Archived: Allied Healthcare London

We carried out an announced comprehensive inspection of this service on 28 and 30 October 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to people’s care and welfare, assessing and monitoring the quality of service provision, staffing, medicines administration and ensuring consent for care was obtained from people who use the service in line with the principles of the Mental Capacity Act 2005.

We undertook a focused inspection to check that the provider had followed their plan to remedy the more serious breaches that related to care and welfare, assessing and monitoring the quality of service provision and staffing and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Allied Healthcare London on our website at www.cqc.org.uk

Allied Healthcare London was established in April 2014 following the merger of three Allied Healthcare services. It provides domiciliary care services to approximately 900 people, of whom approximately 600 receive their service under the contract we had concerns about. The majority of those who receive the service are older people, some of whom are living with dementia or mental ill-health. The service provides care workers to visit people in their own homes at agreed times in order to carry out personal care and other tasks.

The focused inspection took place over two days. On 17 February 2015 our arrival was unannounced. On the second day of the inspection, 19 February 2015, the provider was expecting us. There was no registered manager in place, but an application was in progress. 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 that the provider had completely reorganised the team structure within their office base and the systems used to run the service. The changes they had made had the potential to impact in a very positive way on service delivery, but the benefits were only just starting to filter through to people who used the service and the care staff who supported them. However, the changes were sufficient for the service to meet the regulations, although improvements were still required.

Office based staff who organised the delivery of care had received intensive training and competency checks to ensure they knew how to operate the safer working systems that the provider was in the process of introducing. They spoke highly of the support they had received and told us that now systems were more streamlined, they had time to visit people who used the service to check that the service met their needs and to resolve any problems.

When we looked at the new processes that had been introduced or were going to be introduced within the next month we saw that, if applied properly, there was less margin for error. For example, care workers’ schedules would be more rational with sufficient travel time allotted, therefore their arrival time at people’s homes should be more reliable.

At the time of the inspection, people who used the service and their relatives had mixed views on the quality of the care provided, but it was clear that whilst most valued their regular care workers, the same standard was less often achieved by those who covered the regular care workers’ absence. Care workers also had mixed views on the support and information they received from the provider. Some described a strong relationship with office based colleagues; others felt they were kept in the dark. One area for improvement was telephone access, both people who used the service and care staff complained about how hard it could be to get through to the office.

The standard and timeliness of internal safeguarding investigations had improved. Reassessments of need had been carried out for all people who used the service with complex needs and new care plans had been set up to ensure those needs were met. Reassessments of people with less complex needs were now taking place.

The inspection took place over three weeks. On October 28th and 30th we conducted a site visit to the office. This was followed up over the following three weeks by phone calls to care workers and people who used the service. We gave the service two working days’ notice of the inspection, therefore it was announced.

A brief follow up inspection had been made in September 2014, where we found the service was not meeting the regulation for assessing and monitoring the quality of service provision. It was too soon for the provider to be able to demonstrate major improvements to the service, but we saw a transformation plan “One Best Way” was in the early stages of implementation.

Allied Healthcare London was established in April 2014, from the merger of three Allied Healthcare services. Approximately 900 people use the service, supported by around 360 staff members. Care workers from the service make over 9,000 home visits each week. The majority of those who use the service are older people, some of whom are living with dementia, but there are also specialist teams within the branch, supporting re-ablement, which is assisting people with their recovery after a stay in hospital, and children and young people with complex needs. Staff from the service also support people living in four extra care housing schemes.

The registered manager had recently left, but a registered manager from another Allied Healthcare service had started to cover the post on the first day of our inspection and was in the process of applying for their registration to be completed. 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.

Although the provider was investing heavily in improvements, at the time of the inspection we found that the service was in breach of five regulations covering staffing, medicines management, care and welfare, consent to care and assessing and monitoring the quality of service provision.

Our concerns did not extend to the specialist contracts held by the provider. However, there were insufficient staff numbers in place to cover the non-specialist work without staff members working excessively long hours. This had an impact on their ability to deliver a high standard of care.

Some assessments and care plans were poorly completed and provided insufficient guidance to care workers about the needs of the people who used the service. Important information from referrers was not always taken into account. Quality monitoring systems had not picked up some issues or resulted in prompt action to address shortcomings until very recently. The service’s ability to monitor missed calls was improving, but more work was needed before we could be confident that the provider had effective systems in place to deal with this issue.

Despite the breaches in regulations, when we spoke with most people who used the service they were positive about the care they received, describing good relationships with their regular care workers. However, safeguarding minutes indicated that there were times when some staff members were uncaring. We observed that improvements to make the delivery of care more robust and, therefore, safer were just starting to have an impact. However, it was too early to judge if they would be sustained.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report. Where we have identified more serious breaches of regulation we will make sure action is taken. We will report on this when it is complete.