Background to this inspection
Updated
16 December 2016
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.
This inspection took place on 17 and 18 October 2016 and was announced. We gave the service short notice because we wanted to meet the registered manager and needed to be certain they would be available during the inspection. This also gave the registered manager sufficient time to ask some people if they would be willing for us to contact them by telephone or visit and speak with them in their homes. The inspection was carried out by two inspectors and two experts-by-experience. 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 the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the service before the inspection visit.
During this inspection we spoke with 13 members of staff including four care staff, the registered manager, area manager, transformation lead, trainer, scheduler, administrator, care delivery manager, regional recruiter, trainer and care quality supervisor. We visited five people with their permission in their own homes and spoke with 14 people who used the service and one relative on the telephone.
We looked at a range of records the provider is required to maintain. These included eight service user support plans, risk assessments, medicine administration records and daily reports, staff rotas, four staff recruitment files, staff training records and quality monitoring records. We also looked at records of accidents, incidents, compliments and complaints and safeguarding investigations.
Updated
16 December 2016
The inspection took place on 17 and 18 October 2016 and was announced.
Allied Healthcare Exeter is a domiciliary care agency which provides personal care to vulnerable adults and children in the community in Exeter, Barnstaple and Plymouth. The registered manager told us personal care support was currently being provided to 61 people in the Exeter area, 59 people in the Plymouth area and 69 in the Barnstaple area, totalling 189 people.
There was 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.
From 17 August 2016 the Barnstaple and Plymouth registered branches of Allied Healthcare had merged with the Exeter branch, which means they do not provide any regulated activity from those branches and are no longer registered locations. However they have retained a ‘cell’ office in Barnstaple and Plymouth for staff training and meetings. The new main registered ‘hub’ was run from the Exeter office. The Exeter branch was last inspected on 20 January 2014 and no concerns were identified. The Plymouth branch was last inspected on 16 February 2016 and no concerns were identified.
The Barnstaple branch was last inspected on 1 December 2015 where we found a breach of regulation. Suitable numbers of qualified, skilled and experienced staff were not always deployed in order to meet the needs of the people using the service. The service was rated as ‘requires improvement’ and the provider was required to submit an action plan explaining what they were doing to meet the legal requirement to improve the service. Whilst this service is no longer registered we still checked that improvements had been made around staffing. There had been some staff turnover in the North Devon area but new staff had been employed and this meant the likelihood of people experiencing missed or late visits had reduced significantly. Some people in other areas expressed concern about staff punctuality and staff being rushed. However, the agency had managed to maintain service provision despite high levels of sickness and recruitment difficulties. They had recognised when they did not have enough staff to provide a safe service and withdrawn from this area ‘as a last resort’. There were systems in place to monitor staffing levels and minimise any risks caused by late or missed visits. The registered manager told us there was a ‘permanent recruitment drive’ underway, and was optimistic that staffing levels would improve.
In addition to the creation of a new ‘hub’, combining the Exeter, Plymouth and Barnstaple registered branches; the service was in the process of introducing a new structure with revised systems and processes, called ‘One Best Way’. All staff were being retrained in their new roles. The registered manager told us the aim of the restructure was to achieve consistency across the service. They said, “Before, we were all doing the same thing in a completely different way”. This was evident during the inspection, in the lack of consistency in the quality of risk assessments and care plans, and the experiences of people who were using the service. For example some people were satisfied with the way their complaints had been handled, while one person told us they had tried to make a complaint but had not had a response.
At the time of the inspection some of the key roles in the new structure were yet to be filled, which meant some aspects of the service had not been effectively maintained. Risk assessments and care plans had not been consistently audited to ensure that they accurately reflected people’s needs and were effective in supporting staff to care for people. Gaps in people’s medicine administration records (MAR) had not been identified. Without regular and accurate auditing there was a risk that people may not receive medicines as prescribed.
Overall people told us they felt safe using the service. Comments included, “They always shut the door and lock it after them...If anything’s wrong they’ll phone the office and the doctor”. They were protected from the risk of abuse through the provision of policies, procedures and staff training, and an effective recruitment process.
People who used the service and people closely involved in their care were involved and consulted, and people were asked for their consent before staff assisted them with any tasks. Staff promoted their independence and treated them with dignity and respect. People were supported to make choices about their day to day lives, for example how they wanted their care to be provided.
Each person had their needs assessed before the service began so that staff had access to the information they needed to support the person. The care plan was kept in a folder in the person’s home, with a duplicate in the office for staff to refer to. Care plans contained information about people’s physical and psychological support needs and any related risks. They were personalised and contained information about the person’s preferences. People told us their care plan was regularly reviewed and updated.
People received care and assistance from staff who were well-trained and competent. They told us staff understood their health needs and supported them to keep well. There were good communication systems in place with local health professionals such as community nurses, and guidance was followed by staff.
Staff told us they were well supported. They received regular supervision and support, either face to face, over the telephone or at team meetings. They also received regular monitoring checks by a senior member of staff while they were working directly with people. A comprehensive induction and training programme was in place to support them to do their jobs effectively and meet people’s individual needs. On-going professional development was encouraged for all staff members, with career progression throughout the company.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.