Archived: Allied Healthcare Beccles

We gave 48 hours notice of the inspection as we needed to ensure that the appropriate people would be available to speak with us.

The service provides support to people in their own homes across north Suffolk and south Norfolk. At the time of our inspection the service was supporting approximately 300 people.

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.

After our previous inspection the service provided an action plan to show us how they intended to improve. They kept us regularly updated with how improvements were progressing.

The service management team had implemented a new computer based system for care planning and organising visits. This had led to improvements in the service. However, it had not been in place long enough for us to ensure that these improvements had become embedded.

People told us that the care had improved, however, there were concerns raised about the contact they had with the office. Care staff also raised concerns about the office and the lack of information on changes they received from the management team.

People were receiving the care and support they required. Staff arrived on time and stayed for the required amount of time providing the care and support people needed. Staff were aware of, and put into practise procedures to ensure people were protected from abuse.

People’s care records were written with the involvement of the person or their relative, if appropriate. They contained sufficient information to ensure that care and support was provided safely in accordance with the person’s preferences. Care records were regularly reviewed to ensure the information was up to date.

Where the service supported people with their medicines this was carried out safely and effectively.

Care staff received an induction into the service with support from senior staff members. All staff received regular training in subjects such as moving and handling and medicines. Staff received regular supervision and spot checks to ensure good practice was maintained.

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

Where people were supported with their nutrition systems were in place to assess and meet their needs.

The service worked to provide people with regular care staff. This supported people to build up relationships with care staff. People told us that this was a recent improvement and they were particularly appreciative of this development. They also told us that care staff were caring and compassionate.

The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

A registered manager was in post at the time of the inspection. 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.

At the last inspection in January 2016 we asked the provider to take action to make improvements in the supervision and appraisal of staff and their quality monitoring. At this inspection we found that improvements had not been made.

After our previous inspection the service had also put in place actions to ensure their quality monitoring was effective. However at this inspection we found that these actions had not achieved the required improvement. Audits had not always been effective in identifying problems, for example the length of time carers were spending with people to provide their support.

Staff did not receive regular supervision and appraisal. The service had put actions in place to address the supervision of staff after our previous inspection, however, these had not been sustained. The service had identified that there was an issue prior to this inspection and had put actions in place to address this.

Our previous report had also identified that the service was not complying with NICE [National Institute for Health and Care Excellence] guidelines on the scheduling of travel time between visits for carers. At this inspection we found that the service was still not compliant with the NICE guidelines.

Care records detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their life. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, reviewed and up to date.

People told us that staff were caring. During home visits we observed positive interactions between staff and people. People said they felt comfortable with staff supporting them. Staff treated people in a dignified manner. Staff had a good understanding of people's likes, dislikes, interests and communication needs. This meant that people were supported by staff who knew them well.

People’s medicines were managed effectively and safely.

You can see what action we told the provider to take at the back of the full version of the report.

During our previous follow up inspection, which took place on 30 May 2014 and 2 June 2014, we continued to have concerns about how the service communicated with people. We also had concerns about people not receiving their visits in a timely manner and sometimes not receiving a visit. At the time of the previous inspection we saw that some improvements had been made. However, there were still shortfalls in the way the service responded to telephone calls from people. Visits to people by care staff were not always at the allocated times and were often late.

Most of the concerns that had previously been received by the inspection team during the inspection on 30 May and 2 June were about the way the office staff communicated changes to people and about people being unable to contact the office. People had also told us that they were often not called back if they had left a message. Comments received during our last inspection stated that the office did not communicate in a satisfactory manner with both care staff and field supervisors. This had caused a breakdown in service delivery. The previous inspection report found that the service needed to improve the way the office took calls and the way the office returned calls to people, to ensure an effective and safe delivery of care overall.

The provider sent us an action plan and told us how they were going to implement changes. During this inspection we saw that improvements had been made in all areas where we had concerns. The provider had taken steps to understand the communication issues. They had improved their telephone answering service. They had employed an additional member of staff in order to do this. We saw that the provider had undertaken a range of actions and introduced various initiatives to improve the quality of communication throughout the service. One person who used the service said, "The communication has improved no end." This meant the provider now ensured there were enough qualified, skilled and experienced staff to meet people's needs, including the need for good quality communication.

We visited the service's offices over two days and looked at a sample of records held there. During the course of the inspection we attempted to contact 116 people who used the service or their relatives. We received feedback from 57 people. We also spoke with 11 staff including the registered manager, care manager, internal trainer, case manager and care staff. We spoke with two commissioners of services and gained additional feedback from a further 10 social workers and practitioners who dealt with the service.

This is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff. People we spoke with and those who returned our surveys told us that they were always treated with respect, given choices and never discriminated against.

Systems were in place to make sure that staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

Risk assessments had been undertaken and safe systems of work developed. This reduced risks to people who used the service and staff.

Procedures were in place for the management and administration of medicine. Care records identified the level of support people needed. Staff who supported people with their medication needs had received appropriate training. This helped to ensure that people were kept safe and their needs were met.

The service had a policy for the Mental Capacity Act 2005 (MCA). However, staff did not receive specific training on MCA. Their inductions included dementia care which covered consent and best interest decisions for people.

Staff were able to explain how they would report concerns to the provider and that these were acted on.

Is the service effective?

People's health and care needs were assessed. Nutritional needs, mobility, medication and equipment needs had been identified in people's care plans where required.

People's care needs were taken into consideration when the staff supported them. People's daily records showed the support people received during their visits.

Is the service caring?

People were supported by kind and attentive staff. One person's relative said, 'They (staff) are excellent. Could not do without them." A person that used the service told us about staff, "They are lovely, they are. Couldn't ask for nicer."

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People were supported to maintain their independence in their homes.

Most people told us that they had no complaints and were happy with the care they received. Some people, care staff and commissioners of the service told us that communication with the provider at their offices remained a concern. It was difficult to get hold of anyone at times and often requests for call-backs or information was not done. This meant that there was a risk to people's safety because the office did not respond effectively to calls and requests. The provider told us that they were continually working to improve this.

Is the service well-led?

Staff felt supported in their roles through training, staff meetings and supervision.

The service had an effective quality assurance system in place which included audits of records and supervision and training of staff.

The service had a good induction program which had recently been changed and improved further. Staff received all their mandatory training before they started work. They were paired up with a mentor to support them whilst they were learning what their role entailed and were introduced to people who used the service.

We found where people were supported by the same core group of staff, who turned up on time and never missed a visit, people spoke positively about the standard of service they received. One person told us, 'I have a wonderful carer at the moment, nothing too much trouble'so good to me.'

Where people told us about missed visits, staff who turned up late, or did not turn up in sufficient numbers, they told us that they had lost confidence in the service. One person told us, 'I get so fed up when no one turns up.'

We found issues where care and medication records were not in place when people started with the service. This meant staff had not been given guidance on the person's individual needs in order to provide safe, personalised care. Feedback we received also identified issues about staff arriving late, or not at all. People told us when they contacted the office, they had found information was not always passed on, or acted upon. One person told us, "Sometimes I phone the office and ask who is coming," to do their visit, "But they never get back to me."