The Care Quality Commission
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Archived: Allied Healthcare London East

Overall: Inadequate read more about inspection ratings

Unit 6 Stratford Office Village, 14-30 Romford Road, London, E15 4BZ (01707) 254692

Provided and run by:
Nestor Primecare Services Limited

All Inspections

23 May 2016

During a routine inspection

The inspection took place on 23, 24, 25, and 27 May 2016 and was unannounced. The last inspection took place in September 2015 when the service was rated inadequate and placed in special measures. Following our last inspection the service had been issued with three warning notices regarding person centred care, safe care and treatment and good governance.

The service is a large domiciliary care service providing personal care to people in their own homes. At the time of our inspection they were working with 178 people.

The service had a registered manager in post. A registered manager is a person who had 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.

Care plans and risk assessments lacked details and did not contain the information required to provide safe care that met people's needs. Medicines were not managed in a safe way and staff did not have the information they needed to support people with their medicines. Assessments of people's needs and associated care plans had been poorly completed. People and staff told us care plans were out of date and did not contain the information needed to provide good care. The provider’s policy was for care files to be updated annually, but files had not been amended when people’s needs changed before a year had passed.

Records did not clearly record people's involvement in decisions relating to their care. Consent was not always clearly recorded in line with legislation and guidance. Care plans contained limited details about people's preferences. People were not asked about their sexuality and so were not given the opportunity to discuss if this affected their care preferences. We have made a recommendation about supporting people who identify as lesbian, gay, bisexual or transgender.

Where the service supported people to have their nutrition and hydration needs met, this was not clearly recorded and staff did not have the information they required to meet people's needs. When people required access to healthcare professionals, the service provided this. However, when staff were required to monitor people's health conditions they did not have the information they required to do this effectively.

People and their relatives provided mixed feedback about the attitude of staff. People said they felt safe and cared for by their regular carers. However, they did not feel that all staff had a positive attitude and did not think all staff knew how to perform their roles.

Staff completed a comprehensive induction before they started working in the service. However, on going training and support was insufficient to ensure they had the knowledge and skills required to perform their roles.

The service had a robust complaints policy and records showed that individual complaints and concerns were responded to appropriately. However, there was no analysis of complaints and no record that lessons were learnt in response to feedback.

The quality assurance and audit systems in place were ineffective. They did not address issues identified with the quality of work completed by the service.

We found five breaches of the regulations. We have taken enforcement action against the provider and will publish an updated version of this report when all legal appeals processes have been exhausted.

This provider is in special measures. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

30 September 2015

During a routine inspection

Allied Healthcare London East is a large domiciliary care agency providing personal care support to people in their own homes. At the time of our inspection they were working with approximately 230 people. This was this location’s first inspection.

The inspection took place on 30 September, 1 and 2 October 2015 and was announced. The provider was given 48 hours’ notice as they provide a domiciliary care service and we needed to be sure someone would be in the office during our inspection. The service has 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.

People and their relatives told us that staff were caring and hardworking. Staff had received training on safeguarding adults and staff we spoke with had a good understanding of abuse and how to raise any concerns.

Risk assessments were not robust and did not include measures to identify and control risks to individuals. Care plans did not provide enough information to provide good care and often contained inconsistencies. The care plan review mechanisms were not effective and plans were not updated to reflect changes in peoples needs. Where the service supported people with their food and drink it was not clear what support was provided and how this was reviewed. Where the service supported people with healthcare needs this was not clearly recorded. People who received support with medicines were at risk of unsafe support as records were not kept and it was not clear what level of support was provided to people.

People were not always involved in reviewing their care. We have made a recommendation about involving people in decisions about their care.

Systems to monitor the quality of the service were not effective. The leadership of the organisation had identified issues but appropriate steps to address them had not been taken.

Staff recruitment procedures were not robust. Records showed that people were employed with unexplained gaps in their employment history, insufficient references and their interview answers were not evaluated.

Staff received a thorough induction but on-going support and development was lacking. We have made a recommendation about on-going training and support of staff.

The service had systems in place to respond to feedback from people, relatives and professionals including complaints and incidents. These were poorly completed and feedback was not always responded to. We have made a recommendation about learning from feedback.

We found five breaches of regulations. You can see what action we have asked the provider to take at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.