Archived: Allicare

Updated 23 October 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was completed by two inspectors, one inspection manager and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection. This was to update the provider’s contact list and to arrange to speak to people using the service to gather their views on the service they received. We also wanted to arrange to visit some people in their homes and needed to gain their consent. This meant we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 27 February 2020 and ended on 11 March 2020. We visited the office location on 27 and 28 February and visited people in their own homes on 2 March 2020. We completed the inspection on 11 March 2020, when we arranged a telephone conference to deliver the feedback to the provider and their representatives.

What we did before the inspection

We reviewed available information we held about the provider. We spoke with professionals who worked with the service and looked at information held in the public domain. This information helps support our inspections.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

During the inspection we spent time in the offices of the service and spoke with eight staff including the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We spoke with the registered manager, care coordinators, a team leader and the trainer. We also spoke with five staff and received surveys from eight others. We spoke with people about the support they received. We spoke with seven people that used the service on the telephone and three of their relatives. We visited three people that used the service in their homes and spoke with two relatives and two visiting professionals. We also received feedback from three other professionals.

We looked at the care records for nine people who used the service in the office and three in people’s own homes. We reviewed management information including audits, five staff personnel files and meeting minutes.

After the inspection

We continued to seek assurances from the provider around the information we had received on site and requested additional information. Not all the information requested was returned to us. We continued to seek assurances from other professionals around the quality of the service.

Updated 23 October 2020

About the service

Allicare domiciliary care agency provides personal care to people living in their own homes. At the time of the inspection the service was supporting 67 people. People were supported with varying needs, some requiring just a few hours of support a week to others who required live in staff to provide support 24 hours a day.

We were told everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We found ongoing concerns in how the provider assessed risks to people using the service. This included risks in changing care needs and how medicines were administered. There was not enough staff to ensure the rota was covered in a way that met the needs of people using the service and management were frequently used to support this. Staff were recruited safely and we found staff had the required equipment to control the risk of infection

People had not received assessments to determine their capacity to consent to care and treatment and holistic assessments considering people’s wider circumstances had not been completed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff had received more training since the last inspection but predominantly training did not include recent changes in legislation and best practice guidance. Staff did not have their competency tested to ensure they could effectively implement any training they received. People were supported to have access to enough nutrition and hydration but there were some concerns noted in how people were supported with special diets.

People told us care staff had improved since the last inspection and staff were generally more caring. But people were not involved enough in agreeing how and when their care was delivered. Staff treated people with dignity and respect and were responsive to their requests for support.

Complaints were not managed effectively, they were not responded to appropriately and the provider did not have systems in place to identify themes and trends from complaints received, in order to make any changes required to service delivery. People did not receive care specific to their preferences. Care plans were often not up to date with the most recent information and some areas of people’s support needs had not been assessed or reviewed. End of life care was delivered with the support of local district nursing teams.

A recent satisfaction survey had contained some positive comments and showed improvements had began to be made. However, a lack of an effective governance and quality audit system did not allow this to be evidenced. Action plans from the previous inspection were signed off as completed when there was clearly more work to be done, this included reviews of care plans and the inclusion of best practice guidelines in current policy.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 26 September 2019). Multiple breaches of regulation were found. The provider completed an action plan in January 2020 to show what improvements they would make and when. At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to managing and identifying risk, the safe management of medicines and protecting people from abuse. We identified further breaches due to an inadequate number of staff who had received effective training to deliver a service in line with the requirements of the regulations. There were also breaches identified in how the service acquired appropriate and lawful consent, how the service managed complaints and the governance and audit of the service. Lastly, we found a breach in relation to the lack of provision to meet the specific and individual needs of people using the service. We have also issued three recommendations; one in relation to ensuring there are evidential checks around the competence of internal promotions, one about the timely completion of assessments and one ensuring that advice around people’s dietary requirements from professionals is incorporated into care plans.

Any regulatory action that was planned to be taken was aborted as the service ceased to operate. The provider told us they no longer delivered a regulated activity to people.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.