Archived: Allied Healthcare Clare

We spoke with four people who used the service, and interviewed six staff, including two managers. We attended the office in Clare and went out with two staff on afternoon visits to four people’s private residence with their permission. We looked at six people's care records. Other records viewed included policies and procedures, medication administration records, staff rosters, staff training matrix, supervision records and quality monitoring systems used by the service held on computer. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

When we arrived at the service staff greeted us and noted our identification and we signed in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their records.

We found that risk assessments to keep people safe had been completed in a range of areas. An example being falls prevention. We observed staff moving and handling people safely on two occasions. Risk assessments on equipment used needed more details to keep people safe.

We examined the medication systems in use and found that records were well kept and staff were trained to administer medication. Staff were not following the agency policy on crushing medication. We brought this risk to the attention of the manager.

Effective systems were in place to manage incidents and accidents, and to learn from them so that they were less likely to happen again.

No one at the service required a Deprivation of Liberty Safeguards (DoLS) authorisation.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

The service had effectively recruited more staff since our last inspection and had an additional 12 staff that had completed their induction training. Three more staff were completing this training. One person’s relative was concerned that they did not always have staff who could meet their relative’s needs as they had not received training in a specific technique. Staff were due to receive this training shortly after our inspection.

Is the service caring?

We saw that the staff interacted with people using the service in a caring, respectful and professional manner. People using the service told us staff were caring and met their needs. One person told us, “All the staff are lovely to me”. Staff were seen to promote independence and respect people’s lifestyle choices.

Is the service responsive?

Regular telephone interviews with people who used the service and spot checks completed by senior staff meant that the service could respond to people’s changing needs. The service had a complaints procedure in place that people used. Missed calls accounted for the last four logged complaints. Records showed that these concerns were taken seriously with appropriate actions taken.

The service was also responsive to staff concerns about feelings of being undervalued, high sickness impact and erratic rosters. The actions taken and set out were from engaging with staff, with staff being empowered to be part of the solution.

Is the service well-led?

The registered manager told us they were leaving, but arrangements were in place for cover and recruitment was underway.

We found the managers of the service to be open and provided all information requested efficiently and quickly to aid our assessment of the service. The imminent development of a consistent master roster that the manager had worked hard on would benefit people using the service and staff who worked there. This would lead to a more consistent service for people with staff they knew.

The service had quality assurance systems in place. We saw audits and records which had identified shortfalls and these were addressed promptly. As a result, the quality of the service was continuingly improving.

The purpose of this inspection was to follow up concerns identified at the previous inspection in April 2013 which regarding the safe recording of administered medication. We found the provider had taken actions and we saw evidence of staff training, assessment of staffs competence to administer medication safely and audits of medication records which had been completed accurately. This meant the provider had systems in place to ensure people received their medication safety.

We were also following up anonymous concerns suggesting there were not enough staff to cover care calls effectively and people who used the service did not always get the level of support they required. We found that the service had undergone a lot of changes recently and had been managed by a temporary manager. The provider had restructured the business to provide care staff with more management support. This appeared to be working effectively but it did mean that some staff in post were new into their role and were still familiarising themselves with their job roles. We spoke with four staff and five people who used the service. Staff told us at times they were working excessive hours and found weekends particularly difficult in terms of covering all the care calls required .They also told us that keeping to the times of the care calls as agreed with the person who used the service, was on occasions difficult. People we spoke with had not had any missed calls but told us they did not always have regular carers or calls at the agreed time. One person told us that some carers were better than others and that some carers were always very rushed.

At our last inspection in November 2012 we found that people's skin integrity had not always been correctly assessed. When we returned in April 2013 we found that the errors we had picked up formerly had been corrected. However we found additional errors in risk assessments for people who were at high risk of developing a pressure sore. The manager confirmed that, following training, senior staff were now re-assessing everyone as a priority.

We spoke with nine staff and found that they had accessed relevant training and benefited from regular supervision. We identified that unpaid business mileage had caused a decrease in staff morale and people using the service suggested that good carers left employment with the provider as a result.

We visited two people using the service in their own homes and found that the application of their barrier creams was not being adequately recorded and so we could not be sure that their creams were being correctly applied.

We observed that staff were kind and reassuring when offering care to people. We found that the majority of people's needs were being met by the service. However, we saw risk assessments around skin integrity that had been incorrectly calculated. We found gaps in recording the application of barrier creams for some people. Staff had not been trained in completing risk assessments.

Some people told us that staff were sometimes late to attend calls but that this was not a major issue for them.

Managers had reviewed care plans and medication administration sheets, but there was scope to make further improvements around the accuracy of risk assessments and the recording of cream application.

The service had given people the opportunity to feedback their comments about the care they received and these had been acted on.