Archived: Allied Healthcare Greater Manchester

This inspection took place over several days in October 2015. The initial unannounced visit to the branch office took place on 12 October, and was followed by a second visit on 16 October. We made phone calls to people using the service, on 21 October. On 22 October we visited one of the homes of people with learning disabilities supported by Allied Healthcare Greater Manchester. And on 23 October three inspectors visited people receiving care from Allied Healthcare in their own homes in areas of Manchester and Tameside. Finally on 6 November we visited the office again, by arrangement, to give verbal and written feedback on the inspection.

At a previous inspection in January 2014 we had found that the service was not meeting three of the regulations we looked at. Those three regulations concerned care and welfare, quality monitoring and record keeping. We made a follow up visit in April 2014 and found that these three regulations were now being met.

The main service being provided by Allied Healthcare Greater Manchester was domiciliary care, which means care for people in their own homes. Allied Healthcare had contracts with local authorities in four areas: Manchester, Trafford, Stockport and Tameside. At the time of this inspection Allied Healthcare provided care to a total of around 330 people across all these areas. 126 staff were employed as homecare assistants (or ‘carers’). In addition, at the start of this inspection Allied Healthcare Greater Manchester was managing two homes in Cheshire for six people with learning disabilities.

The former registered manager had left in May 2015. 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.

Allied Healthcare had appointed a replacement manager in or around July 2015 but this person had left after 10 weeks without becoming registered manager. At the start of our inspection a care delivery director from Allied Healthcare was acting as manager, but we did not meet this person during our visits. The acting manager was being assisted by an operational support manager, whom we did meet.

We found that people were happy with their regular carers but had problems at weekends or when their regular carers were on holiday. Times of visits could be erratic and people were not always told when carers would be late. Electronic call monitoring was not being used effectively. Agency staff were frequently used due to staff shortages.

There had been a high number of missed calls which were attributed to a shortage of office staff. At the bank holiday weekend at the end of August calls were prioritised and some people had not received care. This was a breach of the regulation relating to deploying sufficient numbers of staff.

Safeguarding incidents had not been reported to CQC over the last six months. This was a breach of the regulation relating to reporting such incidents.

When carers administered medicines they often had no Medicine Administration Record (MAR) to record on. This was a breach of the regulation relating to ensuring the proper recording of medicines.

We saw staff using personal protective equipment (eg aprons and gloves).

Staff had received appropriate induction training but during 2015 attendance at training courses had decreased. Staff in the supported living service had received role specific training.

Spot checks and supervisions to support carers in their work had not been carried out during most of 2015. The lack of supervisions and reduction in training for staff was a breach of the regulation relating to supporting staff.

People using the service and their relatives told us the carers were kind and sometimes went the extra mile. Some had experienced problems when the office staff had sent the wrong carers. In the supported living home we visited there was a well-established team who cared well for the people living there.

However, we also found examples of very poor care. In one case this had been allowed to continue over a period of months due to a lack of management control and supervision. This was a breach of the regulation requiring people using the service to be protected from abuse and improper treatment.

Care planning varied. Some people had new care plans which were well designed and comprehensive. Other care plans were less thorough. We found that care plans had not been reviewed for many months, and in some cases this meant that significant changes in a person’s condition had not been recorded. We found that the failure to update care plans was a breach of the relevant regulation.

We found there was a mixed reaction regarding how well the service managed complaints. Some people told us that their complaints often went ignored, although some told us that their concerns had resulted in changes. There was a system for recording complaints in the office.

There had been a succession of short term managers since the registered manager left in May 2015. People told us they were dissatisfied with the management. We saw an internal audit from March 2015 had identified problems in the branch but action was not taken until later.

There had been a severe shortage of office staff, which had led to many of the problems. Those staff who were there had needed to take on other roles and were unable to fulfil their own.

Staff in the two supported living homes had received little support or input from the branch office. We learnt that one of the homes was being transferred to a different branch office, and families of residents of the other home had requested transfer to a new provider.

Allied Healthcare had conducted an investigation into allegations of abuse against one person and had identified failings in the management of the branch. They had devised an action plan and appointed a new manager.

Despite this, we considered the recent failings in management had had a significant impact on people who used the service and were a breach of the regulation relating to good governance.

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.

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.