All inspections: Allied Healthcare - Oxford

This inspection took place on 17 December 2014. This inspection was unannounced. This meant the provider did not know that we would be completing an inspection on this day.

Allied Healthcare – Oxford is a service that provides nursing and personal care to people living in their own homes. Care provided includes 24 hour live-in care for people in their own homes. At the time of our inspection the agency was providing services to 43 people.

At our previous two inspections, in January and April 2014 respectively, we identified the service was not meeting essential standards in assessing and monitoring the quality of service and safeguarding people. We issued warning notices and required the service to make improvements. At the inspection in April 2014 we also identified the service was not meeting the regulations in relation to record keeping.

At this inspection in December 2014, we found that whilst some improvements had been made, the provider had not addressed all of the concerns identified in April 2014.

People we spoke with told us they felt safe being cared for by staff at the service. Staff were clear about how to identify and report abuse and systems were in place to respond to incidents of abuse. However, we identified that a safeguarding plan, which had been put in place to protect someone from financial abuse, was not consistently followed by staff. We also found staff were not following the correct procedure to record when they had used people's money to purchase items on their behalf. The provider was not accurately and consistently auditing this information to ensure the person was protected from financial abuse. This was identified at the inspection in April 2014 and had not been satisfactorily addressed by the provider at this inspection in December 2014.

There was guidance for staff on how to provide care and manage risks. However, the provider did not check that staff were following the guidance and risk management plans. Following our inspection in April 2014 the provider told us they would take action to ensure people were protected from the risk of developing pressure injuries. At our inspection in December 2014 we found that this action had not been taken and people remained at risk.

The service followed safe recruitment practices. This meant only staff who were suitable to work with vulnerable people were employed by the service.

People were satisfied with the support they received from staff. However most people we spoke with could not tell us whether they had a care plan and what information was contained within the care plan. This meant we could not be assured that people were involved in making decisions about how their care should be provided.

People told us that staff were kind, caring and respectful to them when providing support and in their daily interactions with them. People told us they were treated with dignity and respect.

Staff were skilled and experienced and received on-going supervision and appraisals to monitor their performance and development needs.

The service undertook and documented assessments of people's capacity in line with legal requirements. However, some staff were not aware of how to support people who lacked capacity. Therefore people’s interests may not always be protected and decisions may not have been made in accordance with the legislation.

The service had a complaints policy and information was given to people, or their families, when they first started using the service. We saw examples which demonstrated the provider responded to people’s concerns in line with their internal complaints policy. The provider's records did not always demonstrate whether people were satisfied with the outcome of their complaint.

People were encouraged to make their views known about the care and support they received and regular opportunities were provided for this. The provider also conducted an annual survey for people who used the service. However, the provider was not able to demonstrate how they had responded to any shortfalls or issues identified.

The service did not have 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.

The service used a range of systems and audits to monitor its quality of service. However, the provider was not able to provide access to all audits on the day of our inspection and did not send them to us within 48 hours of the inspection as requested by us. Some audits in place had been suspended due to staff sickness. Where audits were in place it was not always clear what action the provider had taken to address shortfalls to improve service quality.

We found the service had an open culture with a number of communication channels used to keep staff informed of current issues. Staff told us they had access to a whistle blowing line and said they would be supported if they had cause to raise concerns about unsafe practices.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Allied Healthcare – Oxford is a service that provides nursing and personal care to people living in their own homes. At the time of our inspection the agency was providing services to 54 people.

At our last inspection in January 2014 we required the provider to make improvements to the way they safeguarded people from abuse, assessed and monitored the quality of service, and maintained their records. We found some, but not all, of these improvements had been completed.

The service was managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People we spoke with told us they felt safe being cared for by the service. Most people told us they felt confident to raise any concerns with members of staff, while other people said they would be happy to do this through family members.

We found, in most cases, people were protected from avoidable harm, abuse and breaches of their human rights. Staff were clear about how to identify prevent and report abuse and systems were in place to respond effectively to incidents of abuse.

However, we identified that a staff member had not followed a plan that had been put in place to protect the person they were caring for from financial abuse. We also found that arrangements to record purchases made by care staff on behalf of people who lacked mental capacity could not be audited. Consequently, people were not adequately protected from the risk of financial abuse.

Most other risks were identified, assessed and managed in a way that protected people effectively. We looked at the care plans for seven people and saw they each contained risk assessments which were reviewed regularly. However, an action to monitor and record the condition of people’s skin was not being followed. The provider was, therefore, unable to demonstrate that people were protected effectively from the risk of developing pressure injuries.

The service followed safe recruitment practices. This meant only staff who were suitable to work with vulnerable people were employed by the service. Training records showed staff received appropriate training, although a member of the local authority commissioning team expressed concern about the number of subjects being taught during induction in a short space of time.

Two types of care plan were being used by the service; one for people receiving nursing care from live-in care workers and another for people receiving personal care on a domiciliary basis by staff who visited people in their own homes. We found the nursing care plans were comprehensive. However, personal care plans did not always describe how care and support should be delivered.

People told us they were involved in the assessment of their needs and the development of their care plan. We spoke with 14 people about the care and support they received. Most people told us they were satisfied with the service. However, we found five or the seven care plans we viewed were not up to date and did not reflect people’s current needs.

We visited three people in their homes and observed interactions between them and staff. We saw people were relaxed and comfortable with staff and staff communicated with them in a friendly, yet dignified way. Staff clearly knew people well and understood their individual needs. We also heard office staff talking about people fondly and knowledgably. They were able to tell us about people’s life histories, their interests and their preferences.

However, the comments and attitude demonstrated by one care worker did not show kindness or compassion for the person they supported and did not comply with the provider’s policy of promoting choice and control.

We saw people’s mental capacity was assessed and documented in care plans. However, two members of staff demonstrated a lack of understanding of the Mental Capacity Act 2005 and how to make decisions in people’s best interests. This meant people’s interests were not always protected and decisions may not have been made in accordance with the legislation.

Live-in care workers told us they felt isolated and unsupported as they spent most of their time providing care on a one-to-one basis with little contact or support from colleagues. Although the service had recognised this, a policy they had agreed to develop to support live-in care workers, following our inspection in August 2013, had not been completed. This meant live-in care workers were not supported to deliver care to a safe and appropriate standard.

The concerns we identified meant there had been a breach of the relevant regulation (Regulation10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010). You can see the action we have told the provider to take at the end of this report.

At our inspection in August 2014 we found that the provider was not complying with five regulations. On this visit in January 2014 we found repeated breaches of two regulations and a breach of a regulation not previously looked at.

We did not speak with as many people as we usually do as we focused on the management of the service. We spoke with three people and two relatives of people who used the service. Everyone we spoke with were complementary about the care workers. One said "they are polite respectful and punctual. They are very nice". One relative said "I have no issues at all with the carers".

The provider had not taken adequate steps to protect people from the risk of abuse. We spoke with nine care workers. Five care workers we spoke with did not know how to raise a safeguarding alert. We also saw that the service had failed to implement financial management plans for people who they identified as being at risk of financial abuse.

Care workers were supported in their role. We saw that care workers had received specialist training to support people's individual needs, for example, training in catheter care. All the care workers we spoke with spoke with said they felt supported

The provider did not operate effective systems to identify, assess and manage risks relating to the health, welfare and safety of users and others.

We saw that not all care plans were appropriately reviewed and records were not always accurate and secure.

We inspected this agency because we had received information that care plans were not in people's homes and that the instructions in care plans were not sufficient for staff to undertake their care tasks safely. Our inspection found that the provider was not complying with several regulations.

We did not speak to as many people as we usually do during our inspection. The two people and one relative we spoke with told us that they were 'happy with their care.' Though people told us they were satisfied we found that people did not always experience care and support that met their needs.

Care plans did not provide sufficient instruction to enable staff to meet people's needs safely. We found that people's care was not always delivered in line with their care plan. The agency did not always respond to people's changing needs or changes to their vulnerability appropriately.

Local safeguarding procedures were not operated effectively. Staff did not always understand their safeguarding responsibilities and people's safeguarding plans were not implemented appropriately.

Staff had received some training to enable them to undertake some of their care tasks safely and meet people's needs. However, some staff providing catheter care had not received the appropriate training to undertake this task safely. Records showed that staff received some supervision. Staff's competency had not been regularly assessed and had not been addressed when gaps in their learning and training had been identified.

We found that the provider did not operate effective systems to identify, assess and manage risks relating to the health, welfare and safety of people who used the agency. We saw information about events was used to review some management systems. We did not however see what risk reduction action had been taken to ensure that people in similar situations were safe or that similar events were prevented from reoccurring.

We felt that the concerns we identified during this inspection were too serious to wait for the provider to respond to the publication of our full report. We have therefore sent the provider a letter to request a report be sent to us by 20 September 2013, to tell us what actions they are taking to achieve compliance. In addition to the actions CQC are taking, the local authority quality monitoring and safeguarding team were working with the agency to manage the identified risks. The provider had voluntarily agreed not to take new referrals until improvements had been made. The provider had also commissioned a national team to help with achieving the improvements. They have informed us that members of their senior management team are monitoring progress weekly.

We found that people and relatives were involved in decisions about their care. We spoke with six relatives and people who use the service. One person said 'a lady visited and I was doing it [the care plan] with her and I now have a copy'. We saw records of involvement of people and relatives in most care plans we looked at. Staff treated people with dignity and respect. One staff member we spoke with said 'I give people choices. I chat to them and try to get their opinion'.

We found that people were happy with the care that was provided. People we spoke with said staff were 'extremely pleasant people' and 'most of them [the staff] are brilliant. I get on well with all of them'.

There were effective recruitment and selection processes in place. These ensured that staff had the necessary pre-employment checks. People were supported by experienced and skilled staff. Staff received a five day induction course. The training was followed by a period of shadowing experienced staff. One member of staff told us the induction was 'very thorough". We saw evidence of competency checks in new staff files.

People we spoke with had no complaints. One person told us "if I had a complaint I would phone the office and address it with them". We saw evidence that complaints had been dealt with in line with the complaints procedure.

People told us they had been involved in setting up their care plan and that a copy was available in their home which was available for the staff. Most of the people we spoke to were broadly satisfied with the services they had received from the agency. Some raised issues about the time-keeping or non-arrival of staff. Some were unhappy with the communication they received from the agency office about these issues. Some people said that their carers had often changed.

Archived: Allied Healthcare - Oxford

All Inspections

17 December 2014

During a routine inspection

23-24 April 2014

During a routine inspection

29, 30 January 2014

During an inspection looking at part of the service

28 August 2013

During an inspection in response to concerns

13 March 2013

During a routine inspection

2 March 2012

During an inspection in response to concerns