Alina Homecare Specialist Care - Bournemouth, Christchurch & Poole

Alina Homecare Specialist Care – Poole provides care and support to people living in a number of ‘supported living’ settings, so they can live in their own home as independently as possible. The service is also a domiciliary care agency. Its supported living and domiciliary care services are provided to people with a learning disability.

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.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgement about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting maximised people's choice, control and independence. People made choices about all aspects of their lives. Staff fostered their independence.

Right care:

• Care was person-centred and promoted people's dignity, privacy and human rights. Staff treated people with respect. People's equality and human rights were upheld.

Right culture:

• The ethos of the service and the values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.

We received some mixed feedback regarding how well-led people felt the service was. This was dependant on which scheme people lived in, or whether they were a sole or duo package of care. The registered managers and provider communicated with staff. However, relatives, staff and healthcare professionals told us the communication was poor and needed to be improved.

People and relatives told us they were happy with support staff and felt safe in their care. They described staff as kind and caring and in some cases, a part of the family. People’s independence was supported. They were happy with the way risks were managed. However, relatives and staff told us there were not always enough staff to support people in smaller packages of care to enjoy activities, such as going out in the community for walks or for drives. People told us this had impacted on how they felt.

Managers and staff told us how they had worked hard over the COVID-19 pandemic to manage risk to keep people safe. The branch staffing structure was strengthened with the introduction of new roles and a "Lets Talk" facility for stakeholders to use. They told us how they facilitated group activities in their larger supported living schemes to keep people engaged and how they had worked together in working bubbles to prevent the risk of cross infection.

The provider had an up to date infection prevention and control policy. They had introduced procedures to manage the risks COVID-19 posed to everyone connected with the service. Staff had access to the correct personal protective equipment (PPE) and were using this correctly.

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; the policies and systems in the service supported this practice.

We raised the concerns we found during the inspection to the registered managers. At the end of the inspection the registered managers sent us a service improvement plan. This will be checked upon at our next inspection to ensure improvements have been made and maintained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 19 January 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and management of the service. A decision was made for us to inspect and examine those risks.

We received concerns in relation to the staffing levels and management of the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

We have made recommendations that the service reviews its systems to ensure there are enough competent staff to meet people’s needs. We recommend the service reviews it’s systems to ensure medication audits are effective, reviews its system to ensure good communication with healthcare professionals and to improve governance systems at all packages of care to ensure the service remains consistently well-led.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

The service provided us with a service improvement plan at the end of our inspection identifying areas to improve this will be reviewed at our next inspection to ensure the improvements are followed and maintained.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alina Homecare Specialist Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We gave notice a day ahead of the inspection to ensure the people we needed to speak with would be available. When we last inspected the service in September 2016, it was Good overall and in all domains except Caring, which was Requires Improvement. There were no breaches of the Regulations.

Alina Homecare Specialist Care was previously known as The Care Division – Poole. This service provides care and support to people living in a number of ‘supported living’ settings, so they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The service is also a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Its supported living and domiciliary care services are provided to people with a learning disability, across Poole, Bournemouth, Eastern Dorset and South West Hampshire.

Not everyone using Alina Homecare Specialist Care receives 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.

Under its conditions of registration the service is required to have a registered manager. The registered manager had left the service in September 2017. Their replacement was already in post and had applied to register as manager, as had their line 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.

There had been changes in the management team over the past year. Staff said the new manager seemed experienced, knowledgeable and supportive, and were hopeful that things would change for the better. However, the new manager had only very recently joined the service; hence the improved confidence in management was not embedded or sustained. We will review the positive impact of the manager at our next inspection.

Staffing levels had presented a challenge over the summer, as staff had left and there had been issues with the approval of annual leave that meant more staff were off work than should have been. Some staff reported that they or colleagues worked long hours. The managers had recognised staffing pressures and had a plan in place to address recruitment and retention.

Staff morale had been low in recent months. Staff were fearful that colleagues would leave. Some staff told us that recently there had been a better atmosphere at the office and that communication with the office-based staff and management team had improved. However, the improved morale and communication was a recent development and it was too early to say whether it was embedded and sustained. We will review this at our next inspection.

Staff were supposed to have regular supervision meetings to discuss their work and any issues it presented. The managers were aware these had fallen behind owing to staffing pressures and supervisory staff having to cover gaps in rotas. However, a strategy was in place to address this.

Checks were made to ensure new staff were of good character and suitable for their role. Staff had core training at induction in topics such as safeguarding, moving and handling and health and safety. This was updated at regular intervals. They had opportunities to undertake additional training that was relevant to their work, and were supported to obtain diploma qualifications in health and social care.

People were kept informed about which staff would be working with them.

People were treated with kindness and compassion. Staff understood their responsibilities in relation to safeguarding and knew how to report concerns about possible abuse.

People’s rights were protected because the staff acted in accordance with the Mental Capacity Act 2005 and wherever possible sought people’s consent to their care.

People were supported to follow their interests, develop independent living skills and take part in social activities, education and work opportunities.

Care plans were personalised to the individual and clearly explained how people would like to receive their care and support. Risk assessments and management plans were in place, as were arrangements to keep people safe in an emergency. Staff told us the information they required was all available in people’s homes and that they generally found care plans clear. They had a good understanding of people as individuals and were familiar with people’s care and support needs.

Where their care packages included support with preparing and eating meals, people were supported to have a meal of their choice. People’s dietary needs and preferences were clearly recorded in their care plans.

Peoples’ medicines were managed and administered safely.

When people had accidents, incidents or near misses staff recorded these. Field care supervisors and managers reviewed these records to ensure any necessary action had been taken to keep people safe. The management team monitored accident and incident forms for developing trends.

Complaints and concerns were taken seriously and used as an opportunity for learning or improvement.

The Care Division – Poole provides care and support to people with learning disabilities in their own homes. Some people have domiciliary care, with staff visiting at set times during the week, and others have supported living assistance, with staff present for most, if not all, of the day and night. At the time of our inspection, there were 67 people receiving a personal care service.

The service had a registered manager, which is a condition of its registration. 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.

A manager was registered for The Care Division – Poole who no longer worked there. Following the inspection she submitted an application to cancel her registration and is no longer registered.

The ownership of the service had changed at the start of 2016. The new management team were seeking to foster an open and inclusive culture. They were finding ways of promoting people’s involvement in the service, including setting up a forum for people who used the service and producing more information in an easy-read format. Staff felt confident to share any concerns with the management team and knew how to raise whistleblowing concerns to external agencies such as CQC. Staff recruitment procedures helped ensure that only staff who were suitable for work in a care setting were employed.

People were put at the centre of their care. They were involved in developing their care plans, which reflected their preferences and individual needs. Their rights were protected because staff and management had a working knowledge of the Mental Capacity Act 2005. Staff also understood their responsibilities for safeguarding people against neglect and abuse.

Staff understood people’s care plans and provided the support they needed, including support with their health and nutritional needs. Where people had complex and specialised needs, staff had the appropriate support and training to enable them to meet these. Medicines were managed safely.

Where people’s care packages allowed, care included support to pursue interests and attend social activities. Some people reported that staff not being able to drive restricted the activities they could take part in. The service had already identified this as an issue and were seeking to incentivise more staff to drive.

There were sufficient staff to provide care safely. If support workers were not available, for example, due to sickness or leave, supervisory staff based in the office would attend. However, some people told us that support was on occasion cancelled and that their rotas were sometimes late or showed the wrong times. People also said that they were not always informed about rota changes.

Staff were well supported through effective training. They felt colleagues and the supervision process supported them. Where weaknesses in some supervision processes were highlighted, the management team had already started to make improvements.

Views were mixed about communication with the office. Most people and staff viewed this positively. They said that the on-call system generally worked and that it was usually possible to get hold of supervisory and managerial staff when they needed to. However, two members of staff said they did not always receive sufficient communication from the office, for example, to inform them that new staff would be visiting to work a shadow shift.

The senior management team had set up a quality assurance system. This gave them an oversight of how the service was running and any issues that needed attention. There was an improvement action plan based on the results of audits and any known issues. The management team reviewed this regularly.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

People's care was planned and delivered in a way that was intended to ensure their safety and welfare. For example, we saw that care plans covered people's physical health needs, including epilepsy and swallowing difficulties, and set out how staff should support them to remain safe. Although we did not observe any intimate care, we saw that people were receiving support as specified in their care plans. For example, when we arrived to visit one person, they were tilted in bed in the position that their care plan said they needed to help drain fluid from their chest. Their care notes recorded that staff had tilted them each day in accordance with their care plan.

Where people displayed behaviours that challenged others, care plans contained behaviour guidelines that set out how they behaved when they were feeling settled and happy and how their behaviour changed when they became distressed. The behaviour guidelines were set out in language that was positive about the person and gave clear instructions for how staff should respond to different types of behaviour.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person told us they felt safe with their workers and that staff were careful with their property. The other people we met looked relaxed and happy with the staff who were supporting them. The five support workers we spoke with confirmed they received regular training in safeguarding vulnerable adults against abuse and were all aware of signs or issues that could indicate abuse.

Staff received the training they needed in order to perform their roles satisfactorily. We spoke with five support workers, who all confirmed that they received regular mandatory training. They said that staff from the office checked their training was up to date and called them in for any updates that were due.

Is the service effective?

People were provided with a choice of suitable and nutritious food and drink. Information was available for support workers about people's food preferences and dietary needs. People's care logs and food diaries recorded that staff had supported them to eat a range of healthy foods that were consistent with their food preferences and dietary needs. The person we spoke with told us their support workers helped them to make a menu plan every week and encouraged them to choose food they liked that was healthy.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed that a person's support worker assisted them to sit in an upright position and supervised them while they were drinking, as their care plan specified. Another person's care plan stated that they were able to prepare snacks and cook meals with staff support to ensure their safety. The person told us they liked cooking together with their support workers.

Is the service caring?

The person we spoke with told us their support workers were kind and polite. During our visits to people, we saw that staff interacted with them in a respectful manner. Care plans gave detail about people's individual communication styles, including the gestures and facial expressions they used to indicate pleasure and displeasure.

Is the service responsive?

People's needs were assessed and care was planned and delivered in line with their individual care plan. The care plans we looked at reflected people's assessed needs and contained clear, detailed instructions so that support workers provided the help and support people needed. They were individualised, setting out details of people's daily routines and reflecting their known preferences and communication styles. Staff were familiar with people's care needs, which helped ensure that people received the support they needed. A person told us that staff followed their care plan and that they were happy with the support they received.

There were enough staff to meet people's needs. The person we spoke with told us their support workers were 'good' and said they had a regular team of staff. Records of care given for the previous three weeks for the people whose care we considered showed that people had a consistent team of support workers.

People were supported to be able to eat and drink sufficient amounts to meet their needs. Care plans set out any support people needed with preparing food and drinks and consuming them.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people receive, and to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. There was a system in place to ensure that staff followed The Care Division - Poole policies and procedures, and staff had opportunities to give their views about the running of the service. The staff we spoke with told us they received regular supervision. Records of supervision meetings showed that staff discussed their performance in their role and had the opportunity to raise any issues that they wished. Audits were regularly undertaken to check that staff and records complied with the provider's policy and procedures. There was evidence that learning from incidents took place and appropriate changes were implemented. Incident records showed that each report had been reviewed by a senior member of staff, who had taken action where necessary. A member of staff who participated in the 'on call' rota told us that the managers were 'definitely' supportive if they needed to contact them.

Before people received any care they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We observed that people were supported to make choices and that their preferences were respected.

People experienced care, treatment and support that met their needs and protected their rights. People received assistance to do things they enjoyed.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider assessed and monitored the quality of the service, and assessed and managed risks to people's health, safety and welfare.

The care provided by was person centred, which meant it was focussed on meeting people's needs according to the individual's preferences. We found that staff attitudes, training and records all reflected that the individual needs of the person and how best to meet their needs was at the centre of their work.

One relative told us "They are all absolutely first class. We cannot fault them. They understand how to look after [my relative] and their possessions and they recognise signs that they may be unwell"

Another relative said "I'm very happy. The staff are supportive, kind and helpful. They are good communicators and they understand my needs as well as [my relative's]. They are always happy with their carers".

We spoke with two staff who told us that they understood safeguarding policies and procedures and had good support from their managers. We found that staff were well supported and given specialist training relevant to people's needs as well all mandatory training.

Good record keeping systems were in place to support the work of the staff and protect people using the service from the risks of unsafe treatment.