Allfor Care

Allfor Care is a domiciliary care agency providing care and support to people living in their own homes. The service was supporting 99 people at the time of our inspection.

Not 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 expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Staff had been recruited safely. They underwent appropriate checks before starting work at the service, including reference and criminal records checks. There were sufficient care staff rostered to ensure people’s needs were met. The provider monitored people’s care calls and we saw recorded evidence that lateness was discussed with the relevant staff members.

The provider had carried out person centred risk assessments for people and we saw these were regularly reviewed. People’s risk assessments were linked to their care plans which included guidance for care staff on reducing identified risks.

People’s medicines were managed appropriately. Staff administering medicines had received relevant training. People’s medicines administration records were audited regularly.

Staff had received training to ensure that people were safe. For example, training on safeguarding and infection prevention and control. Staff, people and family members told us personal protective equipment to carry out their tasks safely. People said that they felt safe with the care they received.

The provider had made improvements to their quality assurance processes since our last inspection. Systems had been put in place for monitoring of care calls and auditing of people’s care records and staff files.

People were asked for their views about the service on a monthly basis. The provider maintained a record of actions taken in relation to issues and concerns people had raised.

People and family members told us they received safe and effective care from staff. Staff members said they felt supported by the provider and received the information and support they required to do their work effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 23 October 2021) and there was in breach of regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were no systems in place for monitoring care calls, care records, and staff risk assessments. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider carried out regular reviews of risk management plans in relation to staff. We also recommended the provider carried out regular audits of staff files, including agency staff records. At this inspection we found the provider acted on these recommendations and improvements had been made.

Why we inspected

We carried out an announced focused inspection of this service on 23 October 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Allfor Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Allfor Care is a domiciliary care agency providing care and support to 104 people at the time of our inspection.

Not 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

The provider had made improvements to their quality assurance processes since our last inspection. However, we found there were no systems in place for the monitoring of care visits. Late or missed care visits were followed up by a telephone call. However, there were no records of reasons, nor actions taken to address late or missed visits. Some monitoring of people’s care records had taken place, but this was limited. The records we saw showed that while some people’s care records were audited on a monthly basis, there had been no auditing of other people’s records. This meant we could not be sure the provider had accurately assessed the quality of the service provided to people.

Staff had been recruited safely. They underwent appropriate checks before starting work at the service. The provider had made improvements in relation to ensuring criminal record checks had been sought for all staff. There was evidence of risk assessments being carried out for staff with previous criminal convictions. However, a risk management plan for a staff member was not being followed. The registered manager acknowledged the risk assessment and management plan should have been reviewed. A record for an agency staff worker showed there had been checks in relation to identification documents and records. However, the dates when their identification documents were verified were earlier than the dates on the documents. This meant we could not be sure the provider systematically reviewed staff records.

People and family members said that they received their medicines appropriately. The provider had made improvements to medicines administration records (MARs) since our last inspection. The daily MAR records were now being initialled by staff members prompting people with their medicines.

At our last inspection of the service, we found records were not accessible. During this inspection we were able to view the records we requested, including staff files, people’s care records, quality assurance records and staff rotas. The provider had installed a key safe in the office to ensure access to records in the absence of a key holder.

Staff had received training to ensure that people were safe. For example, training on safeguarding and infection prevention and control. Staff told us they had received training in relation to Covid-19 and they were given personal protective equipment to carry out their tasks safely. People said that they felt safe with the care they received.

People were asked for their views about the service on a monthly basis. The provider maintained a record of actions taken in relation to issues and concerns people had raised.

People and family members told us they received safe and effective care from staff. Staff members said they felt supported by the provider and received the information and support they required to do their work effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was Requires Improvement (Report published 16 March 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for the key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is now Requires Improvement.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last focused inspection, by selecting the ‘all reports’ link for Allfor Care on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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. If we receive any concerning information we may inspect sooner.

Allfor Care is a domiciliary care agency providing personal care to 90 people at the time of our inspection. This is help with tasks related to personal hygiene and eating.

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

The majority of care staff had been recruited safely. They underwent appropriate recruitment checks before they commenced working at the service. However, we found a criminal record check for a staff member was from another employer and was a year old when they started working for the provider This was outside the three-month limit for use of such checks from previous employers. Where criminal record checks had come from previous employers, information had been deleted so we could not see if the staff members had any previous criminal records. Furthermore, the provider had not maintained a record showing that they had discussed and assessed any risk related to staff declaring previous convictions or cautions on their job application forms. This meant we could not be sure that the provider had accurately assessed staff suitability and safety in relation to the work they were required to undertake.

People and family members said that they received their medicines appropriately. We were unable to view records of people's medicines during our inspection, so we requested copies to be sent to us. Medicines care plans and risk assessments appeared detailed and up to date. However, we were only sent two recent medicines administration records (MARs). The daily MAR records had not been initialled by staff and each entry was recorded with a P (for prompting). This meant the provider could not assure us that staff providing care had supported people with their medicines at the correct times or if the charts had been completed later by another staff member.

During our inspection we found that records were not accessible. On the first day of the inspection we requested to see all staff records. We subsequently reviewed the service’s rotas and found that we had not been shown records for a significant number of staff. We sent the provider a list of these to be available when we returned. On the second day of our inspection we found that some staff records were not available to us. When we asked to see people’s care plans, we were told that the registered manager who was unwell had the only key to the filing cabinet. This meant that, if the registered manager was away, office-based staff did not have access to people’s care records should there be an enquiry or concern.

Rotas were unavailable to us to view when we visited. We were told that this was because the staff who managed the ‘on-line’ rota system were not at work. We were not shown copies of manual rotas and there appeared to be no system for other office based staff to have access to the on-line rotas to check that staff had attended care calls.

The service’s policies and procedures were up to date and reflected good practice guidance, but we found a lack of evidence to show that they had always been followed.

There was an absence of evidence to show that the provider’s quality assurance procedures were robust. Information about quality assurance monitoring was limited. The records of monitoring of people’s satisfaction with the service did not appear to have been carried out regularly or consistently and there was no record of any actions taken to address concerns. Spot checks of staff practice had been carried out, but these were not collated and reviewed as part of the quality assurance process.

People and family members told us they received safe and effective care from staff. Staff members said they felt supported by the provider and received the information and support they required to do their work effectively.

Staff had received training to ensure that people were safe. For example, on safeguarding and infection prevention and control. Staff told us they had received training in relation to Covid-19 and they were given personal protective equipment to carry out their tasks safely. People said that they felt safe with the care they received.

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

Rating at last inspection

The last rating for this service was Good (Report published 19 March 2020).

Why we inspected

We received concerns in relation to staff recruitment and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Allfor Care on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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.

Allfor Care is a domiciliary care agency providing care and support to people living in their own homes in the community. At the time of our inspection the service was supporting 60 people. The majority of people supported by the service are older people living with dementia or other conditions associated with ageing. The service also supports younger people with complex physical impairments.

Not 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

The care and support provided to people was person centred. People’s care plans and risk assessments included information about their preferred care and support needs and preferences. Guidance for staff on ensuring that people were supported safely and in accordance with their wishes was included in people’s care records.

Staff had received training about safeguarding and knew how to respond to and report any allegation or suspicion of harm or abuse. They understood the importance of reporting concerns immediately.

The service’s recruitment procedures were designed to ensure that staff were suitable for the work they would be undertaking. New staff members were not assigned work until satisfactory references and criminal records disclosures had been received.

People received support from regular care staff. People and family members told us that they were informed if a staff member was off work and who would be replacing them. They told us that staff were rarely late. The service monitored staff absence and lateness using live information from an electronic call recording system.

New staff received an induction to the service before starting work. All staff received regular training to ensure that they were able to meet the needs of the people they supported. Staff also took part in regular supervision sessions to support them in carrying out their roles. Additional training in relation to people’s individual support needs had been provided to staff.

People and their family members were involved in making decisions about their care. They told us they had been involved in agreeing their care plans and had participated in reviews of the care and support provided to them. People and family members said that staff asked people for their consent to carry out care and support tasks.

Information about people’s religious, cultural and communication needs was included in their care plans. People had been matched with staff who were knowledgeable about their needs and preferences.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

People were regularly asked about their views of the care and support that they received. Spot checks to look at the quality of care and support had taken place in people’s homes. The provider had acted to address concerns arising from these checks.

Processes were in place to manage and respond to complaints and concerns. People and family members were aware of the service’s complaints procedure and knew how to make a complaint if they needed to.

The provider undertook a range of audits to check on the quality of care provided. Actions had been taken to address any concerns.

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

Rating at last inspection:

The last rating for this service was Good (published 15 August 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to inspect as part of our re-inspection programme. If we receive any concerning information we may inspect sooner.

Allfor Care is a domiciliary care service based in Kingsbury that provides a range of support to adults and young people living in their own homes. At the time of our inspection the service provided care and support to 26 people. The majority of these were older people living with dementia and physical conditions associated with ageing. The service also supported younger people with physical and mental health conditions and learning disabilities.

The current location Allfor Care was re-registered with The Care Quality Commission on 8 July 2016 due to a change of address. This was their first inspection under their new registration.

The service had 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

People who used the service told us that they were satisfied with the care that was provided to them. The staff memberswe spoke with also talked positively about the people who they supported.

People were protected from the risk of abuse. Staff members demonstrated that they understood how to safeguard the people whom they were supporting. Safeguarding training had been provided to staff and records of safeguarding concerns showed that the service had taken appropriate actions to address these.

Risk assessments for people were regularly reviewed and amended where there were changes in their needs. These contained guidance for staff members on how to manage risks.

the service had arrangements in place to ensure that people’s medicines were given and recorded. Staff members had received training in safe administration of medicines.

Staff recruitment processes were in place to ensure that workers employed by the service were suitable and of good character. Staff training met national standards for staff working in social care organisations and additional training had been provided to ensure that people’s individual needs were met.

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Staffing rotas were designed to ensure that there were enough staff on duty to meet the current support needs of people using the service and people said that they were supported by staff that they knew. There was an electronic system for ensuring that care calls were managed and monitored. Staff and people who used the service had access to management support outside of office hours.

The service was meeting the requirements of the Mental Capacity Act 2005. Capacity assessments were in place for people. People were asked for their consent to any care or support that was provided.

People’s care plans showed that religious, cultural and other needs and preferences were supported. People told us that staff members respected their wishes and treated them with dignity and respect. Care plans included information about people’s communication needs along with guidance for staff on supporting people to make decisions about their care.

People who used the service told us that they knew what to do if they had a concern or complaint. We saw that complaints that had been received by the service had been investigated and resolved to people’s satisfaction.

People who used the service and staff members spoke positively about its management. A range of processes were in place to monitor the quality of the service, such as audits and spot checks of care practice and documents, along with surveys of people’s satisfaction with their care and support.