Archived: Allied Healthcare Liphook

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 provider had been actively recruiting to this post.

Following the last inspection in October 2016, where we found four breaches of the Regulations. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well-led to at least good. At this inspection, we found the requirements of these four Regulations had now been met, but further work was required to ensure the key questions of safe and well-led achieved a rating of good.

Trained staff administered people’s medicines safely. Processes were in place to ensure staff documented the administration of people’s medicines and these records had been regularly audited. Guidance was in place to ensure the effective application of topical creams for people.

Processes were in place to document and investigate people’s complaints about the service. Processes were in place to ensure that incidents logged on the system were investigated. Statutory Notifications had been submitted and the provider further strengthened this process during the inspection to ensure they could in future provide written evidence of all of the submissions made to CQC.

Staff training and processes were in place to ensure people were protected from the risk of abuse. Staff told us they felt able to approach management about any concerns. Processes were in place to ensure any incidents were investigated, reviewed and any learning points identified and actioned.

A range of potential risks to people had been assessed including generic risks and risks related to people’s clinical care needs. There was clear written guidance for staff with regards to the management of any identified risks for people’s safety. Processes and procedures were in place which staff had been trained in and followed, to protect people from the risk of acquiring an infection.

There was insufficient care staff capacity particularly in Guildford, which had resulted in the provider struggling to consistently provide two care staff for those who required this level of staffing. The provider took immediate action for one person’s safety during the inspection and has committed to not taking on any further care packages whilst they recruit to their vacant staff posts.

People’s needs had been assessed and the delivery of their care and support was based on current standards and relevant guidance. Staff supported people to ensure they received sufficient food and drink for their needs.

The provider worked in partnership with a range of agencies in the provision of people’s care. Processes were in place to ensure people received effective healthcare, which was co-ordinated across services.

Staff underwent an appropriate induction, on-going training and support for their role.

People had been 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.

People felt staff treated them in caring and kind manner. They were encouraged to be involved in decisions about their care and treatment. People’s privacy, dignity and independence had been respected and promoted.

The service was responsive to people’s needs. People had personalised care plans, which reflected their preferences and lives. Where the service had been commissioned to support people with their interests, they provided this care. Processes were in place to enable staff to learn about people’s care needs.

No-one currently supported by the service required end of life care. However, in the event people needed this care staff training was available to staff.

People and staff reported a ‘negative culture,’ following all the changes that had taken place in the office since October 2017. The Operations Support Manager was aware of this and was trying to address the situation. Processes were in place to seek people’s views and to engage staff. However, both people and staff were of the view that communications required improvement to ensure they felt informed and included in the changes that took place.

Processes were in place to audit various aspects of the service in order to drive improvements and the provider was actively monitoring the service.

This is the third time the service has been rated Requires Improvement, but the first time it has been rated as Requires Improvement since the introduction of CQC’s ‘Guidance on Inspecting Services Repeatedly Rated Requires Improvement.’ The provider already had an improvement action plan in place based on the areas that required action identified at the last comprehensive inspection and improvements had taken place, but there were still areas that required further improvement as outlined in this report. Following this inspection, we have asked the provider to submit to us an updated copy of their plan based on the issues identified within this report.

Allied Healthcare Liphook provides care and support to children, adults and older people living in their own homes in Surrey, Hampshire and West Sussex. Some people using the service were living with dementia or had learning disabilities or physical disabilities and complex care needs. At the time of our inspection the service was providing care and support to 91 people.

The service had a registered manager in post. 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.

During our previous inspection of 28 and 29 July 2014 we found one breach of legal requirements in relation to Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010 Consent to Care and treatment. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force on 1 April 2015. They replaced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following the inspection the provider wrote and told us they planned to meet the requirements of this regulation by 1 May 2015. During this inspection we checked to see if the provider had completed their action plan to address the concerns we found. We found the provider had made improvements to meet the requirements of the regulation.

The provider had introduced a screening and assessment tool to assist staff to assess whether people had the mental capacity to make decisions about their care and treatment. We saw this was in use by staff who completed assessments and developed people’s care plans. These staff had completed training in the Mental Capacity Act 2005 (MCA) and arrangements were in place for all staff to complete this training.

People told us they felt safe with the provider’s staff and were cared for safely. Staff completed training in safeguarding people from abuse and knew how to raise any concerns. We saw that action was taken to report concerns to the local authority safeguarding team, however the provider did not always notify us of allegations of abuse. Providers are required to send us a statutory notification of any allegation of abuse so we can monitor the safety of the service people receive.

The provider had merged their services in Guildford and Liphook and both services were now managed from the Liphook branch. Key administrative staff and a number of care staff had left the service following the change resulting in a number of care staff vacancies. At the time of our inspection field care supervisors and care coordinators were also providing personal care to people to ensure people’s care needs were met. This had resulted in some disruption to the organisation of people’s care which some people told us had at times been inconsistent and unreliable because staff were often late and they did not always know which staff would be coming and when. People we spoke with did not report they had experienced any harm due to these arrangements. Whilst the situation was improving the service needs to demonstrate that it can sustain an appropriate level of permanent staffing to enable them to meet people’s needs consistently.

The management of people’s medicines was not always safe. We found that risk management plans were not always robust enough to mitigate the risk to people from missed medicines. Where people used topical medicines (creams applied to the skin) staff had not always recorded when they had been applied and a body map was not always available to ensure staff knew where to apply the cream for people. We found some recording errors in the medicine administration records (MAR) for some people. The provider’s monitoring arrangements of only auditing a proportion of the MARs every month meant that when errors occurred they could remain undetected for some months.

People’s feedback about the management of the service was not consistently good and some people told us communication from management and office staff could be improved. Changes to the service had impacted on the ability of the registered manager to meet all the responsibilities of their role. People and their relatives told us they did not always feel the provider had responded appropriately to their complaints and concerns. Some complaints had not been investigated and responded to within the timescale set by the provider. Some people did not know how to make a complaint.

Incident reports showed that incidents such as missed calls had not always been investigated in a timely manner to identify the impact and the actions taken to mitigate any potential harm to the person and prevent a reoccurrence. This meant people could be at risk where incidents were not investigated and managed promptly. An action plan was in place to address the areas of improvement required. However, the service required more time to fully implement and sustain these improvements consistently into their practice.

People were asked for their views on the service by the provider. However it was not evident how this had always been used to make improvements to the service. Arrangements in place to seek people’s feedback about the service face to face had not been consistently carried out. The registered manager was taking action to address this.

Risks to people were assessed and guidance on how to manage risks to people was available to guide staff. People had achieved positive outcomes such as improvements in their health from the care provided by staff to manage risks to their health and wellbeing. Staff used a screening tool to check people were safe and to identify any changes during their visits.

People spoke positively about the standard of care they received from the provider’s staff. Care staff completed an induction and on-going training to ensure they remained competent in their role. Staff followed the guidance of the provider’s clinical lead and other healthcare professionals as required to deliver safe and effective care.

People were supported with their nutrition and hydration needs. Staff were aware of people’s preferences and choices for food and drinks and guidance was available to prompt staff when people may not be able to tell them about these.

People and their relatives told us staff were kind and caring. Staff we spoke with demonstrated they knew about people’s individual needs. People’s care plans included detailed visit summaries which ensured staff had the information available to meet people’s needs in line with their decisions and wishes.

People’s needs were assessed and used to develop comprehensive and personalised care plans. People and their relatives were involved in the review of their care plan on a regular basis. When people received support with their healthcare their care plan and care delivery was overseen by the provider’s clinical lead to monitor and review progress.

Staff were supported to understand their role and responsibilities through regular supervision, appraisal and team meetings. Staff were recruited safely to protect people from the employment of unsuitable staff.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We found that people's care plans were up to date and informative. We spoke with 17 people who use the service and they were positive about the quality of care they received and the attitude of staff. Different people used descriptions such as 'brilliant', 'superb', 'punctual', 'kind', 'professional' and 'trustworthy' to describe the staff and the care they provided.

We found the service had also asked people for their views of the service and had systems in place to monitor the quality of service provision.

The service had implemented improvements and achieved compliance in four of the five essential standards. The outcome relating to staffing was still non-compliant as although recruitment was underway the provider had not ensured there were enough staff to support care workers in the field.

Care planning was more person-centred, and people were involved in decisions about their care. Most people said they that consistency of service had improved. One person commented, 'It's going in the right direction'.

Most care plans had been reviewed and included key information about people's support needs. These reviews were behind schedule however, and we found that there were not enough field care supervisors in post to review care plans, support care workers and carry out quality monitoring roles.

All staff had attended training in safeguarding vulnerable adults.

The provider had implemented a call monitoring system, to track that calls were completed and on time. We saw that complaints, incidents and accidents were managed appropriately. People's views were more positive. One person said, 'It's working very well now. I have three care workers and they are all very good.' One staff member said, 'The office staff are top rate'.

Care plans showed that risks had not always been assessed and managed. People said that care workers supported them well however, and took appropriate action if medical care was needed. They said that some care workers were rushed and sometimes people's calls were cut short. Although people praised the care staff, they felt that some required additional skills.

Safeguarding procedures were not robust, although we saw evidence that people had been safeguarded appropriately. Not all staff had received appropriate training for their role.

A full quality audit had been carried out recently and the findings showed that all areas required improvement. Although an action plan had been developed, and additional staff were being recruited, at the time of our visit the improvements had not been implemented.

You can see our judgements on the front page of this report.