Archived: Allied Healthcare Salisbury

Leadership and management of the service had not ensured people received a high-quality service. The service was providing some clinical services they were not registered to provide at this location.

Systems to assess and monitor the quality of the service and plan improvements were not effective. The management team had not identified all the improvements that were needed and there was not an effective plan to address shortfalls.

People were not always safe when using the service. The provider did not have effective systems to investigate incidents or learn lessons when things went wrong. Staff were not always thoroughly checked before they started providing care for people.

The provider did not consistently ensure people making decisions on behalf of others were legally authorised to do so. Assessments about people’s capacity to consent to their care and treatment were not clear. The provider had not followed the principles of the Mental Capacity Act 2005.

Complaints were not well managed. Some people did not feel confident the provider would listen to and act on their concerns. Poor record keeping had resulted in the provider being unable to respond fully to a complaint they had received.

Despite the concerns about the management of the service, people felt the care staff were good and provided care in a kind and respectful way.

More information is in Detailed Findings below.

Rating at last inspection:

Requires improvement (report published 15 November 2017).

About the service:

Allied Healthcare Salisbury is a domiciliary care agency (DCA). The service provides personal care to people living in their own homes in the community as well and people living in extra care housing schemes.

Why we inspected:

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

Follow up:

We have told the provider they must take action to improve the service. We will meet with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

We carried out this inspection on 24 August 2017 and made telephone calls to people and staff to gain their feedback on 22 August and 21 September 2017.

There was 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. The registered manager was available throughout the inspection.

Allied Healthcare Salisbury had recently amalgamated three different areas in terms of location. This meant that as well as covering Salisbury and the surrounding villages, the agency now supported people in the Bournemouth and Yeovil areas. The restructuring meant the closure of offices and some staff reapplying for their jobs. In addition, different systems and paper formats were being used, so work was required to ensure consistency. The amalgamation had a impact on the service and staff morale but people's support was not affected. The registered manager confirmed that following the amalgamation, the agency was now in a better place although had further work to do. The registered manager was assured people’s support was working well but stated their support plans needed a full review.

Some aspects of people’s support plans were detailed and well written. However, other parts lacked detail and did not clearly reflect people’s needs and the support they required. Not all support plans had been reviewed, as people’s needs changed. Risk assessments were in place but the information did not clearly identify the risks or the action required to enhance safety. The registered manager was aware of these shortfalls and there was an action plan in place to address them.

People’s medicines were safely managed although this was not so for topical creams. Instructions for the cream’s application were not always clear and not all were applied, as prescribed. Staff had undertaking training in the safe administration of medicines. However, after the inspection, additional training sessions were arranged to address the shortfalls in the application of topical creams.

People were very happy with the support they received. They said staff arrived on time and there were no concerns about missed visits. They said the service was flexible and could accommodate requests for an earlier or late visit. People were supported by a small team of staff to ensure consistency. People liked the staff who supported them and positive relationships had been built. Emphasis was given to people’s rights, which were clearly promoted. People were able to give feedback about the service and were aware of how to make a complaint.

People were supported by staff who were well trained. Records showed staff completed a range of courses, which the provider deemed mandatory as well as other topics, which were person specific and related to individual needs. All new staff received a detailed induction before starting work with people. Staff felt well supported and received formal one to one meetings with their supervisor to discuss their performance and any challenges. There were clear “on call” systems which enabled staff to gain advice at any time.

There were many positive comments about the registered manager and the support they gave. A caring, person centred ethos was strongly promoted and adopted throughout the staff team. The registered manager valued the attitude of staff and the work they did. Management systems included regular meetings to discuss the allocation of people’s visits and safe recruitment practice. Systems were in place to assess and monitor the quality and safety of the service.

During our inspection we found one breach 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.