Archived: Allied Healthcare Maidstone

Updated 7 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection site visit activity started on 01 October 2018. The first day of our inspection was unannounced. The inspection was carried out by three inspectors. The inspection included two inspectors visiting people in their homes, shadowing staff providing care and talking with relatives. Assistant inspectors supported the inspection by making telephone calls to people and their relatives to gain their feedback about the service received. These telephone calls took place over several weeks as we had trouble getting hold of people and staff. The last telephone calls were held on 19 October 2018. We visited the office location on 01 and 02 October 2018 to see the management team and to review care records and policies and procedures. We also visited the office on 24 October 2018 to provide feedback to the management team.

Before the inspection, we reviewed the information we held about the service including previous inspection reports. We looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We also reviewed information of concern that we had received from the local authority and from people and staff sharing their experience of poor care through our website. The information of concern received from the local authority included information about Allied Healthcare Maidstone not being able to provide care and support to some people because of a lack of staff. Some people had gone without care visits.

We spoke with 28 people who received a service from Allied Healthcare Maidstone as well as nine relatives. We observed care and support with permission of people in their homes.

We contacted health and social care professionals including the local authority commissioners and Healthwatch to obtain feedback about their experience of the service. There is a local Healthwatch in every area of England. They are independent organisations who listen to people’s views and share them with those with the power to make local services better.

We spoke with 15 staff; including care staff, field care supervisors, care coordinators, the branch administrator and the branch manager. We also spoke with the care delivery manager, the care delivery director, the area support manager, the regional director, the quality manager and the nominated individual for the provider.

We looked at eight people’s personal records, care plans, medicines records, risk assessments, staff rotas, staff schedules, five staff recruitment records, audits and action plans as well as policies and procedures.

We asked the management team to send additional information after the inspection visit, including action plans, business continuity plans, audits, meeting records, copies of daily records, medicines administration records and policies. The information we requested was sent to us in a timely manner.

The service was last inspected on 25 October 2016, the service was rated ‘Good’.

Updated 7 December 2018

This inspection took place between the 01 and 19 October 2018, the first two days of the inspection were unannounced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, older people, people with learning disabilities and autistic spectrum disorder, people with a mental illness, people who have a physical disability and younger adults.

Not everyone using Allied Healthcare Maidstone receives a 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. There were 141 people receiving support with their personal care when we inspected.

There was no 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The previous registered manager had left on the 27 July 2018. The provider had employed a new manager, who was planning to apply to CQC to become the registered manager.

People were not always protected from abuse and harm. We found evidence that safeguarding concerns raised by staff had not always been dealt with following the provider’s and the local authority’s policies and procedures. Whilst the provider had taken some action to internally investigate the allegations, they had not contacted the local authority or the police.

The provider had not deployed enough staff to meet people’s needs. This has impacted on people who have had missed and late visits. A person who had experienced a missed call explained they were found in bed by the lunchtime care staff that came. They were not able to mobilise on their own. They said, “I had to lie in bed, I could not do anything.” They went on to explain that the experience was not pleasant, they could not go to the toilet and they were hungry. People did not always get their care at a time that met their needs and preferences. Care staff were not always allocated adequate travel time between care visits. People received shortened or clipped care visits.

The provider did not follow safe recruitment practices. Essential documentation was not available for all staff employed. Gaps in employment histories had not been explored to check staff suitability for their role.

Risks to people and staff had not been well managed. When people’s health and mobility had drastically changed, risk assessments had not been reviewed and updated in a timely manner. People and staff were at risk because staff had been providing care to people alone when the person had been assessed as requiring two staff. Accident and incident data on showed that a staff member was injured whilst carrying out a care visit to a person on their own instead of with another staff member. The provider had failed to take adequate action when accidents and incidents had occurred. Lessons had not been learnt from accidents and incidents to prevent further concerns and to strive for improvement.

Medicines had not been well managed. People receiving administration help and support did not always have medicines administration records (MAR) in place to detail what the person was prescribed, what time staff should administer the medicines, what route the medicine should be given and other essential information. We identified practice of leaving medicines out for a person putting the person at risk of harm from overdose.

Measures were in place to minimise the spread of any infection. Staff were provided with appropriate equipment to carry out their roles safely.

The provider had not provided staff with the resources to apply their training to ensure people received effective care and support. Staff had received training on how to move people safely but regularly carried out care visits which had been identified as needing two members of staff to safely support people by themselves. Although the systems were in place to support and develop staff, these were not being applied effectively. There was a programme of supervision in place which included ‘spot checks’. However, this had not identified that staff were not applying their training effectively.

People’s care and support needs had been assessed prior to them receiving a service which included recording their preferred name, religion, ethnicity and background. The assessment did not capture all of the protected characteristics under The Equality Act 2010. When people’s needs changed they had not been reassessed in a timely manner.

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 did not always support this practice. Staff knew and understood how to support people with decision making, such as offering people different options verbally or by showing them the choices to help them make an informed choice. People’s capacity to make decisions had not always assessed or recorded.

The service had failed to provide care and support to meet people’s nutritional needs. Essential information about one person’s nutritional intake had not been effectively monitored. This meant that action had not been taken to address concerns about suitability of food to sustain the person’s life and good health.

Most people received medical assistance from healthcare professionals when they needed it.

Care records showed where staff had taken action when people were unwell. However, the care records did not always record an outcome or whether there had been medicines changes. This is an area for improvement.

People told us staff that provided them care and support in their homes were kind and caring.

Despite the mainly positive feedback from people and their relatives about the care received. Allied Healthcare Maidstone had not treated people with dignity and respect by providing rushed and clipped care visits, cancelling care visits and not providing enough staff to meet people’s needs. People and their relatives had not always felt listened to and in control of their own lives. The service has not always given staff the time, training and support they need to provide care and support in a compassionate and personal way. One person had complained of being left by the staff in soiled sheets for some considerable time. Staff recorded that they supported this person with their personal care but left them in a wet sheet as there was only one member of staff at the call and the person needed two members of staff to support them to move. No telephone call was made to the office to ask for an additional member of staff to attend and support the person with their mobility so they could change the bed linen.

We observed staff supporting people in their own homes. Staff were friendly and discreet and clearly knew people well. Staff had a good rapport with people and knew people well. Staff were able to describe people's care routines, likes and dislikes. We observed staff chatting with people about their day and showing a genuine interest in people and their lives.

People and their relatives knew how to complain. At the time of the inspection records of individual complaints were not available. We were unable to asses if the complaints had been responded to effectively and within timescales. People did not feel that Allied Healthcare Maidstone listened to them. People and their relatives did not have all the information they needed to escalate their complaints. Each person received a pack of information about the service which included essential information and contact telephone numbers. The complaints information did not include information about how to contact the local government ombudsman.

Some people and their relatives told us they received a personalised service. They said they had been involved in planning their care so the support provided could meet their needs.

Care plans were personalised and had been developed from initial assessments of people's needs. However, care plans were not updated promptly when people’s needs and wishes changed. We found care plans in place which did not represent people’s current care and support needs both in the office and when visiting people with staff in their own homes. One person was described by staff as at the end of their life, their care plan had not been updated to detail their wishes and choices about how they wanted to be cared for when they deteriorated further.

There were multiple and serious shortfalls in key systems and processes used to assess, monitor and evaluate the service. Which meant the provider did not have adequate oversight of the service. Although there were systems and processes in place to monitor the service. The systems were not robust enough to capture the breaches of regulations found during this inspection. There has been a lack of management oversight at Allied Healthcare Maidstone with regional management and senior managers concentrating on other services in the south of the country. The providers intelligence systems had not been used by the management team to effectively monitor the service. It is very clear from the data from these systems that there were concerns in relation to staffing levels, clipped calls, complaints, medicines errors and missed care visits that have been apparent for some time. The provider failed to notify the commission of serious incidents such as safeguarding concerns.

Records were not complete or accurate. Care plans and risk assessments were not updated when incidents occurred.

People were sent quality surveys annually to gather th