Archived: Allied Healthcare Exeter

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 They had recognised when they did not have enough staff to provide a safe service and withdrawn from this area ‘as a last resort’.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.

We spoke with 26 people and relatives about the care they received and we looked at 10 people's care records. We spoke with twelve staff and looked at six staff files. This including office based staff, care workers and the registered manager.

People and relatives we spoke with were happy with the care provided by the agency. One person said, 'I am able to do some things for myself but I do not know what I would do without them, they are a God send'. A second person said, 'They (the care workers) are brilliant'. People reported they were treated with dignity and respect by staff.

We found people's care needs were assessed and there were clear care plans in place about how to meet people's needs. These included detailed information about any individual risk factors and how to reduce those risks for people. People said they thought the agency was reliable and confirmed they received weekly rota information about the times of planned visits and the names of care workers. They said staff mostly arrived on time, and stayed for the agreed time. Where there were any delays, most people said the agency let them know.

We looked at staffing levels and at staff training and found the agency had enough staff to meet people's needs and that staff received regular training and updating. We also looked at medicines management and found appropriate systems in place to ensure staff supported people safely with their medicines.