Archived: Allied Healthcare Liphook

Updated 12 April 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 activity to ensure staff we needed to speak with were available and to enable the service to inform people the inspection was taking place and that they may be contacted. Inspection activity started on 1 March 2018 and ended on 6 March 2018. It included telephone calls to people and home visits. We visited the office location on 5 and 6 March 2018 to speak with staff; and to review people’s care records and policies and procedures.

The inspection team included two adult social care 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. The Expert by Experience had experience of caring for older people.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events, which the provider is required to tell us about by law.

Prior to the inspection, we received written feedback on the service from the local authority and the local clinical commissioning group, neither of whom had any concerns about the service provided. We sent questionnaires to 36 people of which 12 were returned, seven staff of which one was returned and 36 relatives of which three were returned. Following the inspection, we spoke with a person’s social worker about their care.

During the inspection, we spoke with 10 people and four relatives and we completed three home visits to people with care staff. We spoke with seven care staff, the Care Delivery Manager, a Clinical Lead Nurse, a Field Care Supervisor and the Operations Support Manager.

We reviewed records, which included six people’s care plans, five staff recruitment and supervision records, and records relating to the management of the service.

The service was last inspected in October 2016 when we found four breaches of the Regulations.

Updated 12 April 2018

The inspection took place on 05 and 06 March 2018 and was announced to ensure staff we needed to speak with were available. This service is a domiciliary care agency. It provides personal and nursing care to people living in their own houses and flats. It provides a service to people living with dementia, people with a learning disability or an autistic spectrum disorder. In addition to people with a mental health issue, people who misuse drugs and alcohol and people with a physical disability or sensory impairment. At the time of the inspection, they provided care to 59 people, of which a total of 11 adults and children received nursing care and 48 adults received personal care.

The service did not have a registered 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. The provider had been actively recruiting to this post.

Following the last inspection in October 2016, where we found four breaches of the Regulations. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well-led to at least good. At this inspection, we found the requirements of these four Regulations had now been met, but further work was required to ensure the key questions of safe and well-led achieved a rating of good.

Trained staff administered people’s medicines safely. Processes were in place to ensure staff documented the administration of people’s medicines and these records had been regularly audited. Guidance was in place to ensure the effective application of topical creams for people.

Processes were in place to document and investigate people’s complaints about the service. Processes were in place to ensure that incidents logged on the system were investigated. Statutory Notifications had been submitted and the provider further strengthened this process during the inspection to ensure they could in future provide written evidence of all of the submissions made to CQC.

Staff training and processes were in place to ensure people were protected from the risk of abuse. Staff told us they felt able to approach management about any concerns. Processes were in place to ensure any incidents were investigated, reviewed and any learning points identified and actioned.

A range of potential risks to people had been assessed including generic risks and risks related to people’s clinical care needs. There was clear written guidance for staff with regards to the management of any identified risks for people’s safety. Processes and procedures were in place which staff had been trained in and followed, to protect people from the risk of acquiring an infection.

There was insufficient care staff capacity particularly in Guildford, which had resulted in the provider struggling to consistently provide two care staff for those who required this level of staffing. The provider took immediate action for one person’s safety during the inspection and has committed to not taking on any further care packages whilst they recruit to their vacant staff posts.

People’s needs had been assessed and the delivery of their care and support was based on current standards and relevant guidance. Staff supported people to ensure they received sufficient food and drink for their needs.

The provider worked in partnership with a range of agencies in the provision of people’s care. Processes were in place to ensure people received effective healthcare, which was co-ordinated across services.

Staff underwent an appropriate induction, on-going training and support for their role.

People had been 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 supported this practice.

People felt staff treated them in caring and kind manner. They were encouraged to be involved in decisions about their care and treatment. People’s privacy, dignity and independence had been respected and promoted.

The service was responsive to people’s needs. People had personalised care plans, which reflected their preferences and lives. Where the service had been commissioned to support people with their interests, they provided this care. Processes were in place to enable staff to learn about people’s care needs.

No-one currently supported by the service required end of life care. However, in the event people needed this care staff training was available to staff.

People and staff reported a ‘negative culture,’ following all the changes that had taken place in the office since October 2017. The Operations Support Manager was aware of this and was trying to address the situation. Processes were in place to seek people’s views and to engage staff. However, both people and staff were of the view that communications required improvement to ensure they felt informed and included in the changes that took place.

Processes were in place to audit various aspects of the service in order to drive improvements and the provider was actively monitoring the service.

This is the third time the service has been rated Requires Improvement, but the first time it has been rated as Requires Improvement since the introduction of CQC’s ‘Guidance on Inspecting Services Repeatedly Rated Requires Improvement.’ The provider already had an improvement action plan in place based on the areas that required action identified at the last comprehensive inspection and improvements had taken place, but there were still areas that required further improvement as outlined in this report. Following this inspection, we have asked the provider to submit to us an updated copy of their plan based on the issues identified within this report.