Archived: Allied Healthcare Maldon

At our last inspection we rated the service as ‘inadequate’ in safe and well led. We had concerns about the impact and risk of missed and late calls resulting from insufficient staff, poor organisation and a lack of oversight. We found the provider in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, specifically Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good Governance) and Regulation 18 (Staffing).

We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This is because the service was not meeting some legal requirements in these two key questions. No urgent risks were identified in the remaining key questions through our ongoing monitoring so we did not inspect them. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Allied Healthcare Maldon on our website at www.cqc.org.uk.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a reablement service to adults on a short-term basis until they are able to care for themselves or alternative social care arrangements are made. Placements are predominantly for people recovering from a hospital stay. This location also provides a standard domiciliary care service. There was no indication that there were any significant concerns within this part of the service at the time of our inspection so we did not inspect this element of the service.

At the time of the inspection there was a registered manager, however the registered manager had taken time away from the service. The manager who had been covering this absence had left suddenly in the week before our inspection. A replacement manager was recruited shortly after our visit, so we were not able to measure the impact from this new appointment. 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 improvements had been made since our last inspection, however there had not been enough time to measure whether these improvements were sustainable, especially if the numbers of people using the service increased. In addition, the lack of an established management team had resulted in inconsistency and instability, which challenged the long-term success of any improvements at the service. We therefore found a continued breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection we spoke to people who told us they were anxious and felt unsafe due to rushed, missed and late visits. People who were now using the service gave us much more positive feedback and told us they felt safe.

There had been a marked reduction in the number of missed visits. There were very few missed visits and, where these happened, senior staff investigated each incident and took action to minimise the risk of them happening again. Staff stayed the required length of visit to ensure they carried out the agreed support tasks and people were safe.

There were systems in place to assess the level of risk of each person at the service. Senior staff assessed people’s needs to ensure staff had enough information to provide the support required and to make sure they were aware of any key risks staff should be aware of before care visits started. Care plans gave staff improved information about people’s needs. Staff carried out regular reviews to assess any changes in people’s needs and level of risk. People were supported to exit the service appropriately, freeing up staff to take on new people in a managed way.

Staff morale had improved since the last inspection as they felt they had enough time to meet people’s needs and respond to any concerns. However, communication at the service, particularly, from the senior managers to office staff, had not improved sufficiently to ensure the whole staff team were involved in driving improvements. The provider had failed to promote a culture where people felt able to speak out and together learn from mistakes and feedback.

The provider had made some improvements in the way they monitored the quality of the service, in particular, how they measured missed visits and responded to risk. However, the regular audits were not tailored to a reablement service and so were not a sufficiently robust and appropriate check on how well the service as a whole was working.

The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This is because the service was not meeting some legal requirements in these two key questions.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a reablement service to adults on a short-term basis until such time as they are able to care for themselves or alternative social care arrangements are made. Placements are predominantly for people recovering from a hospital stay. This location also provides a standard domiciliary care service. There was no indication that there were any risks, concerns or significant improvement within this part of the services so we did not inspect this element of the service.

At the time of the inspection there was a registered manager, however the registered manager had just taken time away from the service for maternity leave. An interim manager was in post to cover the day to day running of the service. 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 service was not safe. We found that a reablement service was provided to 530 people all who had been assessed as requiring social care support. We found that the majority of people had experienced missed and late calls due to insufficient staff, poor organisation and a lack of oversight. Missed and late calls had left several people at risk of harm.

Insufficient staffing levels meant that people did not receive the care that met their needs. Staff were systematically double booked for calls and unable to fulfil their rota requirements. Office staff were routinely calling several people each hour to let them know that their care call would not be taking place. Not all of these calls were being reported as missed calls so managers at Allied were not aware of the number of calls which were being missed.

Risk assessments were not up to date and those which were in place were lacking detail and in some cases, inaccurate. This meant that people’s risk rating was not appropriate to their actual level of risk. Therefore, when calls were being cancelled for low risk people, the staff could not be sure that the risk of missing this call was low and in some cases, this meant people were left at a high risk of harm.

There were insufficient numbers of staff available to carry out reviews and further risk assessments of people to ensure they received care that met their current needs. Several people were not being reviewed which meant that the service was continuing to provide a reablement service to people for much longer than they were contracted to do so. They were also continuing to take further new packages of care without the capacity to be able to do so.

Staff felt unsupported and not listened to. We found that whilst staff had raised the issues we identified, the management team had not recognised the extent of the lack of capacity and had focussed on the importance of keeping the contract going and accepting new packages of care over the safety of people using the service. During the inspection the opportunity to stop taking new packages was given and not accepted. Therefore, the Commission had to take urgent enforcement action to impose conditions on the registration of the provider in order to ensure the safety of people using the service and to support the service to implement the required improvements quickly so that the reablement service could continue safely.

At the time of writing this report the service had had some time to stabilise and recover. There has been a vast improvement in the number of late and missed calls which are now minimal. The provider has been working with the Local Authority commissioners to ensure further improvements are in place so that people receive a good quality service and are kept safe. At the time of writing this report the numbers of people using the service had reduced from 530 to under 200. This meant there was capacity to ensure people received their calls on time and for the allocated time.

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 insufficient 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.

Allied Healthcare Maldon provides two distinct services. One is a domiciliary care service providing long term personal care to people living in their own homes. The other is a short term reablement service providing care and support for up to six weeks of rehabilitation after being in hospital. The domiciliary care service covers the areas of Maldon and Basildon, whilst the reablement service covers the whole of Essex except for Southend on sea. At the time of our inspection there were approximately 470 people using the service, the majority of which used the reablement service.

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.

People were kept safe by staff who had the skills and knowledge about safeguarding and protecting them from harm. Staff knew what they would do if they had any concerns about a person’s health, safety or wellbeing. We saw that comprehensive risk assessments and care plans were in place to ensure that staff were aware of how to support people to remain safe in their homes and to be as independent as possible.

There were sufficient staff to meet people's needs and to manage risk safely. The recruitment process for all new staff was robust and all the required checks had been completed.

The registered manager and staff had taken steps to ensure that accurate medicine records were in place and maintained. People received their medicines as prescribed. We made a recommendation that the provider ensures that the medicine policy and procedure reflect current working practice guidelines.

Staff had access to relevant training and regular supervision to equip them with the knowledge and skills to care and support people effectively. They were aware of the principles of the Mental Capacity Act (MCA) 2005 when people did not have capacity to make their own choices and decisions. People or their legal representatives signed their consent to their care arrangements.

The service was meeting the Accessible Information Standard by ensuring people’s sensory and communication needs were met.

Support with food and drink of people's choice was provided and records of people’s food and fluid intake were kept if staff had concerns. Staff worked in cooperation and liaison with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely way.

Staff were kind and caring and treated people with dignity and respect. People and their families were involved in their care arrangements and on-going support plans.

Robust systems to monitor the quality of the service were in place. These included processes to support people if they wished to complain or raise concerns about the service. Complaints were taken seriously and were responded to in an appropriate and timely way. The provider had appropriately notified the Care Quality Commission of any significant events as required by law.

Effective management systems were in place which included a solid infrastructure, strong leadership and a staff team with the skills and knowledge to manage the service into the future.