Archived: Allied Healthcare York

Updated 25 May 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 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.

The inspection took place on 9 and 29 March 2016. The inspection was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the location offices when we visited.

The inspection was carried out by one Adult Social Care Inspector and an Expert by Experience (ExE). An ExE is someone who has personal experience of using or caring for someone who uses this type of service. The ExE supported this inspection by carrying out telephone calls to people who used the service and their relatives following our first office visit.

Before our visit we looked at information we held about the service, which included notifications and information we had received from the local authority. Notifications are when registered providers send us information about certain changes, events or incidents that occur within the service. We did not ask the registered provider to complete a Provider Information Return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

As part of this inspection we visited two people using the service and spoke with seven people by telephone. Where people were unable to provide feedback about the service, we spoke with their relatives or carers and we received feedback from a further five people this way.

We visited the location’s offices and looked at six people’s care records, three care workers recruitment and training files and a selection of records used to monitor the quality of the service. We spoke with the care delivery director, operational support manager, home care coordinator, acting care supervisor and five care workers.

Updated 25 May 2016

Allied Healthcare York is a domiciliary care agency and is registered to provide personal care to people living in their own homes. We inspected this service on the 9 and 29 March 2016. The inspection was announced. The registered provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the location offices when we visited. At the time of our inspection Allied Healthcare York was supporting 20 people living in the York, Harrogate and the Northallerton area.

At our last inspection of the service on the 29 April 2015 we identified four breaches of the legal requirements set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included breaches in Regulation 9 (Person centred care), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing). Following the inspection we asked the registered provider to take action to address these concerns and they sent us an action plan informing us that the required improvements would be made by February 2016. This inspection was planned to check whether these improvements had been made and that the registered provider was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The registered provider is required to have a registered manager as a condition of registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. At the time of our inspection the service did not have a registered manager. The Operational Support Manager told us that a new application had been submitted to the CQC for a registered manager to be appointed.

During this inspection we found that not all care plans and risk assessments had been updated and there were still examples of ineffective risk management. Where care plans and risk assessments had been reviewed and updated risk assessments were being appropriately used to keep people safe, however, we were concerned about the lack of progress in addressing concerns with care plans and risk assessments identified during our last inspection of the service in April 2015.

People were supported to take their prescribed medication, although Medication Administration Records (MARs) were not always well maintained and audits were not being effectively used to address these concerns.

Records were not always well-maintained and did not consistently contain relevant person centred information. The system used to audit and monitor the quality of records kept was not sufficiently robust enough to identify concerns and drive improvements. Whilst some improvements had been made there were on-going issues and concerns that had not been robustly addressed.

People we spoke with raised concerns about the management of the service and the lack of communication.

This was a breach of Regulation 17 (2) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a lack of clarity about people’s ability to make informed decisions and care plans did not effectively evidence that people were supported to make decisions in line with relevant legislation.

This was a breach of Regulation 11 (1) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

We received mixed feedback about staffing levels and there were still examples where people’s care was provided more than two hours late.

This was a breach of Regulation 18 (1) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take in relation to these breaches at the back of the full version of the report.

Staff received training to enable them to recognise and appropriately respond to signs of abuse to safeguard vulnerable adults.

Staff received training, supervision and had appraisals to support them to develop in their role.

People were supported to eat and drink enough and access healthcare services where necessary.

We received generally positive feedback about the kind and caring nature of staff. However, people did not always know which carer would be visiting and we received mixed feedback about the continuity of care staff.

Staff supported people to be in control of their care and support and listened to people’s wishes and views. People told us their privacy and dignity were respected.

Care plans did not consistently contain detailed person centred information.

There were systems in place to manage and respond to complaints.