Background to this inspection
Updated
30 January 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced.
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 4 December 2020 and ended on 18 December 2020. We visited the office location on 15 December 2020.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since it registered with the CQC. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
We spoke with two people who used the service and four relatives by telephone about their experience of the care provided. We spoke with seven members of staff including the regional director, registered manager, quality manager, service manager and three care workers. We also spoke with the extra care housing scheme manager.
We reviewed a range of records. This included three people’s care records and medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
After the inspection the registered manager sent us updates regarding a response to a complaint raised about poor infection control practices. They also sent information regarding the assessible information standard.
Updated
30 January 2021
About the service
Allied Health-Services Limited Mill View is a domiciliary care agency that provides personal care to people living at an extra care housing scheme in Hauxton Cambridgeshire. The scheme consists of seventy, one- and two-bedroom flats, that can be purchased or rented. Each person's flat is provided with kitchen, lounge, bedroom[s] and a bathroom. The building, communal areas, flats and facilities such as the restaurant are run by a different organisation to the care service. Communal lounges, and dining facilities are provided within the scheme but were closed at the time of inspection, due to COVID-19. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The service was providing personal care to 14 people at the time of the inspection.
People’s experience of using this service and what we found
During the COVID-19 pandemic, people, their relatives and the registered manager told us staff did not have access to face masks, that met the government guidelines, for two days as they had run out. Actions were taken to reduce the risk of recurrence, but some people and relatives told us that staff, when wearing face masks, did not always wear them correctly. This was seen during this inspection, although quickly rectified once noted. This demonstrated to us that the checks in place around safe infection control were still not robust enough.
People felt safe having their care provided by staff at the service and staff answering emergency call bells gave people reassurance. Risk assessments were in place to identify individual risks to people’s health and well-being. Measures were implemented to guide staff on how to reduce these risks. However, not all staff told us they had read this information, and this increased the risk of people receiving unsafe and ineffective care and support. Systems and checks were only now being introduced to ensure that staff were washing their hands during COVID-19, in line with their training, to reduce the risk of cross contamination. A new service manager had been recently recruited to ensure more day to day managerial oversight at this location. This was while the registered manager was not present as they were registered for two different services.
Audits were carried out to monitor the service and address any improvements required. However, the registered manager had not notified the CQC of two incidents that they were legally obliged to. One notification was received after the inspection
People and their relatives told us staff were usually punctual, but that their care call visits were sometimes cut short. This had been identified by an audit of people’s daily notes and staff had been spoken with to reduce the risk of recurrence.
Most people and their relatives had no concerns around the safe management of people’s medicines. Audits had identified that a new format medicines administration record would be clearer for staff and help reduce the risk of errors. People’s end of life wishes were not recorded.
There was a complaint process in place that was followed when a complaint or concern was raised. A concern raised again during the inspection was currently being relooked at by the registered manager.
Recruitment checks were completed to ensure staff were suitable to work with the people they supported. To develop their skills and knowledge staff received induction training, refresher training and supervisions. People were supported to maintain their independence.
Most people and their relatives told us staff promoted and maintained people's privacy and dignity. People and their relatives had mixed opinions of the standard of care they received. One relative confirmed that it depended on the staff member. This was fed back to the registered manager on inspection.
Staff worked in conjunction with guidance from external health and social care professionals across different organisations to help promote people's well-being. People’s personal information was kept confidential. People and their relatives were involved in discussions about their family members care and support needs. Staff felt well-supported.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
This service was registered with us on 5 August 2019 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about infection control, safe care and treatment and safe medicines management. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to regulation 12 (safe care and treatment) and regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.