Alma Care (UK)

About the service:

Alma Care (UK) is a domiciliary care agency that provides personal care and support to people living in their own homes. Not everyone using Alma Care (UK) receives the regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the time of our inspection visit there were 11 people using the service. The service had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Rating at last inspection:

At our previous inspection in June 2018, the overall rating for this service was 'Requires improvement'. However, we placed the service in 'special measures' because the service had been rated as 'Inadequate' in a key question over two consecutive comprehensive inspections. We found several issues which indicated a continued lack of good governance including a lack of effective systems to assess and monitor the quality of care people received.

Following that inspection we met with the provider to discuss our concerns. The provider sent us regular action plans stating how they were making the required improvements and the date by which these actions would be completed.

Why we inspected:

We scheduled this inspection based on the previous rating; as well as to check the provider had completed the actions set out in their action plans and made the required improvements. During this inspection we found the provider was meeting the regulations. The overall rating for the service is now “Good”.

People’s experience of using this service:

People felt safe receiving support from Alma Care staff because they were usually supported by the same staff who arrived for planned visits when expected and knew what to do once they arrived. Staff were caring and treated people with respect. They supported people in a way which maintained their independence.

People received their medicines safely and as prescribed. People were protected from the risk of infection because staff followed the provider’s infection control policies and procedures.

Appropriate checks were carried out on staff before they began to work alone with people. Staff received relevant training, supervision and performance reviews which helped them to provide safe and effective care.

The provider conducted risk assessments to help make sure care was provided safely to people; and to protect people from abuse and foreseeable harm. Staff understood the importance of reporting accidents and incidents. The provider learned from accidents and incidents; and used this learning to improve the service. Staff knew how to recognise abuse and report any concerns about people’s safety.

The provider gave people regular opportunities to provide feedback on the quality of care they received. The feedback received by us and the provider was that people were satisfied with the quality of care they received.

Following our previous inspection, the provider took prompt action to improve the systems to assess and monitor the quality of the service. During this inspection we found that these systems were consistently used by the provider and were operating effectively.

Follow up:

We will continue to monitor this service and plan to inspect in line with our re-inspection for services rated "Good".

At our last announced comprehensive inspection of this service in October 2017 we rated the service ‘Requires Improvement’ overall because we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to safe care and treatment, safeguarding, consent, person-centred care, good governance and submitting notifications to the Care Quality Commission (CQC). The provider sent us an action plan setting out when the required improvements would be made. Some of these actions have been completed.

We found breaches of the regulations relating to safe care and treatment, fit and proper person’s being employed, the provider's failure to submit statutory notifications and good governance. The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Alma Care (UK) is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people. Not everyone using Alma Care (UK) receives the regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. Most people using the service lived in Surrey.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The registered manager told us there were nine people receiving the regulated activity (personal care) from Alma Care (UK) at the time of our inspection. After speaking to Alma Care (UK) staff and representatives of Surrey County Council, it appeared that Alma Care (UK) were providing the regulated activity to at least 13 people. As there was a discrepancy in the number of people the registered manager told us was using the service, on five occasions after the inspection we asked the registered manager to confirm the number of people using the service. These requests were responded to promptly but on each occasion the information supplied was incorrect. We have sent the provider a requirement letter. This means the provider is required under Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 provide us with information we have requested relating to the safety of people using the service.

At our previous inspection we found the provider did not always assess risks to people to ensure robust management plans were in place to reduce the risks. At this inspection, the provider had improved the assessment process so that people had personalised risk assessments and risk management plans in place. This included risks relating to people’s health needs.

The provider did not always manage people’s medicines safely. The provider did not know the number of people that staff were supporting with their medicines. In addition, the systems in place in relation to medicine administration were not sufficiently robust to help ensure people received their medicines safely.

Staff had received training in how to recognise and report abuse. They knew how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. However, the provider did not notify the CQC of an allegation of abuse as required by law. This meant the CQC did not have oversight of and could not fully monitor any risks associated with the service.

Appropriate checks were carried out on staff before they began to work with people. However, when these checks revealed that an applicant had a criminal record, the provider did not conduct a risk assessment or give any consideration as to whether it was safe for the applicant to work with vulnerable people. The provider deployed a sufficient number of staff to meet people’s needs. The provider continued to support staff with relevant induction, training, supervision and appraisal.

The provider had improved the systems to provide care in line with the Mental Capacity Act (MCA) 2005. The provider now investigated whether family members had legal capacity to consent on behalf of people and carried out mental capacity assessments when necessary.

The provider was now working more closely with people in developing and reviewing their care plans. The care plans we had access to were person-centred. Staff knew the people they supported well. People were treated with respect and their privacy and dignity were maintained. People received the support they needed in relation to eating and drinking and the provider supported people in relation to their healthcare needs.

People were satisfied with the care and support they received. They told us they were supported by a consistent staff team whose punctuality had improved recently. In addition, staff supported people to maintain their independence.

The provider had improved the processes for obtaining people’s feedback and using this information to improve the service. The provider had an appropriate complaints policy in place and people knew how to make a complaint.

Some aspects of the service were not well organised. The provider did not have effective systems in place to monitor, assess and improve the service. This was because the provider had not identified the issues we found during our inspection.

At our last announced comprehensive inspection of this service on 31 July 2015 we rated the service ‘Good’ overall and found the service was meeting the fundamental standards.

Alma Care (UK) is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people. There were six people receiving services from Alma Care (UK) at the time of our inspection. Most people using the service lived in Surrey.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider did not always assess risks to people to ensure robust management plans were in place to reduce the risks. This included risks relating to people’s health needs.

The provider did not always manage people’s medicines safely. The provider did not provide us with all records relating to medicines management we requested. In addition, medicines records the provider shared with us for one person indicated staff recorded medicines administration poorly which meant people were at risk due to poor medicines practices.

The provider did not always provide care in line with the Mental Capacity Act (MCA) 2005. This was because the provider did not investigate whether family members had legal capacity to consent on behalf of people. In addition the provider did not carry out mental capacity assessments when necessary and did not follow procedures to make decisions in people’s best interests when people were found to lack capacity. The provider did provide training to staff to help them understand their responsibilities in relation to the MCA.

The provider did not always involve people in developing and reviewing their care. In addition, the provider did not ensure people’s care plans were detailed and contained information about the person’s background, people who were important to them, how they would like to receive their care and what mattered to them in relation to their care.

People were not always safeguarded from abuse and neglect because the provider had not made the necessary improvements to protect people after two safeguarding allegations relating to missed calls and lateness were upheld against the provider. The provider did not always deploy sufficient staff to support people safely.

The provider did not have effective systems in place to monitor, assess and improve the service. This was because the provider had not identified the issues we found during our inspection and there were no systems in place to monitor medicines management. In addition, the provider did not always seek feedback, or record people’s feedback as a way of improving the service.

The provider had not notified CQC of allegations of abuse made in relation to people using the service.

The provider continued to support staff with suitable induction, supervision and appraisal. The training offered to staff was suitable except for the lack of MCA training.

People received the support they needed in relation to eating and drinking and the provider supported people in relation to their healthcare needs.

One person was not satisfied with the way staff cared for them in relation to maintaining their dignity, although other people and relatives were satisfied in respect of this. The provider did not always treat people with respect by informing them when staff would arrive late to care for them. Otherwise the service was caring. Staff were kind and knew people well as people had consistency of care workers. In addition staff supported people to maintain their independence.

There was a complaints policy in place. The policy contained some inaccurate information which the provider told us they would correct as soon as possible. Some people told us they had not complained even though they had reason to in relation to missed visits and lateness. The service was not always well led and the registered manager was not always aware of their responsibilities. However, the registered manager involved staff in developing the service.

We found breaches of the regulations relating to safe care and treatment, safeguarding, consent, person-centred care, good governance and submitting notifications to CQC. We are taking further action in relation to the good governance breach and we will report on this when our action is complete. You can see what action we have asked the provider to take to address the other breaches at the back of this report.

We also gathered evidence of people's experiences of the service by reviewing completed satisfaction surveys. We saw the majority of people that responded were positive about the care received by the service.

We looked at the plans in place to provide care and support to people using the service. There were instructions and guidance for staff about how to meet people's care and support needs. Staff were also given guidance about what they should do to protect people who may be at risk of abuse, harm or neglect.

There were effective procedures in place to recruit and appoint staff and appropriate checks were made about staff's suitability to work for the service. People's views and suggestions were used to make changes and improvements that people wanted.