The Care Quality Commission
  • Services in your home
  • Homecare service

Archived: Allied Healthcare York

Overall: Inadequate read more about inspection ratings

Unit 1 Horizon Cout, Audax Court, York, North Yorkshire, YO30 4US (01904) 425841

Provided and run by:
Nestor Primecare Services Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

9 March 2016

During a routine inspection

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.

29 April 2015

During a routine inspection

The inspection took place on 29 April 2015. The inspection was announced. The provider was given two days’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available at the location offices to see us.

Allied Healthcare – York provides domiciliary support to people in their own homes. There were approximately 50 people being supported at the time of our inspection. The service provides care to older people and to people living with dementia.

The service did not have a registered manager as the previous manager had left and a new manager had been employed but they were not yet 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.

At the previous inspection which took place in October 2013 the service was compliant with all of the regulations we assessed.

People told us they felt safe and staff were clear of the process to follow should a safeguarding allegation be made. Although we had received some alerts previously we did identify an incident which had not been appropriately reported.

Risks to people were not always well managed and although risk assessments were included within care plans they were not always reviewed at sufficient intervals.

We found and people told us that there were not enough staff and staffing levels were impacting on the care being delivered. The agency was trying to recruit additional staff and appropriate recruitment checks were completed on new staff.

People told us they received support with their medicines when this was needed. Minor improvements were required to the recording on medicine administration records.

Staffing levels were said to be impacting on the effectiveness of the service as calls were late and in some cases missed.

Staff received induction, training and supervision to support them in their roles although some staff felt that more role specific training would be beneficial.

People did not always sign their agreement to their care records and staff did not always evidence that they were asking people to give their consent.

Some people received support with the preparation of their meals. They told us that staff cooked a meal of their choice.

People said that they were confident that staff would support them in accessing any health support required and we saw that people’s health needs were included in their care plans.

Although people consistently told us that they liked the staff and were well cared for; we found that staffing levels were impacting on the care provided to people.

There was little to evidence that people were involved in planning and discussing their own care preferences.

People told us that when staff attended their visits on time they were treated with dignity and respect, however when they attended late this could impact on their dignity.

Although end of life care was provided staff working at the agency advised that the paperwork did not support them. They recognised that this may benefit from review.

Each person supported had an assessment and care plan in place. Care plans were in the process of being reviewed and updated onto alternate documentation. People told us they were not always involved in reviews of their care.

Although there was a structured system for managing complaints this was not always managed effectively. People were not always satisfied that complaints were investigated or responded to. We found that complaints were not always responded to within the appropriate timescales. Some people felt that their views of the service were sought others did not.

We found that improvements were required in regard to the way in which the service was being managed. We have identified four breaches in regulation in relation to risk management, staffing, person centred care and good governance. You can see what action we have told the provider to take at the back of the report.