Archived: Allied Healthcare Maidstone

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, older people, people with learning disabilities and autistic spectrum disorder, people with a mental illness, people who have a physical disability and younger adults.

Not everyone using Allied Healthcare Maidstone receives a 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. There were 141 people receiving support with their personal care when we inspected.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The previous registered manager had left on the 27 July 2018. The provider had employed a new manager, who was planning to apply to CQC to become the registered manager.

People were not always protected from abuse and harm. We found evidence that safeguarding concerns raised by staff had not always been dealt with following the provider’s and the local authority’s policies and procedures. Whilst the provider had taken some action to internally investigate the allegations, they had not contacted the local authority or the police.

The provider had not deployed enough staff to meet people’s needs. This has impacted on people who have had missed and late visits. A person who had experienced a missed call explained they were found in bed by the lunchtime care staff that came. They were not able to mobilise on their own. They said, “I had to lie in bed, I could not do anything.” They went on to explain that the experience was not pleasant, they could not go to the toilet and they were hungry. People did not always get their care at a time that met their needs and preferences. Care staff were not always allocated adequate travel time between care visits. People received shortened or clipped care visits.

The provider did not follow safe recruitment practices. Essential documentation was not available for all staff employed. Gaps in employment histories had not been explored to check staff suitability for their role.

Risks to people and staff had not been well managed. When people’s health and mobility had drastically changed, risk assessments had not been reviewed and updated in a timely manner. People and staff were at risk because staff had been providing care to people alone when the person had been assessed as requiring two staff. Accident and incident data on showed that a staff member was injured whilst carrying out a care visit to a person on their own instead of with another staff member. The provider had failed to take adequate action when accidents and incidents had occurred. Lessons had not been learnt from accidents and incidents to prevent further concerns and to strive for improvement.

Medicines had not been well managed. People receiving administration help and support did not always have medicines administration records (MAR) in place to detail what the person was prescribed, what time staff should administer the medicines, what route the medicine should be given and other essential information. We identified practice of leaving medicines out for a person putting the person at risk of harm from overdose.

Measures were in place to minimise the spread of any infection. Staff were provided with appropriate equipment to carry out their roles safely.

The provider had not provided staff with the resources to apply their training to ensure people received effective care and support. Staff had received training on how to move people safely but regularly carried out care visits which had been identified as needing two members of staff to safely support people by themselves. Although the systems were in place to support and develop staff, these were not being applied effectively. There was a programme of supervision in place which included ‘spot checks’. However, this had not identified that staff were not applying their training effectively.

People’s care and support needs had been assessed prior to them receiving a service which included recording their preferred name, religion, ethnicity and background. The assessment did not capture all of the protected characteristics under The Equality Act 2010. When people’s needs changed they had not been reassessed in a timely manner.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did not always support this practice. Staff knew and understood how to support people with decision making, such as offering people different options verbally or by showing them the choices to help them make an informed choice. People’s capacity to make decisions had not always assessed or recorded.

The service had failed to provide care and support to meet people’s nutritional needs. Essential information about one person’s nutritional intake had not been effectively monitored. This meant that action had not been taken to address concerns about suitability of food to sustain the person’s life and good health.

Most people received medical assistance from healthcare professionals when they needed it.

Care records showed where staff had taken action when people were unwell. However, the care records did not always record an outcome or whether there had been medicines changes. This is an area for improvement.

People told us staff that provided them care and support in their homes were kind and caring.

Despite the mainly positive feedback from people and their relatives about the care received. Allied Healthcare Maidstone had not treated people with dignity and respect by providing rushed and clipped care visits, cancelling care visits and not providing enough staff to meet people’s needs. People and their relatives had not always felt listened to and in control of their own lives. The service has not always given staff the time, training and support they need to provide care and support in a compassionate and personal way. One person had complained of being left by the staff in soiled sheets for some considerable time. Staff recorded that they supported this person with their personal care but left them in a wet sheet as there was only one member of staff at the call and the person needed two members of staff to support them to move. No telephone call was made to the office to ask for an additional member of staff to attend and support the person with their mobility so they could change the bed linen.

We observed staff supporting people in their own homes. Staff were friendly and discreet and clearly knew people well. Staff had a good rapport with people and knew people well. Staff were able to describe people's care routines, likes and dislikes. We observed staff chatting with people about their day and showing a genuine interest in people and their lives.

People and their relatives knew how to complain. At the time of the inspection records of individual complaints were not available. We were unable to asses if the complaints had been responded to effectively and within timescales. People did not feel that Allied Healthcare Maidstone listened to them. People and their relatives did not have all the information they needed to escalate their complaints. Each person received a pack of information about the service which included essential information and contact telephone numbers. The complaints information did not include information about how to contact the local government ombudsman.

Some people and their relatives told us they received a personalised service. They said they had been involved in planning their care so the support provided could meet their needs.

Care plans were personalised and had been developed from initial assessments of people's needs. However, care plans were not updated promptly when people’s needs and wishes changed. We found care plans in place which did not represent people’s current care and support needs both in the office and when visiting people with staff in their own homes. One person was described by staff as at the end of their life, their care plan had not been updated to detail their wishes and choices about how they wanted to be cared for when they deteriorated further.

There were multiple and serious shortfalls in key systems and processes used to assess, monitor and evaluate the service. Which meant the provider did not have adequate oversight of the service. Although there were systems and processes in place to monitor the service. The systems were not robust enough to capture the breaches of regulations found during this inspection. There has been a lack of management oversight at Allied Healthcare Maidstone with regional management and senior managers concentrating on other services in the south of the country. The providers intelligence systems had not been used by the management team to effectively monitor the service. It is very clear from the data from these systems that there were concerns in relation to staffing levels, clipped calls, complaints, medicines errors and missed care visits that have been apparent for some time. The provider failed to notify the commission of serious incidents such as safeguarding concerns.

Records were not complete or accurate. Care plans and risk assessments were not updated when incidents occurred.

People were sent quality surveys annually to gather th

Allied Healthcare Maidstone is registered as a domiciliary care agency providing personal care and support to people in their own homes. These included older people, some living with dementia, as well as people with physical disabilities and mental illness. The service is able to provide a range of visits to people, from one visit a day, up to several visits per day. At the time of the inspection the service was providing support to 155 people.

There was a registered manager for the service, who was registered for both the Maidstone location office and the Dartford location office. 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 and associated Regulations about how the service is run.

The feedback we received from people was positive. Those people who used the service expressed satisfaction and spoke highly of the staff. For example, one person said, “I am very happy with the service”.

The safety of people who used the service was taken very seriously and the registered manager and staff were well aware of their responsibility to protect people’s health and wellbeing. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed. Risks had been identified for individual people and their circumstances and measures had been put in place to control and reduce risks, helping to keep people safe. The home environment of people was checked for hazards before support was commenced to ensure the safety of people and staff. However, the environmental risk assessments seen had not always been fully completed and the registered manager was addressing this issue.

Most people either managed their own medicines or members of their family helped them. Some people required staff assistance with medicines. Staff who administered medicines had received training and management checked that staff were safe to administer people’s medicines by carrying out regular competency assessments. The registered manager ensured that staff had a full understanding of people’s care needs and had the skills and knowledge to meet people’s needs. People received consistent support from staff who knew them well. People felt safe and secure when receiving care.

People had positive relationships with the staff who supported them and were confident in the service. People who used the service felt they were treated with kindness and told us their privacy and dignity was always respected. People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care package amended to meet their changing needs. The service was flexible and responded to people’s requests.

The provider had a robust recruitment process in place to make sure new staff were suitable to work with people in their own homes. Staff were supported to gain the skills necessary to be able to support people in their own homes. Staff had the relevant induction and training updates to feel confident in their role. Support was given through regular one to one supervision, observational assessments and annual appraisals.

Staff presented a caring approach as did the staff working in the office who supported the delivery of care. People were happy with the staff and made many positive comments about the staff who supported them. The provider made sure people had information about the service before the commencement of care and support being provided.

People were supported with meal planning, preparation and eating and drinking as required. People had positive relationships with staff who knew them well. There were enough staff available to meet people’s needs. Staff supported people, by contacting the office to alert management, to any identified health needs so that their doctor or nurse could be informed.

The service had processes in place to monitor the delivery of the service. People were given information about how to make a complaint and the people we spoke to knew how to go about making a complaint if they needed to. People and their families thought the service was well run. Some staff felt they were supported and found the management approachable and would be happy to raise any concerns with them, confident they would be acted on. People’s views were obtained through meetings with the person and meetings with families of people who used the service. The provider checked how well people felt the service was meeting their needs, by carrying out surveys.

The registered manager ensured that they had planned for foreseeable emergencies, so that should they happen, people’s care needs would continue to be met. Incidents and accidents were recorded and checked by the provider or registered manager to see what steps could be taken to prevent these happening again.

The registered manager was very committed to continuous improvement and feedback from people, whether positive or negative, as this was used as an opportunity for improvement. The registered manager demonstrated understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.