Background to this inspection
Updated
18 December 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We gave the service 48 hours’ notice of the inspection. This was so we could be sure that there was suitable management available when we visited due to the absence of the registered manager.
We visited the office location on 1 November. The inspection included visiting and talking to people using the service, talking to their relatives, interviewing staff and reviewing records.
The inspection team consisted of two adult social care inspectors, two pharmacy inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before this inspection we reviewed all the information we held about the service. We had received a number of safeguarding concerns raised about the service following the closure of their Redcar branch and the transfer of the management of staff and care packages to the Middlesbrough branch.
A number of care workers had left the provider and the Middlesbrough branch were unable to provide suitable cover to all care packages. We spoke with the nominated individual to raise our concerns. Following this they developed an action plan that we looked at before our inspection. The nominated individual has overall responsibility for supervising the management of the regulated activity, and ensuring the quality of the services provided.
Prior to inspection, the service had been placed into a serious concerns protocol with one of the local authorities who commission services. We attended the meetings which had taken place and had shared relevant information. At these meetings, the provider was asked to outline how they would make the necessary improvements to the service.
We also looked at notifications the provider had sent to us. A notification is a record about important events which the service is required to send to us by law.
We contacted professionals involved in caring for people who used the service, including commissioners and Healthwatch England. Healthwatch England is the national consumer champion for health and social care services.
During the inspection we spoke with nine people living across the Middlesbrough and Redcar area, and four relatives by telephone.
We also spoke with the regional director, the care delivery director, three supervisors, two care co-ordinators and nine care workers.
We looked at eight people’s care records, three care workers recruitment files, the care workers rotas, medicines administration records (MARs) and the records of quality assurance checks carried out by the provider
Updated
18 December 2018
The inspection took place on 1 November 2018 and involved visiting the service, reviewing records, visiting people using the service in their own homes, talking to relatives and, interviewing care workers.
The inspection was announced which meant that we gave the provider 48 hours’ notice of our visit. This was because the location provides a domiciliary care service and we needed to ensure that suitable management would be available.
This inspection had been brought forward because we had received a number of safeguarding concerns which had been raised about the service following the closure of their Redcar branch. When this branch was closed, all staff and care packages were moved to the Middlesbrough branch. Concerns included missed calls, care workers not knowing people’s care needs and rotas not being issued in a timely manner.
Allied Healthcare Middlesbrough is a domiciliary care agency which provides personal care to people living in their own houses and flats in the community. This includes children, younger adults and older adults. Not everyone using Allied Healthcare Middlesbrough receives a regulated activity. The Care Quality Commission (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.
At the time of the inspection there were 168 people using the service, 153 people were living within the Middlesbrough area and 15 people were living within the Redcar area. We looked at all records relating to both areas during this inspection.
We last inspected the service on 26 April 2017 and rated the service to be Good. At this inspection we found the service had deteriorated and rated the service as requires improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At the time of the inspection the service had a registered manager who was currently absent from their work. A registered manager is a person who has registered with the 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.
People and their relatives told us they did not think the service was consistently well led and raised concerns about how the standard of the service had deteriorated over recent months.
The provider had a range of quality monitoring audits in place but these had not been undertaken effectively over recent months to identify issues within the service and act upon them to make improvements. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations.
Medicines records were not being managed safely and did not always keep people safe. We found records completed by care workers were not always accurate and up to date. Audits of medication administration records (MARs) had not been undertaken to identify if people were receiving their medicines as prescribed.
Best interest decisions were not always recorded to reflect the process had taken place and who was involved when best interest decisions were made for people.
Individual risk assessments were not always in place where specific health issues had been identified in care plans. This meant that care workers were not always provided with the information to enable them to mitigate these risks when providing care to people.
The provider had safe recruitment and selection procedures in place and most checks had been undertaken before staff began work. We found some gaps in people’s employment history had not been recorded prior to the person commencing their employment.
People were supported by enough people to meet their needs safely.
People told us that they felt safe when they received support from care workers in their own home. Care workers understood safeguarding, what their responsibilities were and could tell us what action they would take if they had any concerns about the way people were supported. Care workers received training in both safeguarding of adults and children.
People told us they felt care workers were kind, caring and treated them with dignity and respect when providing care. People and their relatives knew how to raise a complaint. Policies and procedures were in place to investigate and respond to complaints appropriately.
The provider told us that they had a training programme in place for all care workers which included mandatory and refresher training. Care workers told us they received training in all aspects of their role. However, records provided were not always up to date to evidence care workers training.
Although care workers had not consistently received regular supervision they gave us positive feedback and told us they were supported by management and could approach them at any time.
At the time of our inspection nobody was receiving end of life care. However, with the support of other health care professionals people could remain at the home at the end of their life and receive appropriate care and treatment.
People’s nutrition and hydration needs were met and they were supported to maintain a healthy diet. Where needed records to support this were detailed.
People were supported by person centred approaches this means peoples preferences and choices are respected when planning and receiving care and support.
Notifications of significant events were submitted to us in a timely manner by the manager.
Partnership working was in place with other professionals, including; health care professionals, or specialist consultants including community nurses and physiotherapists were Involved in people’s care as and when this was needed and care workers supported people with any appointments.
Evidence was available to show that all accidents and incidents were responded to appropriately by the registered manager and used as a learning opportunity.
We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach relates to risk management and good governance of the service. You can see what action we told the provider to take at the back of the full version of this report.