Allcare Agency Limited

Allcare Agency Limited is a domiciliary care service providing personal care to older people, people with dementia or people with physical disabilities in their own home. At the time of our inspection there were 15 people using the service.

People’s experience of the service and what we found:

At the time of the inspection, the location did not provide care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support

Individual care plans and risk assessments were in place for people. These contained information for people’s needs and preferences and gave guidance to staff on how to support people safely. However, we found that some records were lacking in detail.

Staff supported people to make decisions following good practice in decision-making.

The provider supported people to have choice and control to be independent with managing their own lives. People were encouraged to set targets and in some areas of life for example, maintain more independence. However, this wasn't always recorded so it was difficult to see people’s progress.

Medicines were managed and administered safely. People were supported with their medicines in a way that promoted their independence and achieved the best possible health outcome. Staff competency to administer medicines was checked, however, we made a recommendation for improvement in this area.

Right Care

People had enough staff to meet their needs and keep them safe. Staff followed appropriate infection control practices. Staff were undergoing satisfactory background checks and induction process.

People were supported by person centred practices. Risk assessments were in place for people.

The provider acted to protect people from abuse. Staff knew how to report any concerns to the appropriate people. Staff had training on how to recognise and report abuse. Staff knew people well.

Right Culture

An auditing and monitoring system was in place. Issues identified in these audits were mostly followed up by management and then acted upon. We found that not all issues were always identified in audits.

A robust system was in place to ensure safe staff recruitment. Even though solid foundations for safe induction for new staff were in place, we came across gaps in training and in consistent staff development.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement published on 25 January 2020. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

At this inspection we found improvement had been made. However, the provider remained in breach of regulation 17(Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Allcare Agency Limited on our website at www.cqc.org.uk.

You can see what action we have asked the provider to take at the end of this report.

Enforcement

We have identified breaches in relation to governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Recommendations

We made some recommendations to the provider regarding care planning and medication records.

Follow Up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Allcare Agency Limited is a domiciliary care agency that provides personal care to older adults and younger disabled adults in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. They were providing personal care to 11 people at the time of the inspection.

People’s experience of using this service and what we found

At our last inspection in April 2019 we found there had been breaches to regulations on safe care and treatment, fit and proper persons employed, staffing, person centred care, good governance and also a breach of the Registration Regulations Act 2009, a failure to notify the CQC of incidents that affect people in receipt of regulated activity. At this inspection we found improvement had been made, though the service remained in breach of safe care and treatment and good governance; specifically, medicines management was not always safe, risk assessments needed clarity, there was not always recording of lessons learned when things went wrong, spot checks were completed infrequently, and staff meetings were either not recorded or poorly recorded.

Staff received an induction, but this was recognised as needing improvement by the registered manager. Staff received supervision, though two staff had yet to receive their annual complement of supervision. We have made a recommendation about following best practice about recording people’s end of life wishes.

There were robust recruitment practices in place and sufficient staff working at the service. There were safeguarding systems and processes in place. Recruitment was carried out with people's safety in mind. Staff used infection control practices. Staff understood and used infection control practices.

Staff received training to complete their roles. People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice. People’s needs were assessed before they used the service. People were supported with their health care needs and the service worked with other agencies to support people. People were supported to eat healthily.

People and relatives told us staff were caring and paperwork at the service sought to ensure people’s rights. People and relatives were involved in care plan reviews and were able express their views. People’s independence was promoted and their dignity and privacy respected.

Care plans were person centred. People’s communication needs were met, and people were supported to avoid isolation. People knew how to make complaints though there had not been any since our last inspection.

People thought highly of the management. People and staff were able to give feedback about the service. The management acted responsively to concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The previous rating for this service was inadequate (published 11 June 2019). The service has improved to requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

This service has been in Special Measures since 10 April 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified continued breaches in relation to safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Allcare Agency is a domiciliary care agency that provides personal care to people living in their own homes, including older adults and younger disabled adults. At the time of our inspection the service was supporting 14 people.

People’s experience of using this service:

The provider had failed to ensure that people were supported in a safe way. Risk assessments did not identify and mitigate individual risk; medicines were not being managed safely; recruitment practices did not ensure staff were suitable to support vulnerable people and there was no recording or analysis of accidents and incidents. We also found that the systems in place to protect people from harm and abuse were inadequate. This placed people at risk of harm or unsafe care.

There were significant shortfalls regarding staff training, the induction procedures for new members of staff and support through supervisions. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems did not support this practice.

The service lacked a consistent approach to people and their relatives being involved in the care and support they received, and the service was failing to ensure it promoted a culture and equality and diversity. Care plans remained inconsistent and did not always guide staff to provide person-centred care.

We found that the systems in place to manage complaints and end of life care were insufficient.

The quality assurance systems were inadequate as they had not identified the shortfalls we found during our inspection and did not ensure people were always kept safe. We found that staff, including the registered manager failed to demonstrate they were providing care and support that was safe, caring or effective. This put people at continued risk of harm.

However, people and their relatives felt the care and support they received was person-centred, and they trusted staff to look after them.

Rating at last inspection:

At the last inspection the service was rated Inadequate (published: 4 December 2018).

At that time, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were related to Safe care and treatment; Fit and proper persons employed; Staffing; Person-centred care; Good governance. We also found one breach of the Registration Regulations Act 2009, as there was a failure to notify the Care Quality Commission (CQC) of incidents that affected people in receipt of a regulated activity.

During this inspection, we found the overall rating had not improved and an additional key question had changed from requires improvement to inadequate. We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were related to Safe care and treatment; Fit and proper persons employed; Staffing; Person-centred care; Need for consent; Safeguarding Service Users from abuse and improper treatment and Good governance.

This service has been rated ‘inadequate’ at the last two inspections.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

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 and there is still a rating of inadequate for any key question or overall, we will act 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.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our last inspection on 15 September 2017 the service was rated ‘Requires Improvement’ overall. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not ensure staff received regular training, supervision and an appraisal to enable them to carry out their role in an effective manner. The service did not have adequate governance systems in place to ensure people were receiving a service that safe, effective or responsive to their needs.

At this inspection we found that these previous breaches had not been addressed and we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 service had a registered manager. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

People’s risk assessments had failed to identify or address their support needs, which meant staff were not aware of how to keep people safe. Staff were not always recruited in a safe manner and line with the provider’s recruitment policy, which meant we could not be assured that they were suitable to carry out their role. People were not supported to receive medicines in line with best practice and the provider had failed to provide medicines training for all staff who required it. The service did not have systems in place to oversee safeguarding which placed people at risk of potential abuse. Staff did not always arrive on time to see people and there was no system in place to monitor time keeping. The service did not record accidents or incidents or evidence how they learnt lessons which placed people at risk of repeated incidents. People and staff were protected from the risk of cross-infection.

Staff did not receive an induction into the service. Training was not well managed and systems were not in place to ensure all staff received regular support through supervisions and appraisals. This meant staff were not equipped with the necessary skills and tools to practice in a safe and effective way. The service did not complete pre-admission assessments or review people’s needs and preferences prior to support starting which meant staff were not aware of people’s specific needs and wishes. The service worked in line with the principles of the Mental Capacity Act 2005 and staff ensured they gained consent from people before providing care or support. People were protected from discrimination.

The service had not involved people in reviewing their care plans, which meant care may not be delivered in line with their wishes. People told us staff were kind, caring and friendly. Staff understood how to support people in a manner that ensured people were protected from discrimination. People told us their privacy and dignity was maintained throughout their care and staff promoted a sense of independence for all people.

The service did not always work in a person-centred way. People had their own care plans but we found these were not detailed and they were not regularly reviewed with people and their relatives. People knew how to make complaints; however, these were not documented or monitored which meant we could not be assured of the action taken to resolve concerns or complaints. People were supported at the end of their life; however, staff did not receive up to date training in this area and care plans did not reflect this.

The governance systems at the service were ineffective and failed to identify areas of concern or drive improvements. Previous breaches of regulations had not been addressed and the quality assurance systems in place had not identified the additional concerns we found during our inspection. People, relatives and staff were mixed in their feedback about the management team. People and staff completed feedback surveys for the provider; however, this information was not used to make improvements. Statutory notifications, required by law, were not always sent to the CQC.

All Care Agency Limited provides personal care services to people living in their own homes mainly in the London borough of Havering. On the day of our visit there were 17 people using the service who were mainly privately funded.

On the day of the inspection there was a registered manager in place. 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.

During this inspection the provider was not meeting legal requirements in relation to record keeping, staff training and appraisals. Training was not up to date in key areas such as first aid infection control and, mental capacity. Similarly appraisals and supervisions were not always completed in a timely manner leaving a greater risk of people receiving inconsistent care from staff who had not updated their knowledge and practice. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe and were happy with the service provided. They said they were treated with dignity and respect by staff who understood their needs. People felt able to express any complaints about their care and told us they were resolved.

Staff were aware of the procedures in place to keep people safe. They were aware of the different types of abuse and how to report any allegations of abuse. Although there had been no recent incidents there were aware of the incident and accident reporting procedures.

There were enough staff to support people. Schedules were prepared a week in advance so staff and people were aware of expected visit times. People received consistent care form a core set of staff in order to encourage continuity of care.

There were effective recruitment practices in place which included appropriate checks to ensure suitable staff were recruited.

People, their relatives and staff thought there was an open and transparent culture where the registered manger was also very visible and hands on.

There were effective systems in place to monitor and receive feedback. However we noted the current systems in place to monitor staff training, reviews of policies and risks assessments were not consistent and had failed to ensure training, appraisals, spot checks and care plans were updated in a timely manner.

The provider was a small agency and had difficulty recruiting care workers but was able to deliver the activities to people. The manager worked on shifts and the relatives told us that the staff never let them down. The provider was recruiting additional care workers. We found that the recruitment process included the required checks on the suitability of staff before they commenced their duties.

People's views were sought and we found that people were happy with the quality of the services and the care workers. One relative told us, "I speak to the office regularly and can raise concerns, if needed."

People's care and welfare needs were being met and the agency cooperated with other providers to ensure that people had access to other health and social care services that they needed. A healthcare professional said 'they are proactive. They contact me and give me feedback about my client and they say if they have any concerns." A person who uses the service commented 'they will phone up on my behalf if there is anything I need or am worried about. Recently they phoned the district nurse for me.' Some staff assisted people with their medication and had received training and guidance to do this. People were satisfied with the support that they received with their medication.

People who use the service and their relatives said that staff 'knew what they were doing.' Staff received training and support from the provider and felt that this enabled them to provide a good service to people.