Archived: Alo Care Community Services

The inspection took place on 10 and 13 March 2017 with further evidence and phone gathered following these visits. Alo Care Community service is registered to provide personal care to people living in their own homes. At the time of our inspection, the service was providing support to four adults. Three people in receipt of support required 2:1 staffing. All four people required 24 hour support and one person only received a service during the weekend as respite support.

As a condition of registration the service must have a registered manager. 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. The manager registered with us was not managing the carrying on of the regulated activity at the time of the inspection.

The provider organisation was in an unsettled state at the time we inspected due to several changes in the management structure. The provider organisation had brought in a consultancy to assist with the organisational structure and we spoke with them during the inspection. Alo Care Community was being managed by the group manager and team leader at the time of inspection. Neither of these staff had previous management qualifications or experience.

The consultancy firm had spent time identifying gaps in the provision at the service and there was an action plan identified to meet these at the time we inspected. Some improvements had been implemented but the majority were in the planning stage and it was not clear about who would be overseeing these actions once the consultancy left.

People receiving support had complex needs including learning difficulties, mental health and autistic spectrum disorder. Some people were unable to communicate verbally and needed support to communicate in ways which were meaningful to them. Each person needed support to develop and maintain relationships both with staff, relatives and other people.

.

The service was providing accommodation for people without the correct registration in place to provide this regulated activity.

People were not supported safely because there were no systems in place to monitor or manage the risks people faced.

There were risks that people did not always receive their medicines as prescribed because there were some inaccuracies and errors in recording and no systems in places to monitor these.

Where there were identified safeguarding concerns, there were no effective systems in place and the service had not alerted external agencies about these concerns.

Staff had appropriate pre-employment checks but references did not consistently include assurances about previous conduct. Staff had training in some relevant areas, but they were not enabled to access further training and did not receive supervision or support to develop their knowledge or skills.

The service did not have capacity assessments in place for people in line with legislation and did not have paperwork available to assess a person’s capacity or make a decision in a person’s best interest where this might be required.

We observed some staff with people and saw that they knew people well and understood how to offer them choices in a way which was meaningful to them.

There were no systems in place to monitor whether people were receiving a balanced diet or share how people had been or what activities they had been involved with. The electronic recording system meant that staff were unable to access information from previous shifts to see how people had been and what support they had received.

People did not have access to consistent methods of communication which were meaningful for them. Staff understood how to communicate with people but the lack of consistency meant that people were not effectively enabled to make decisions about their support.

People did not receive person centred care which meant that there was an increased likelihood that they may become upset and staff did not have clear guidance about how to meet people’s needs.

Care plans identified goals which people wanted to achieve but did not include any plans about how to enable people to work towards achieving these.

Communication with relatives and professionals was not effective and we were consistently told that relatives were not updated or informed about how their loved one was being supported. Where complaints had been made, there were no consistent records of these and no evidence of investigations or outcomes from concerns raised. There was evidence that other electronic records had been altered by management to remove references to the use of restraint and to reduce the severity of incidents.

There were no systems in place to monitor the quality of services provided or to identify gaps or improve practice. There was a lack management oversight and staff did not have clear roles and insufficient management support.

Relatives all told us that the changes in organisational management were positive and gave examples of issues with the previous management structure. Monthly meetings had recently been introduced to enable relatives, staff and other professionals to meet and discuss how people were being supported and raise ideas and suggestions for improvements.

People had care plans which included a ‘pen picture’ which gave details about how people showed that they were upset or anxious and what support from staff would be helpful for people.

Staff understood how to support people when they became upset and consistently told us that they used restraint options as a last resort. They were able to explain what approaches they used to calm people and understood what triggers people had which could cause them to become upset.

Staff spoke with genuine affection abut people they supported and were enthusiastic about suggestions and ideas to improve the support for people. They felt that the changes in management were positive and wanted the chance to move forwards and improve the service for the people in receipt of support.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach under the Health and Social Care Act 2008. The overall rating for this service is 'Inadequate' and the service is therefore placed into '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 time frame. 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.

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.

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