Archived: Allied Healthcare Leeds

Allied Health Care Leeds is a domiciliary care agency that is registered to provide personal care and support to people in their own homes. The service provides assistance to a variety of groups of people, including those nearing the end of their lives, those with long term complex health issues, support for when family or carer required a respite break from their caring duties, together with general personal care support to people in their own homes.

The people who required support with complex health and end of life issues were supported by nurses employed by the service to assess their needs and provide clinical training to care workers. At the time of the inspection there were 192 people were receiving personal care from the service.

This comprehensive inspection took place on 9 and 12 October 2017 and was announced on the first day. This was because we needed to make sure someone would be available to support with the inspection.

The service was last inspected in August 2016 when we found the provider was not meeting the requirements relating to specific regulations. These included delivering person-centred care, obtaining appropriate consent and following the principles of the Mental Capacity Act 2005, providing safe care and treatment, safeguarding people from abuse, managing complaints and governance. The provider sent us an action plan which they updated weekly, telling us the improvements they had made and what they still needed to make. At this comprehensive inspection we found satisfactory improvements had been made in all areas and the service was no longer in breach of the Health and Social Care Act 2008 (Regulated activities) regulations.

There was a registered manager who had been in post for five months at the time of our inspection. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s needs were being appropriately reviewed and we saw their care plans included information to enable care staff to deliver support in a person centred way and in accordance with people’s preferences and wishes. Details in people’s care plans were included about their medical conditions to help care staff support their needs with involvement from appropriate healthcare professionals when this was required. There was evidence a range of training had been provided to care staff to enable them to support people’s complex needs and enable them to maintain a healthy diet.

People’s consent had been gained and recorded appropriately and the service was working in line with the principles of the Mental Capacity Act 2005. People who used the service told us care staff involved them in decisions concerning about their support to ensure they were in agreement with how this was delivered.

People’s needs had been assessed to ensure care staff knew how to deliver people’s care and support in a safe way. We saw reviews of people’s care and support had been undertaken and that their care records and risk assessments had been developed, including provision of relevant information to enable care staff to deliver people’s support in a safe and managed way. We found care staff had signed people’s medicines administration records accurately to demonstrate these had been administered to people as prescribed. We saw evidence people’s medication records were being audited to enable potential errors to be highlighted, together with medicines management training for care staff and checks of their skills to ensure they were competent to safely carry out their roles.

Safeguarding incidents and accidents were being effectively monitored by the registered manager, together with action taken to investigate these when required, in order to minimise them from reoccurring. We found care staff had been safely recruited to ensure they did not pose a risk people who used the service. We saw evidence of on-going recruitment of staff to ensure the needs of the business were appropriately met.

People’s complaints were acknowledged, responded and investigated in a timely manner. We saw evidence people’s complaints were being monitored by senior management to ensure areas of concern were addressed and action taken to make improvements where this was possible.

We saw internal governance systems had been developed since our last inspection and saw evidence these were monitored to ensure actions were undertaken when required. This included reviews of people’s care and support, responding appropriately to people’s concerns and safeguarding issues and the development of staff support arrangements. We were told improvements had been introduced by the registered manager to simplify the office functions to ensure staff were clear of their roles and responsibilities, however we found these had not yet been fully implemented.

The service is registered to provide personal care to people living in their own homes. The service provided a variety of support to people such as those to people nearing the end of life, support for people with long term complex health issues, support to people when their family/ carer required respite from their caring duties and everyday personal care for people in their own homes. The people who required support for complex health issues were supported by nurses employed by the service to assess their needs and provide training to care workers. At the time of the inspection 222 people were receiving a service.

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.

Systems in place for the management of medicines were not robust enough to ensure people received their medicines safely as prescribed.

There were systems and processes in place to protect people from the risk of harm. However the system did not always effectively recognise safeguarding, report safeguarding to the Care Quality Commission (CQC) and it did not always contain a full record of the investigation, outcome and actions to prevent a recurrence.

Assessment of risks to people the service supported and staff members were not always identified and sufficient control measures recorded to provide staff with adequate guidance to keep people safe.

Assessments were undertaken to identify people’s care and support needs. However person centred information about how a person wanted their support was not always gathered or recorded in the person’s care plan. Care plans did not always reflect the support a person required.

The registered manager and staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA) 2005. No mental capacity assessments were completed in the development of people’s care plans where required. The documentation staff were asked to use did not support them to assess capacity in line with the MCA.

The registered provider had a procedure for staff to follow when a person raised a complaint. We saw this was not always followed. Some people told us they were not sure how to complain but felt confident contacting the office if they had concerns.

The systems in place to monitor and improve the service provided were not robust or effective enough to ensure safety and quality.

Effective recruitment and selection procedures were in place and we saw appropriate checks had been undertaken before staff began work.

There were enough staff employed to provide support and ensure people’s needs were met. The registered manager and team in the office told us they worked hard to provide consistency and to prevent missed or late calls for people. People told us this was an area the service did well most of the time.

Staff who provided direct support to people told us they felt supported and had received regular supervision and appraisal. Records we saw confirmed this. However staff who worked in the office had not received the same level of support. The registered manager told us they would work to improve in this area.

Staff training was up to date and staff told us they had received training which had provided them with the knowledge and skills to provide care and support.

People and their family members told us staff treated people with dignity and respect. Staff gave examples of how they supported people in a caring and compassionate way. People we spoke with confirmed staff were caring.

People were provided with their choice of food and drinks which helped to ensure their nutritional needs were met. Staff at the service worked with other healthcare professionals to support the people. Where people had complex health issues plans to manage their needs in an emergency were in their care plans.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.

However some people told us their care worker did not always turn up when expected and they were not always sure the workers spend the full allocated time because they were sometimes late.

People who used the service or their relatives told us they had good relationships with staff and had agreed the support they would receive.

Staff confirmed they had received appropriate training and would report any safeguarding concerns to the registered manager.

There were effective recruitment and selection processes in place. People were cared for, or supported by, suitably qualified, skilled and experienced staff.

There was an effective complaints system in place and any complaints made were responded to appropriately. Information was recorded in an electronic database as well as paper format which enabled effective monitoring and audit.