We visited Allied Healthcare - Bournemouth on 12 May 2014 to review three warning notices related to unsafe care or support. The warning notices detailed specific breaches of the Health and Social Care Act 2008 (The Regulated Activities Regulations 2010) in relation to consent to care and treatment, care and welfare and assessing and monitoring the quality of service provision. We also looked at two additional outcomes, management of medicines and records.The inspection was undertaken by one inspector over the course of three different days. Time was spent in the office, visiting people in their homes and talking with staff. In total we visited four people in their homes. We contacted a further eight people by telephone to obtain their views on the care provided. We also spoke with one member of staff whilst they were at the office and three members of staff by telephone.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service caring?
' Is the service responsive?
' Is the service effective?
' Is the service well led?
This is a summary of what we found:
Is the service safe?
Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Where a need was identified a plan was in place to meet this need. For example, one person was identified that they were at risk of falling. Their care plan set out clear guidance for staff and included the equipment to be used to ensure their safety and welfare.
Risk assessments had been carried out both with regard to people's care needs, use of special equipment, such as hoists, and to any environmental hazards that may be present. Those staff that we spoke with were aware of people's needs and how to ensure that they were met safely.
People using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. All of the people that we spoke with told us that they felt safe with staff and the care provided. We spoke with staff who understood their responsibility to safeguard vulnerable adults. They received training about safeguarding vulnerable adults when they started working at the agency and this was updated periodically. One person told us, "I feel safe with [staff] I think they are well trained."
People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.
Is the service effective?
People told us that they were happy with the care they received and felt their needs were well met. It was clear from what we saw and from speaking with staff that they understood people's needs, likes and dislikes and knew them well. One person told us, "Over Christmas there were a lot of problems, changes to management, lack of communication from the office, but the new manager took on-board my concerns and they are being addressed. I did have a lot of different carers but there now seems to be a regular four since she took over."
We found that there were systems in place to monitor the quality of the service provided and staff had received training to ensure that they could meet people's needs.
When a person was unable to make decisions independently, "best interest" processes were not always followed in line with the Mental Capacity Act 2005 (MCA).
Is the service caring?
Throughout our inspection we received positive feedback from people who use the service and their relatives. One person commented that staff acted in a kind and professional manner. Another person told us 'They are very friendly and helpful, and do what I want them to'. A relative told us, 'I have a fantastic carer and in the main been able to stick with the same one. My husband gets muddled if there is someone different."
People confirmed that staff always took care to protect their privacy when providing personal care and encouraged them to do as much for themselves as possible even if this took longer. One person told us, "I don't embarrass easily. They cover me up bit by bit and chat to me.'
Is the service responsive?
We found that people's needs had been assessed before the package of care was started to ensure that they could meet their needs. Once the service had started, people's needs were regularly reviewed and any changes were responded to as necessary either by consultations with professionals. For example, one member of staff told us that the Occupational Therapist had recently visited one person in their home to review their moving and handling plan.
Is the service well-led?
The provider had recently appointed a new manager. The manager showed us an action plan of the things that they were improving.
The provider undertook a variety of audits to check the quality of the service. For example, we looked at audit reports relating to medicines, care plans and accidents. We found that actions had been taken as a result of this monitoring. For example, a recent medicines audit highlighted the need for a team meeting with staff to discuss shortcomings in recording.
People were able to comment on the service provided. People told us that they had completed customer satisfaction surveys. We saw that responses for these surveys had been analysed by the provider and action plans put in place to address lower scoring areas. For example, a communications book was introduced in the office to improve communication between the office and care staff.