Archived: Allied Healthcare London Central

Updated 31 January 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.

Since our last inspection between 21 and 24 February 2017 there had been 33 safeguarding concerns relating to the service. Of these, 16 related to late or missed calls, of which 14 had been substantiated. Three allegations related to financial or material abuse, of which one had been substantiated and resulted in criminal prosecution of a care worker. Nine related to neglect or inappropriate care, one of these had been substantiated. Five related to physical or emotional abuse, one had been substantiated but this did not relate to the conduct of a staff member and one was still being investigated. We had also been contacted by the local authority who had concerns about the measures the provider had in place to address missed calls. We used this information to inform our inspection planning.

This inspection took place between 7 and 24 November 2017 and was announced. We gave the provider 48 hours’ notice of this inspection as we needed to be sure that staff we needed to speak with would be available. Between 7 and 9 November four inspectors, a pharmacy inspector and a specialist professional advisor who worked as a nurse visited the office. One inspector visited Lime Tree House, Charlestone House and Tayo Situ House on 13, 14 and 15 of November. One inspector visited Lingham Court on 20 November and Lew Evans House on 21 November. One inspector returned to the office location on 23 and 24 November.

Between 7 and 9 November three experts by experience made calls to people who used the service. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On 10 November one inspector made calls to care workers from the domiciliary care service.

We looked at records of care and support relating to 54 people, and records of medicines support for 40 people. We spoke with 41 people who used the service and eight relatives. We looked at records of recruitment and supervision for 11 care workers and records relating to training and team meetings. We looked at records relating to the management of the service, including audits of finances, medicines, logs of care, branch-wide audits, action plans and records of incidents, accidents and complaints. We accessed the provider’s electronic call management (ECM) system in order to view records related to the movement of care workers. We spoke with the branch manager, the care delivery director, the manager of the nursing bureau, five care quality supervisors and 19 care workers. We carried out observations of communal activities, including lunch clubs, at the five extra care services.

Updated 31 January 2018

We carried out this announced inspection between 7 and 24 November 2017. At our last inspection in February 2017, we found breaches of legal requirements relating to risk management, medicines and record keeping. Following the last inspection, we issued two warning notices and asked the provider to complete an action plan to show what they would do and by when to meet these regulations.

We found that the provider had taken action to improve risk management and the management of medicines, but there were still some areas where the provider was not meeting these regulations. The provider was still not meeting regulations relating to record keeping although there had been some improvements.

Allied Healthcare London Central provides support to 482 people. This service includes a domiciliary care agency. It provides personal care to people living in their own homes in the London Boroughs of Southwark and Lambeth. It provides a service to 301 older adults, younger disabled adults and children. It also provides care to 22 people living in their own homes at night under the Night Owl Scheme in the London Borough of Southwark, and Nightingale Nursing Bureau, which provides nursing care to two families who care for children with complex needs.

Additionally, the provider told us they managed care and support to people living in five specialist ‘extra care’ housing services from this office. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. Two of these were in the London Borough of Lambeth, which were Lingham Court, which provided care to 26 people and Charleston House, which provided care to 22 people. In the London Borough of Southwark there were three extra care services which were Tayo Situ House, Lime Tree House and Lew Evans House, which provided care to 31, 46 and 32 people respectively.

We visited these services as part of our inspection of this location and have included our findings in this report. However, we found that in practice the regulated activity of personal care for these services was not managed from the registered location, which was not compatible with the provider’s registration arrangements. After the inspection, the provider told us they would be applying to the Care Quality Commission to register these services separately.

Not everyone using this service receives 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.

Since our last inspection, the provider had appointed a new branch manager who had applied to become a registered manager. There was a separate registered manager in place for the Nightingale Nursing Bureau. 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. We found that the branch manager had no direct oversight of the extra care schemes managed from this location.

The provider had implemented an improvement plan for addressing concerns about the service. This had been very effective in some areas. For example, the provider was now managing medicines safely within the domiciliary care service, but within the extra care services records relating to medicines were not always completed or audited effectively and in some cases did not ensure people had the right medicines. The provider had reviewed risk assessments and care plans to ensure that care was delivered safely and in a person centred way, and these documents contained considerably improved detail on how to meet people’s needs. In some cases the provider did not ensure that people had access to pendant alarms which people used to call for help in emergencies, and although there was a register of equipment, in a small number of cases appropriate checks had not been carried out of these. The provider did not have the right tools to make sure they were assessing people’s capacity to make decisions for themselves so they did not always obtain consent to provide care.

Staff received appropriate training and supervision to carry out their roles and were recruited in line with safer recruitment processes. However the provider did not always obtain the right references to make sure that staff had previous good conduct when they had previously worked in health or social care. There were systems of spot checks and observations of competency to make sure that staff had the right skills to carry out care.

At our last inspection we found the provider was not safely using electronic call monitoring systems to ensure staff arrived for visits. We found that this had improved, but that staff frequently arrived late for calls. There had been previous concerns about the risk of missed visits, but there were now measures in place to address this. However, sometimes only one care worker attended a double handed call.

There were measures in place to ensure that people received the right support to eat well and staff made sure people accessed medical care when they needed it. The provider had a system to monitor and record complaints, but some people we spoke with did not feel that complaints were always well addressed. People told us that they were treated with respect by staff, but not everyone received support from consistent care workers. We saw that people were treated well by care workers in communal environments.

People received high quality care from the nursing bureau, which had strong measures in place to address risks to people who used the service and detailed plans for delivering complex care packages.

We have made a recommendation about how the provider ensures that people wear emergency call pendants. We found breaches of regulations relating to consent to care, management of medicines and good governance and a breach of regulations relating to the provider’s registration arrangements. You can see what action we told the provider to take at the back of the full version of this report.