Archived: Allied Healthcare Plymouth

Updated 11 May 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 was announced. It was undertaken by two inspectors, five experts by experience and a specialist advisor for nursing care. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the service. We also contacted Healthwatch Plymouth, the local authority quality and service improvement team (QAIT), and commissioning teams for the local authority and clinical commissioning group (CCG), to ask if they had any feedback about the service. Where feedback was provided, it can be found throughout the inspection report.

We gave the service 48 hours’ notice of the inspection visit because we needed to ensure that there would be someone in the office to support the inspection process. It also allows us to arrange to speak and visit people receiving a service in their own homes. Inspection site visit activity started on 22 March 2018 and ended on 19 April 2018. We visited the office location on 22 and 23 March 2018, and on19 April 2018 to see the manager, office and care staff; and to review care records and policies and procedures.

During our inspection, we spoke with 29 people on the telephone to obtain their views and visited five people in their own homes. We also spoke with 18 members of staff, the branch manager, the operations manager and regional director.

We looked at six people’s care records, training records, staffing rotas, policy and procedures and the provider’s monitoring checks.

Updated 11 May 2018

Allied Healthcare Plymouth is a domiciliary care agency. It provides personal care to people living in their own homes. It currently provides a service to children, and younger and older adults who need support with their personal care and/or have complex clinical healthcare needs. The service supports people within the localities of Cornwall, Plymouth, Barnstaple and Exeter. The service is owned by Nestor Primecare Services Limited, who have 83 branches across the UK.

Not everyone using Allied Healthcare Plymouth received 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. At the time of the inspection there were 99 people receiving personal care.

The inspection was announced and started on 22 March 2018 and ended on 19 April 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available in the office. It also allowed us to arrange to visit people receiving a service in their own homes.

Prior to our inspection we received concerns about poor staffing arrangements within the service. So this was looked at, as part of our inspection. The provider had already recognised improvements were required, so as a result had made changes to the structure of the organisation, by registering the service in Plymouth, and had recruited a new manager. The new manager had applied to the Commission to become the 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.

Staff told us since the recruitment of the new manager, they felt confident changes would be made and improvements seen for them, and for people using the service. Staff, were complimentary of the new manager, and of their kindness and passion, with one member of staff commenting, “Hopefully we have turned a corner and going forward. I think the manager, seems to be competent, confident and knows where she wants to get the company”.

The new manager was supported by the operations manager, and weekly meetings were held to discuss the compliance and financial accounts. Whilst the new manager told us they felt supported, they had not received a formal management induction into the organisation. This meant the manager may not be aware of essential policy and procedures pertaining to the day to day management of the organisation.

Whilst staff recognised how busy senior managers were, some staff told us they did not feel supported by the operations manager. Despite the provider having a comprehensive governance policy and quality assurance framework in place to help monitor the quality and safety of the service, which included a variety of audits. It had failed to promptly identify the areas requiring improvement. It had also failed to identify the in cohesive culture of the organisation.

Staff told us, they felt they worked for the ‘branch’ and did not feel part of the bigger organisation. The provider’s vision statement was, “To be the choice for care that give people the freedom to stay in their own homes”. However staff, were not aware of this statement, which demonstrated staffs lack of engagement with the wider organisation. Despite an employee recognition scheme, staff did not feel their contribution was valued.

People, staff and the public were involved in the ongoing development of the service. Surveys were sent to people to obtain their views, and feedback was collated. At the time of our inspection, no recent survey had been carried out.

The failings identified as part of this inspection demonstrated that the provider did not ensure that continuous learning took place to facilitate improvement. However, the manager attended a weekly meeting to discuss the provider’s ongoing improvement plan, making sure it was being completed and starting to have an impact on the overall quality of the service.

There was a confidential safeguarding and whistleblowing line which staff could use to raise concerns and whilst staff told us they would feel confident about raising concerns, they had failed to raise concerns about the culture of the service.

People told us there were not enough staff and told us they were not always informed of who would be arriving to support them. Whilst some staff told us they had enough traveling time, some staff told us they did not. The operations manager told us a staffing analysis was being carried out to look at how staff, were deployed within the service. They also told us they recognised that people’s care was being commissioned in a different way, and as an agency they needed to be receptive to that, and make changes accordingly.

People’s risks associated with their care were known by staff, such as how people needed to be moved by the use of moving and handling equipment. However, people did not always have risk assessments in place relating to health risks. This meant people may not be supported safely and/or with continuity. People had environmental risk assessments in place, which detailed any risks to staff, such as pets, trip hazards, or poor outside lighting.

People told us they felt safe when staff entered their home, with one person telling us, “They are very trustworthy”. Staff, were supplied with a uniform and an identification badge so they were recognisable. People who had a ‘key safe’ had their details held securely.

People were protected from abuse. Staff had undertaken safeguarding training, and knew what action to take if they suspected someone was being abused, mistreated or neglected. Staff had been recruited safely to ensure they were safe to work with vulnerable people.

People’s medicines were managed safely. Overall, people were protected by infection control procedures to help reduce the spread of infections. Staff had undertaken training and told us there was always a good supply of personal protective equipment (PPE). However, one person told us they had to buy their own gloves as they were allergic to the silicone gloves staff used, and explained staff did not always wear PPE.

People told us staff had the right skills to meet their needs. However, despite the provider having a comprehensive induction programme, two members of staff told us that they had to ‘learn on the job’. With one of these members of staff having never worked in the health and social care sector.

Staff had undertaken training the provider had deemed as ‘mandatory’. Staff, who supported people with clinical needs, received healthcare training and staffs ongoing competency was assessed by specialist nurses, employed by the provider. Staff, were complimentary of the training they received, but told us they had not received supervision of their practice for some time. The manager recognised this, and already had a plan in place to rectify this.

People’s health and social care needs were assessed to help ensure their needs were met. People were supported to obtain help from external professionals if their care needs were changing.

People’s human rights were protected. People were assessed in line with the Mental Capacity Act 2005 (MCA), to check their ability to consent to their own care and treatment. People’s care plans provided detail about their mental capacity and how this impacted on the decisions they made.

People’s individual communication needs were known by staff, and staff described how they adapted their approach to each person. People’s care plans supported staff to meet people’s individual needs. However, one person who was unable to read had not been provided with a care plan in a suitable format. This demonstrated the provider had not fully considered the Accessible Information Standard (AIS). The AIS is a national requirement to help make sure people with a disability or sensory loss are given information they can understand, and the communication support they need.

When required, people were effectively supported with their nutrition and hydration. People’s likes and dislikes had been recorded and people told us staff listened to what they wanted, and accommodated there requests.

Overall people’s privacy and dignity was respected. Staff explained how they promoted people’s privacy and dignity, by closing curtains and shutting doors. However, one person told us that staff did not always do this, and had at times, called out for staff to return to the room to cover them up.

People were supported to be part of decisions relating to their care. Checks of people’s care helped to ensure people were satisfied with how they were being supported. However, people’s views were not always respected or listened to.

People told us, staff were kind, commenting “I have the highest respect for these carers, they’re very good, I have no worries or concerns about them at all”, and “They always sit down, and we have a chat and a cup of tea”.

Staff spoke fondly of the people they supported, and displayed passion for their job. One member of staff told us how they had flexibly changed their visit time to enable one person to enjoy a lie in.

Staff had received training in the Human Rights Act 1988 and explained how they supported people in the same compassionate way, regardless of their gender, sexuality or ethnicity.

People’s independence was promoted, staff told us how they encouraged people to do as much for themselves as possible. One person commented, “They encourage my independence”, and a relative explained, “They seem to be encouraging her independence”.

Overall, people had a care plan which had been constructe