Archived: Allied Healthcare London Central

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.

We undertook this focused inspection between 21 and 24 February 2017 to check they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Allied Healthcare London on our website at www.cqc.org.uk.

There was a registered manager at the service. 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 time of this inspection, there were 533 people using the service, including 306 people who used the domiciliary service and a further 227 people who either lived in one of five extra care services or used the Night Owl Service, which provides care and support to people in their own homes at night.

We found that the provider was still not meeting the requirements for safe care and treatment. We found that although the provider had audited checks of equipment in some services, this was not taking place across the whole service, which meant we couldn’t be certain that equipment used was safe. There was insufficient recording and checking of financial transactions to protect people from loss or abuse.

The provider had carried out assessments of risks to people who used the service, however these did not always contain details on the risks to people from health conditions and did not always provide information for staff on possible warning signs that people were becoming unwell or how to respond to behaviour which may challenge. Medicines were not always safely managed, with gaps in medicines recording charts which were not always detected by audits. The provider had improved monitoring of calls through an electronic call monitoring system, and now had alerts in place for everyone who used the service. There had been a reduction in the number of missed calls, but use of the system was still not widespread enough to protect people from missed calls.

The provider had updated fire safety protocols at Lew Evans House to provide clear instructions on who would be responsible for contacting emergency services.

We found the provider was now meeting its requirements to obtain consent for care. However, we found that protocols and staff use of these did not always demonstrate an understanding of the Mental Capacity Act (2005). We have made a recommendation about this.

At our last inspection we found the provider was not meeting regulations with regards to good governance, as care logs were not audited in a timely manner in a way which would detect possible errors. We found that this was still not taking place, and in some cases audits had overlooked potential problems.

At our last inspection we found that the provider was not always meeting regulations with regards to informing the Care Quality Commission of significant events and allegations of abuse. At this inspection we found the provider was meeting this requirement, but did not notify us of incidents of missed visits when these were raised as safeguarding alerts by the local authority. We have made a recommendation about agreeing a protocol for missed visits in line with the Pan-London Safeguarding Policy and Procedures.

At this inspection we found continuing breaches of regulations with regards to safe care and treatment, management of medicines and good governance. We served a warning notice against the provider with regards to these breaches.

Allied Healthcare Central London is a large care provider which supports people in their own homes. At the time of our inspection the service was providing domiciliary care to 343 people in the boroughs of Lambeth and Southwark, including the Night Owl service, which provides care and support to people in their own homes at night, and additionally providing care to 109 people across four extra care services which were registered at this location. These are Lingham Court, Charleston House, Lime Tree House and Lew Evans House. Additionally, the registration includes Nightingale Nursing Bureau, which was providing nursing care for five people, including children and adults, in their own homes.

There were two registered managers in place, one with responsibility for the nursing care provided by the service and one responsible for the personal care provided by the service. 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 branch was organised in a way which meant that smaller teams were responsible for individuals’ care, and managers oversaw this in a way which meant the provision of care was improving. The provider did not always notify CQC of significant issues as they were required to do so.

We found that care plans were detailed and comprehensive in their scope, and contained sufficient information to ensure that people were supported appropriately to have enough to eat and drink. There was information about people’s preferences and how to ensure that their dignity and privacy were promoted and maintained. There was an assessment process which identified when people required support from health services, and we saw good examples of joint working to promote good health. People’s services were regularly reviewed and their views were sought on the quality of their care. We found that care plans did not always reflect the support that people received or the times of their visits. Consent to care was not always sought in a satisfactory manner in line with the Mental Capacity Act (2005).

Some people told us that their care workers were often late, and we found that although an electronic call monitoring system was in place, this was not yet sufficient to protect people against late or missed calls. Some staff rotas did not allow sufficient travel time to ensure staff arrived on time.

There was a good consistency in the staff people received, and people were positive about their regular care workers. People told us they were not always informed about changes to their care workers. We saw that there was a programme of activities in place for the extra care services, and the provider worked with local community organisations to implement this. We found that many people experienced problems in contacting the office, and that people’s concerns were not always followed up in a satisfactory manner. There was a process in place for ensuring that complaints were investigated and responded to when these were addressed by the provider.

Staff were well supported by the organisation, and received a comprehensive programme of training, assessments of their competency and supervision. There were measures in place to ensure that staff were suitable for their roles.

Risk assessments were detailed, however these did not always cover the risks to people with certain conditions, and there were insufficient measures in place to ensure that equipment such as hoists were safe for staff to use. There were significant problems with the monitoring and recording of medicines, which were not checked by managers promptly to ensure that issues were addressed.

We have made a recommendation about the quality of care plans. We found breaches of regulations in regards to risk management, the management of medicines, consent to care, notifications of serious incidents and the audit of records. You can see what action we told the provider to take at the back of the full version of this report.