Archived: Allied Healthcare Hythe

Allied Healthcare Hythe provides care and support to people in their own homes. The service is provided to mainly older people and some younger adults and people who have a learning disability. At the time of the inspection there were approximately 82 people receiving support with their personal care. The agency provides care and support visits to people across the Ashford, Hythe, Folkestone, Dover, Deal, Romney Marsh and surrounding areas. It provides short visits to people as well as longer visits such as 24 hour support to people.

There was not a registered manager employed at the service. 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. However, the provider was in the process of employing a manager. At the time of this inspection the agency was being managed by the registered manager for their Maidstone branch who visited two to three times a week and undergoing registration for this branch with CQC when we inspected.

At our previous inspection on 12, 13, 14 and 15 September 2016, we found continued breaches of Regulation 9, Regulation 12, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to do all that was reasonably possible to mitigate risks to people's health and safety and failed to have proper and safe management of medicines. The provider had failed to ensure sufficient numbers of suitably competent, skills and experienced staff in order to meet people's needs. The provider failed to ensure care plans reflect people's assessed needs, preferences and were up to date. The provider had failed to have systems and processes operated effectively to ensure compliance with requirements in a timely way.

The provider sent us an action plan on 26 September 2016 and continued to update this action plan weekly. The updated action plan was sent to us as part of this inspection evidence, which showed us planned changes, actions they had already taken and how they were now meeting the regulations.

The agency provided sufficient numbers of staff to meet people’s needs. However, there continued to be incidents of late visits or missed visits. These were caused by limited travel times given to staff. We have made a recommendation about this.

There were a range of policies available at the agency, which provided guidance and support for staff. However, these policies and procedures did not include specific detail on how they would be assessed, in terms of practice and timescales. We have made a recommendation about this.

The agency continued to have suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the branch manager, or the local authority safeguarding team.

The agency continued to have robust recruitment practices in place. Applicants were assessed as suitable for their job roles.

All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding adults and infection control. They worked alongside experienced staff and had their competency assessed before they were allowed to work on their own. Refresher training was provided at regular intervals.

Procedures, training and guidance in relation to the Mental Capacity Act 2005 (MCA) were in place which included steps that staff should take to comply with legal requirements.

The provider carried out risk assessments when they visited people for the first time. Other assessments identified people’s specific health and care needs, their mental health needs, medicines management, and any equipment needed. Care was planned and agreed between the agency and the person concerned. Some people were supported by their relatives to discuss their care needs, if this was their choice to do so.

People were supported with meal planning, preparation, eating and drinking. Staff supported people, by contacting the office to alert the provider to any identified health needs so that their doctor or nurse could be informed.

Most people said that they knew they could contact the provider at any time, and they felt confident about raising any concerns or other issues. The provider carried out spot checks to assess staff performance and to check they were following procedures, with people’s prior agreement. This enabled people to get to know the provider.

Staff had received regular individual one to one supervision meetings and appraisals as specified in the provider’s policy.

There were systems in place to monitor and improve the quality of the service provided. However, this had not been effective in rectifying some issues identified by both the management and people.

Staff spoke positively about the way the agency was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the branch manager was approachable and understanding.

Allied Healthcare Hythe provides care and support to people in their own homes. The service is provided to mainly older people and some younger adults and people who have a learning disability. At the time of the inspection there were approximately 128 people receiving support with their personal care. The service provides care and support visits to people in Ashford, Canterbury, Folkestone, Hythe, the Romney Marsh and surrounding areas. It provides short visits to people as well as covering shifts over a 24 hour period to support people.

The service is run by 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection in February 2016 we found the service was not meeting the standards of quality, safety and personalisation of care and support to people and there were significant shortfalls, the service was rated inadequate and placed into special measures. We took enforcement action against the provider and registered manager and asked them to tell us what they were going to do to put the shortfalls right. Since that time the provider has kept us regularly informed of progress they have made towards meeting the required standards. This inspection was to check the progress made against the shortfalls, the quality of the improvements and the impact of the improvements on people using the service.

Our inspection highlighted that whilst there had been improvements made there were still shortfalls that required further management action to ensure people received safe care.

People were still not fully protected by safe medicine management and handling. How staff should support people with their medicines was much clearer. Written guidance in relation to medicines prescribed ‘as required’ in most cases was now in place, but still required work. Staffs recording of medicines they had administered had improved, but not all instances of administration were recorded so we were unable to ascertain if people had received their medicines on those occasions.

The provider had had a consistent recruitment drive in the last six months, but the turnover of staff had remained high and had continued to impact on the time people received their visits and whether they were from regular staff, although the number of missed visits and the timing of visits had improved since the last inspection.

Most people had had their needs reassessed and a new care plan put in place. These varied in detail about risk and personalised care and some required further work, to ensure they reflected people’s preferred routines and how to keep them safe. Some people’s care plans and information about risks associated with their care and support still required review to ensure they contained sufficient information to inform staff and were up to date.

People felt staff were kind and caring. Most people staff respected their privacy and dignity, but some staff talked about their work problems when visiting them, which was not professional.

People gave their consent for their care and support and records were being improved to show the legal arrangements in relation to decision making people had in place and their capacity to make decisions to ensure people were support accordingly.

Staff received training, supervision and team meetings to help them do their job effectively. Some additional training had been identified by senior staff to enhance the service people received. People were fully protected by robust recruitment procedures.

People had been asked for feedback about the service they received, any negative feedback had been or was being addressed. There continued to be a fairly high number of complaints since the last inspection, but action was taken to try and resolve people’s concerns.

Most people felt communication with the office and the registered manager had got much. Audits and systems were more effective in picking up shortfalls and further systems had been put in place to help ensure people would receive a quality service that met their needs.

As this service is no longer rated as inadequate, it will be taken out of special measure. Although we acknowledge that this is an improving service, there are still areas, which need to be addressed to ensure people’s health, safety and well-being are protected. We have identified a number of continued breaches of regulations. We will continue to monitor Allied Healthcare Hythe to check that improvement continues and are sustained.

Allied Healthcare Hythe provides care and support to people in their own homes. The service is provided to mainly older people and some younger adults and people who have a learning disability. At the time of the inspection there were approximately 236 people receiving support with their personal care. The service provides care and support visits to people in Ashford, Canterbury, Folkestone, Hythe, the Romney Marsh and surrounding areas. It provides short visits to people as well as covering shifts over a 24 hour period to support people.

The service is run by 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There had been a high number of medicines errors and medicine management required improvement in most areas, to ensure people received their medicines safely and when they should. Most risks associated with people’s care and support had been assessed, but staff lacked clear guidance on how to reduce these risks to keep people safe.

People did not have their needs met by sufficient number of staff resulting in a high percentage of late calls and a number of missed calls. People did not always receive care and support from regular staff that were familiar with their care and support needs. Some staff were not sufficiently trained, experienced or competent to fully meet people’s needs. People were not fully protected by robust recruitment procedures.

People gave their consent for their care and support. However there was a lack records relating to the legal arrangements in relation to decision making people had in place.

Most people on the whole felt that staff were caring and respected their privacy and dignity. However people gave examples where they felt this was not the case.

People’s needs had been assessed when they started to use the service and care plans were in place. However these varied in detail and all required further information to ensure people’s care and support reflected their wishes and preferences. Care plans were not all up to date and some had not been reviewed for some time.

People had mixed opinions whether they were asked for feedback about the service. There had been a high number of complaints since the last inspection. People that had complained had mixed opinions about whether when they complained things really changed.

There had been a high turnover of office staff and this had impacted on the service people received and staff morale was low. People had very mixed opinions about their communications with the office and the registered manager. Audits and systems had not been effective in ensuring people received a quality service that meet their needs.

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 12months. 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.

After speaking to people who used the service we spoke again to the manager and also the registered manager to give feedback and to discuss and request further information. The registered manager had recently left the service to manage another service owned by the same provider and was in the process of making the changes to her registration.

People told us that their privacy and dignity were respected and their independence was encouraged.

People we spoke with told us that they were satisfied with the care and support they received from care workers. People felt their care was personalised to their needs. One person said, 'The majority of the time it's great'. Another person said, 'It's good'. Some people felt the organisation and continuity of care workers could be improved. People were aware of their care plan folder (a records folder kept in their home), although not always of their care plan. We found that care plans contained information about people's needs and preferences.

People felt safe using the service and when staff were present in their home.

People were generally complimentary about the staff. They felt that the service usually recruited the right calibre of staff to meet their needs.

Most people said they had been asked for their views and feedback on the service provided. There were systems in place to monitor the quality of the service.