Archived: Allied Healthcare Maldon

Updated 25 September 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 carried out the inspection to check the provider had taken the necessary actions in response to our last inspection. We focused on the key concerns from the previous inspection and did not review all areas of safe and well led.

This inspection took place on 26, 27 and 28 June 2018, and consisted of one day spent in the office and two days making phone calls to staff, people and families. The inspection was announced. We provided 24 hours’ notice of the inspection because the location provides a domiciliary care service and we needed to be sure the right staff would be available for us to talk to, and that records would be accessible.

The inspection team consisted of two inspectors, an assistant inspector and one 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, and their expertise was in the care of older people. The expert by experience and assistant inspector telephoned staff and people who used the service and their families to ask them their views about the quality of the support they received. In total they spoke with five staff, 15 people and one family member.

During our visit, we met with the care delivery director, the senior manager who had been overseeing the service since our last inspection. We met with office staff responsible for quality monitoring and the management of the service plus care coordinators and four care staff. We attended an information sharing meeting regarding the reablement service which was arranged by the local authority in the week before our inspection.

As part of the inspection, we reviewed a range of information about the service. This included a Provider Information Return (PIR). A PIR is a form completed by the registered manager to evidence how they are providing care and any improvements they plan to make. However, the PIR used had not changed since the last inspection, as we had returned within six months. We also looked at safeguarding alerts and statutory notifications, which related to the service. Statutory notifications include information about important events, which the provider is required to send us by law.

We looked at twelve care records for people who used the service. We also looked at further records relating to the management of the service, including the systems which monitored the quality of the care people received.

Updated 25 September 2018

We carried out this announced focused inspection of Allied Healthcare Maldon on 26, 27 and 28 June 2018. This inspection took place to check the provider had made the necessary improvements to meet legal requirements after our last inspection of 15 March 2018.

At our last inspection we rated the service as ‘inadequate’ in safe and well led. We had concerns about the impact and risk of missed and late calls resulting from insufficient staff, poor organisation and a lack of oversight. We found the provider in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, specifically Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good Governance) and Regulation 18 (Staffing).

We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This is because the service was not meeting some legal requirements in these two key questions. No urgent risks were identified in the remaining key questions through our ongoing monitoring so we did not inspect them. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Allied Healthcare Maldon on our website at www.cqc.org.uk.

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 reablement service to adults on a short-term basis until they are able to care for themselves or alternative social care arrangements are made. Placements are predominantly for people recovering from a hospital stay. This location also provides a standard domiciliary care service. There was no indication that there were any significant concerns within this part of the service at the time of our inspection so we did not inspect this element of the service.

At the time of the inspection there was a registered manager, however the registered manager had taken time away from the service. The manager who had been covering this absence had left suddenly in the week before our inspection. A replacement manager was recruited shortly after our visit, so we were not able to measure the impact from this new appointment. 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.

We found improvements had been made since our last inspection, however there had not been enough time to measure whether these improvements were sustainable, especially if the numbers of people using the service increased. In addition, the lack of an established management team had resulted in inconsistency and instability, which challenged the long-term success of any improvements at the service. We therefore found a continued breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection we spoke to people who told us they were anxious and felt unsafe due to rushed, missed and late visits. People who were now using the service gave us much more positive feedback and told us they felt safe.

There had been a marked reduction in the number of missed visits. There were very few missed visits and, where these happened, senior staff investigated each incident and took action to minimise the risk of them happening again. Staff stayed the required length of visit to ensure they carried out the agreed support tasks and people were safe.

There were systems in place to assess the level of risk of each person at the service. Senior staff assessed people’s needs to ensure staff had enough information to provide the support required and to make sure they were aware of any key risks staff should be aware of before care visits started. Care plans gave staff improved information about people’s needs. Staff carried out regular reviews to assess any changes in people’s needs and level of risk. People were supported to exit the service appropriately, freeing up staff to take on new people in a managed way.

Staff morale had improved since the last inspection as they felt they had enough time to meet people’s needs and respond to any concerns. However, communication at the service, particularly, from the senior managers to office staff, had not improved sufficiently to ensure the whole staff team were involved in driving improvements. The provider had failed to promote a culture where people felt able to speak out and together learn from mistakes and feedback.

The provider had made some improvements in the way they monitored the quality of the service, in particular, how they measured missed visits and responded to risk. However, the regular audits were not tailored to a reablement service and so were not a sufficiently robust and appropriate check on how well the service as a whole was working.