Archived: Allied Healthcare - Bournemouth

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw written records that showed consent had been sought and obtained for people concerning; care planning and the sharing of information.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

' Is the service caring?

This inspection was carried out to check that areas of non compliance identified in our previous inspection that took place in May 2014 had been rectified. Therefore we did not specifically review this question.

' Is the service responsive?

This inspection was carried out to check that areas of non compliance identified in our previous inspection that took place in May 2014 had been rectified. Therefore we did not specifically review this question.

' Is the service effective?

This inspection was carried out to check that areas of non compliance identified in our previous inspection that took place in May 2014 had been rectified. Therefore we did not specifically review this question.

' Is the service well led?

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found that systems for assessing people's needs, planning how to meet them and recording how care had been delivered had been reviewed and improvements had been made. Each of the four files we looked at contained detailed assessments of each person's needs, a plan of how the needs would be met together with a risk assessment that identified any potential hazards and documented any actions that were to taken to reduce the risk. We also found detailed records for each visit that was made to a person using the service.

The inspection was undertaken by one inspector over the course of three different days. Time was spent in the office, visiting people in their homes and talking with staff. In total we visited four people in their homes. We contacted a further eight people by telephone to obtain their views on the care provided. We also spoke with one member of staff whilst they were at the office and three members of staff by telephone.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Where a need was identified a plan was in place to meet this need. For example, one person was identified that they were at risk of falling. Their care plan set out clear guidance for staff and included the equipment to be used to ensure their safety and welfare.

Risk assessments had been carried out both with regard to people's care needs, use of special equipment, such as hoists, and to any environmental hazards that may be present. Those staff that we spoke with were aware of people's needs and how to ensure that they were met safely.

People using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. All of the people that we spoke with told us that they felt safe with staff and the care provided. We spoke with staff who understood their responsibility to safeguard vulnerable adults. They received training about safeguarding vulnerable adults when they started working at the agency and this was updated periodically. One person told us, "I feel safe with [staff] I think they are well trained."

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

Is the service effective?

People told us that they were happy with the care they received and felt their needs were well met. It was clear from what we saw and from speaking with staff that they understood people's needs, likes and dislikes and knew them well. One person told us, "Over Christmas there were a lot of problems, changes to management, lack of communication from the office, but the new manager took on-board my concerns and they are being addressed. I did have a lot of different carers but there now seems to be a regular four since she took over."

We found that there were systems in place to monitor the quality of the service provided and staff had received training to ensure that they could meet people's needs.

When a person was unable to make decisions independently, "best interest" processes were not always followed in line with the Mental Capacity Act 2005 (MCA).

Is the service caring?

Throughout our inspection we received positive feedback from people who use the service and their relatives. One person commented that staff acted in a kind and professional manner. Another person told us 'They are very friendly and helpful, and do what I want them to'. A relative told us, 'I have a fantastic carer and in the main been able to stick with the same one. My husband gets muddled if there is someone different."

People confirmed that staff always took care to protect their privacy when providing personal care and encouraged them to do as much for themselves as possible even if this took longer. One person told us, "I don't embarrass easily. They cover me up bit by bit and chat to me.'

Is the service responsive?

We found that people's needs had been assessed before the package of care was started to ensure that they could meet their needs. Once the service had started, people's needs were regularly reviewed and any changes were responded to as necessary either by consultations with professionals. For example, one member of staff told us that the Occupational Therapist had recently visited one person in their home to review their moving and handling plan.

Is the service well-led?

The provider had recently appointed a new manager. The manager showed us an action plan of the things that they were improving.

The provider undertook a variety of audits to check the quality of the service. For example, we looked at audit reports relating to medicines, care plans and accidents. We found that actions had been taken as a result of this monitoring. For example, a recent medicines audit highlighted the need for a team meeting with staff to discuss shortcomings in recording.

People were able to comment on the service provided. People told us that they had completed customer satisfaction surveys. We saw that responses for these surveys had been analysed by the provider and action plans put in place to address lower scoring areas. For example, a communications book was introduced in the office to improve communication between the office and care staff.

At this unannounced inspection we spoke with the acting manager, five members of staff, two relatives and ten people who used the service provided by Allied Healthcare (Bournemouth). We visited two of the ten people in their homes and we used an expert by experience who spoke with the remaining eight people by telephone about the care they received.

Following our inspection in March 2013 the provider had failed to provide the Care Quality Commission (CQC) with agreed updates detailing the progress regarding ongoing improvements.

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements.

People did not experience care, treatment and support that met their needs and protected their rights. This was because their needs were not assessed and planned for. People told us they did not always receive care in accordance with their care plans. Seven people we spoke with told us that calls were frequently missed and care workers did not always arrive on time.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

The provider did not have suitable systems in place to assess and monitor the quality of service provision.

During the inspection we visited the office; spoke with five members of staff, the acting manager and three individuals who received support or care from Allied Healthcare (Bournemouth) in their own homes. We also spoke with two relatives of people supported by the domiciliary care agency.

There were systems in place to assess and monitor the quality and safety of the service provided by Allied Healthcare (Bournemouth), although we identified areas that required further improvement. All of the people we spoke with told us that they had experienced some improvements in the provision of their care since our inspection in January 2013.

We spoke with the manager, four people who used the service, three relatives and four members of the staff team.

People told us that they receive care, treatment and support in line with their care plans.

People told us that they had good relationships with the care staff, who were described as 'kind and respectful'.

We found that the provider had complied with the warning notice issued relating to the care and welfare of people using the service.

However they had not yet fully implemented the action plan developed following the last inspection, and did not have a robust quality assurance system in place to ensure the standard of service was maintained.

People told us that care workers treated them with respect, promoted their dignity, encouraged them to be independent and provided them with the help and care they needed. They said that the support they required was discussed and agreed with them.

People told us that care workers did not always arrive on time; they told us they received their help from a regular group of care workers. We identified several concerns in respect of the care and welfare of people using the service.

People told us that they could not recall receiving questionnaires to fill out about the service.

We spoke with three care workers about the training they received. They told us they received training in areas such as safeguarding vulnerable adults, person centred care and managing medication.

We found that there was not a robust complaints system in place. We spoke with two people who told us that their complaints had not been addressed. This meant the provider could not be sure complaints or concerns made about the service were acted upon.