Background to this inspection
Updated
24 March 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.
This inspection took place on 27 and 28 May 2015 and was announced with 48 hours’ notice. The inspection was carried out by one inspector 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 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. The provider also supplied information relating to the people using the service and staff employed at the service. Prior to the inspection we reviewed this information, and we looked at previous inspection reports and the notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.
During the inspection we reviewed people’s records and a variety of documents. These included five people’s care plans and risk assessments, two staff recruitment files, the staff training, supervision and appraisal records, staff rotas and quality assurance records and surveys.
We spoke with 17 people who were using the service, three of which we visited in their own homes, we spoke to four relatives, the registered manager and eight members of staff.
After the inspection we contacted two social care professionals who had had recent contact with the service and received feedback from them both.
Updated
24 March 2016
The inspection took place on 27 and 28 May 2015, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. This was the first inspection since this location was registered on 8 December 2014.
Allied Healthcare Canterbury provides care and support to adults in their own homes. The service is provided mainly to older people and some younger adults. At the time of this inspection there were less than 60 people receiving support with their personal care. The service provided visits from half an hour up to five hours to support people. The service was awarded a contract with the local authority and this provided a rapid increase in the numbers of people who used the service.
The service is run by a registered manager, who also manages another service in Hythe owned by the same provider. 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.
Most people told us they received their medicines when they should and felt their medicines were handled safely. However we found shortfalls in some areas of medicine management. Care plans did not always reflect current medicine information. There was a lack of systems, guidance or procedures about some areas of medicine management. Some medicine records had not been audited to ensure safe practices were being followed.
Most risks associated with people’s care had been identified and people told us staff used safe practices, but there was not always sufficient or up to date guidance in place for staff, to ensure people were safe.
People and/or their families were involved in the initial assessment and the planning their care and support. However care plans varied greatly in the level of detail and required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan. Care plans were reviewed periodically, but not all of them were up to date and reflecting people’s current needs.
There was not sufficient staff to meet people’s needs. People had experienced missed or late visits; some people that required two staff to meet their needs had experienced only one member of staff arriving to undertake the care and support. The registered manager told us the service was actively recruiting to increase staffing levels. Most people received a service from a team of regular staff and knew who would be undertaking their visit. Each person received a schedule of visits in advance.
People had mixed opinions about whether the service was well-led and well-organised and where people were not positive most of their concerns related to staffing levels and the organisation of staff schedules. The provider had a mission statement and aims and objectives. However staff were not aware of these and they were not readily accessible within the office.
People were protected by safe recruitment procedures. Staff files contained most of the required information. New staff underwent a thorough induction programme, which included reading policies and procedures, relevant training courses and shadowing experienced staff until they were competent to work on their own. Staff received most training appropriate to their role, which was refreshed regularly, but there was a lack of specialist training reflecting people’s specific needs, such as dementia and diabetes.
People were supported to maintain good health. People told us how observant staff were in spotting any concerns with their health. The service made appropriate referrals and worked jointly with health care professionals, such as occupational therapists. Information about some health conditions, such as diabetes and epilepsy was lacking in care plans. This meant if people became unwell relating to these conditions staff may not identify this or take timely appropriate action to ensure the person’s good health.
People felt safe whilst staff were in their homes and whilst using the service. The service had safeguarding procedures in place, which staff had received training in. Staff demonstrated a good understanding of what constituted abuse and how to report any concerns. Accidents and incidents were reported and action taken to reduce the risk of further occurrences.
People felt staff had the right skills and experience to meet their needs, although a few people felt newer staff would benefit from further training or experience. Supervisors monitored staff practice during unannounced checks. Staff felt supported and attended one to one and group meetings with their manager.
People had mixed views about communication with the office. People felt confident in complaining. Several people had complained about missed calls or late calls, but not all felt they had received a satisfactory response. Some people had opportunities to provide feedback about the service they had received. Negative feedback about the service was being acted on.
People told us their consent was gained at each visit. People had also signed a consent form as part of their care plan. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection. Some people had Lasting Power of Attorneys in place and some others chose to be supported by family members when making decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.
People felt staff were caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs.
People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their preferences.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.