Archived: Allied Healthcare Sutton

At the comprehensive inspection of this service on 20 July 2016 we found four breaches of regulations. These were in relation to safe care and treatment, person centred care, good governance and notification of incidents, which in this case referred to allegations of abuse. The provider wrote to us with their action plan on 9 September 2016 and told us these actions would be completed by 30 November 2016. We then carried out an announced focussed inspection on 27 April 2017 where we found the service to be in continuing breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served two warning notices for these continuing breaches of the regulations and as a consequence we rated the service as ‘requires improvement’ overall and in the same three key questions of ‘safe’, ‘responsive’ and ‘well led’.

Allied Healthcare Sutton provides personal care and support to people living in their own homes. This includes both younger and older adults, people with physical and mental health needs, people with learning disabilities and people who may be living with dementia. At the time of this inspection there were 164 people using the service.

A new manager was in post, registered with the Care quality Commission on 27 September 2017. 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 purpose of this inspection was to check the improvements the provider said they would make in meeting their legal requirements. At this inspection, we found the provider had taken sufficient action to rectify the two breaches in relation to safe care and treatment and good governance.

Our inspection found that risks were now being managed appropriately and people who required assessments of their risk of developing pressure ulcers were assessed. Risk assessments contained sufficient information and guidance for staff to follow and provide safe support and care for people.

People told us they were safe. Staff understood their responsibilities in relation to safeguarding.

The service had safe, robust recruitment processes. The provider ensured people were supported by staff deemed suitable and appropriate. Staffing levels were appropriately maintained.

Medicines were managed safely. Records relating to the administration of medicines were accurate and complete. Where people were prescribed medicines with specific instructions for administration we saw these instructions were followed. Staff responsible for the administration of medicines had completed training and their competency was assessed regularly to ensure they had the skills and knowledge to administer medicines safely.

Learning was identified for incidents and accidents and action taken to make improvements which enhanced people's safety.

Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. Staff received effective support through supervision, spot checks and training. Staff training plans were monitored and up to date.

People's nutritional needs were met and where people required support with nutrition, care plans provided staff with guidance on people's support needs.

People were supported to have healthier lives. Staff assisted them to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

People told us they benefitted from caring relationships with the staff. There were sufficient staff to meet people's needs.

People were treated as individuals by staff committed to respecting people's individual preferences. The service's diversity policy supported this culture. Care plans were person centred and people were actively involved in developing their support plans.

People told us they were confident they would be listened to and action would be taken if they raised a concern. We saw a complaints policy and procedure was in place.

The service had systems in place to notify the appropriate authorities where concerns were identified.

The provider monitored the quality of the service and strived for continuous improvement. There was a clear vision to deliver high quality care and support and promote a positive culture that was person-centred, open and inclusive.

At our last inspection on 20 July 2016 we found four breaches of regulations. These were in relation to safe care and treatment, person centred care, good governance and notification of incidents, which in this case referred to allegations of abuse. The provider wrote to us with their action plan on 9 September 2016 and told us these actions would be completed by 30 November 2016.

Allied Healthcare Sutton provides personal care and support to people living in their own homes. This includes both younger and older adults, people with physical and mental health needs, people with learning disabilities and people who may be living with dementia. At the time of our inspection there were 229 people using the service. There was no registered manager in post, but a new manager had been recruited and told us they were about to commence the process to become registered. 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 purpose of this inspection was to check the improvements the provider said they would make in meeting legal requirements. At this inspection, we found the provider had taken sufficient action to rectify two of these breaches. They were now notifiying us of incidents in line with legal requirements and had taken action to ensure care plans were sufficiently personalised to meet people’s needs and were kept up to date. However, they were still in breach of the regulations in relation to safe care and treatment and good governance.

Some risks were still not managed appropriately. People who required assessments of their risk of developing pressure ulcers did not have them. Some risk assessments lacked information that staff may have needed to care for them safely.

The provider had not taken sufficient action to ensure medicines were managed safely. Medicines records still contained unexplained gaps or were otherwise unclear. The provider was not following appropriate guidance about recording medicines staff prompted people to take.

We are taking further action against the provider for a repeated failure to meet the regulations in relation to safe care and treatment and good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found that the provider had made improvements to risk assessments and management plans and also in terms of the management of medicines. However, the improvements were not sufficient to meet the required standards. Although audits were identifying some of the above concerns, the provider had not taken sufficient action within an appropriate timescale to rectify them.

Care plans now contained sufficient detail for staff to provide person centred care that met people’s needs and reflected their preferences. This included information about people’s life history, interests, relationships, health needs, the support they required from staff on each visit and how they preferred this to be done. Senior staff checked regularly with people to ensure they were happy with their current care package and to gather their views and feedback. This was used to inform regular reviews of care plans.

The service had recently recruited a new manager, who told us about their plans for improving the service and addressing the concerns we raised. Some of the plans were already in progress and there were new systems in place to improve monitoring of service quality.

Allied Healthcare Sutton provides personal care and support to people living in their own homes. At the time of our visit there were approximately 250 people using the service. The service had a registered manager in post. 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.

People had individual risk assessments and risk management plans to help staff keep them safe but some of these were not detailed and were missing key information about risks such as choking. In these cases, staff did not have the information they needed to keep people safe from foreseeable harm.

Medicines were not always managed safely. There were no clear instructions for when staff should administer some medicines prescribed to be taken only as required. Medicines that were prescribed to be taken no more than every four hours were given more frequently, which can be dangerous. Medicines administration records were incomplete or unclear in several cases, which meant we could not always be sure people were receiving their medicines and that there was a risk that others involved in people’s care did not have the information they needed about what medicines people received and when.

People told us they felt safe using the service. The service had safeguarding policies and procedures in place and staff were aware of these. This meant staff were able to recognise and report signs that people were being abused or mistreated. Record showed that the provider took prompt action to address any safeguarding concerns that were raised.

The registered manager had taken action to address problems with staffing. This included recruiting new staff and assigning supervisors to monitor staffing levels more closely. This meant there were enough staff to cover all visits and keep people safe. The provider vetted new staff thoroughly to ensure they did not recruit staff known to be unsuitable or unsafe.

There were appropriate policies and procedures in place to keep people safe from the risk of infection and staff were aware of these.

Staff had the skills and knowledge to carry out their roles effectively because they received training, supervision and guidance about best practice in caring for people. The provider used several methods of sharing this knowledge with staff on a regular basis. Staff were able to access extra support if they needed it.

The provider adhered to appropriate legislation and guidance to ensure people only received care they had consented to or, if they did not have the mental capacity to consent, decisions about their care were made in their best interests.

Staff were aware of the importance of ensuring people had enough to eat and drink. The provider carried out assessments of people’s risk of becoming malnourished, but did not always follow up where a high risk was indicated. We recommend that the provider seeks advice on current best practice around meeting people’s nutritional needs in domiciliary care.

People told us staff were friendly and caring. Staff took time to get to know people and their individual communication styles to enable communication and help people feel at ease with them. People and their relatives were involved in care planning and some people’s preferences and what was important to them was included in their care plans. However, this was not consistent as other care plans were based on completing tasks and did not contain this information. We recommend that the provider consider the use of current best practice guidance around the use of life histories in person-centred care planning.

Each person had a care plan but these were not always sufficiently personalised to ensure the service was responsive to their individual needs. Some assessments, such as those around continence, allergies and the use of bed rails, were not completed when they were relevant to people so there was a risk that people’s needs were not met in these areas. Some assessments and care plans were not updated to reflect changes to people’s care and this meant there was a risk that people were not consistently cared for in a way that reflected their current needs.

People’s care plans were designed to meet their emotional, social and cultural needs. There was information about how staff should support people to remain in contact with loved ones or to access the local community.

People were aware of how to complain and told us the provider regularly contacted them to check they were happy with the service. There was a robust complaints policy that helped to ensured the provider responded promptly to complaints and concerns that were raised.

We found that the provider was not submitting notifications about certain events that happen within the service and which they are required by law to tell us about.

People were not sure who the manager was, but the manager was aware of this and was working on an introductory letter to send people. People were familiar with office-based staff and spoke positively about them. People, relatives and staff fed back that the service had an open and supportive culture with a clear vision and values.

The provider used feedback from people, their relatives and staff to help them assess and monitor the quality of the service. Where they identified improvements to be made, they put action plans in place and discussed these with staff so they were aware of the changes that needed to be made and how the service was progressing. The provider carried out a number of spot checks and audits to check that care was being delivered to a high standard. However, these were not always effective as they had not identified the issues that we found during our inspection.

During the inspection we found breaches of regulations in respect of sending statutory notifications to the CQC, ensuring the safe care and treatment of people, making sure people received personalised care and good governance. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 which we found during the inspection is added to the report after any representations and appeals have been concluded.