the statement of purpose, meaning people who used the service were supported to maintain their independence from care staff who demonstrated a good understanding of people’s needs and individualities.