Archived: Allicare

Allicare domiciliary care agency provides personal care to people living in their own homes. At the time of the inspection the service was supporting 67 people. People were supported with varying needs, some requiring just a few hours of support a week to others who required live in staff to provide support 24 hours a day.

We were told 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.

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

We found ongoing concerns in how the provider assessed risks to people using the service. This included risks in changing care needs and how medicines were administered. There was not enough staff to ensure the rota was covered in a way that met the needs of people using the service and management were frequently used to support this. Staff were recruited safely and we found staff had the required equipment to control the risk of infection

People had not received assessments to determine their capacity to consent to care and treatment and holistic assessments considering people’s wider circumstances had not been completed. 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 and in their best interests; the policies and systems in the service did not support this practice.

Staff had received more training since the last inspection but predominantly training did not include recent changes in legislation and best practice guidance. Staff did not have their competency tested to ensure they could effectively implement any training they received. People were supported to have access to enough nutrition and hydration but there were some concerns noted in how people were supported with special diets.

People told us care staff had improved since the last inspection and staff were generally more caring. But people were not involved enough in agreeing how and when their care was delivered. Staff treated people with dignity and respect and were responsive to their requests for support.

Complaints were not managed effectively, they were not responded to appropriately and the provider did not have systems in place to identify themes and trends from complaints received, in order to make any changes required to service delivery. People did not receive care specific to their preferences. Care plans were often not up to date with the most recent information and some areas of people’s support needs had not been assessed or reviewed. End of life care was delivered with the support of local district nursing teams.

A recent satisfaction survey had contained some positive comments and showed improvements had began to be made. However, a lack of an effective governance and quality audit system did not allow this to be evidenced. Action plans from the previous inspection were signed off as completed when there was clearly more work to be done, this included reviews of care plans and the inclusion of best practice guidelines in current policy.

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 last rating for this service was Inadequate (published 26 September 2019). Multiple breaches of regulation were found. The provider completed an action plan in January 2020 to show what improvements they would make and when. At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to managing and identifying risk, the safe management of medicines and protecting people from abuse. We identified further breaches due to an inadequate number of staff who had received effective training to deliver a service in line with the requirements of the regulations. There were also breaches identified in how the service acquired appropriate and lawful consent, how the service managed complaints and the governance and audit of the service. Lastly, we found a breach in relation to the lack of provision to meet the specific and individual needs of people using the service. We have also issued three recommendations; one in relation to ensuring there are evidential checks around the competence of internal promotions, one about the timely completion of assessments and one ensuring that advice around people’s dietary requirements from professionals is incorporated into care plans.

Any regulatory action that was planned to be taken was aborted as the service ceased to operate. The provider told us they no longer delivered a regulated activity to people.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Allicare is a domiciliary care agency that was providing support to over 130 people at the time of our inspection. 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.

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

The provider and registered manager had failed to ensure the quality monitoring systems in place were effective to ensure people received safe care. Oversight of the administration of medicines failed to identify in a timely way where actions were required. In some areas where care was provided, there were not enough staff to ensure all care calls were provided or delivered on time. This had place people at significant risk of harm.

Recruitment processes were not robust, and staff had been knowingly sent to work in people’s homes before checks of their suitability had been completed. Not all staff had completed training in safeguarding vulnerable people and we found that not all safeguarding incidents had been reported to the Care Quality Commission. Assessments of risks to people’s wellbeing were not robust

Staff training and supervision was not effective to meet the needs of people, we identified widespread gaps in training records. The registered manager and provider did not ensure people’s needs were assessed and supported in line with legislation, standards and evidence-based guidance. The registered manager, provider and staff did not demonstrate enough understanding of the Mental Capacity Act 2005 and assessments of people’s capacity were not undertaken. Staff did however, seek peoples consent before providing them with care.

Most people told us that staff were kind and caring however, we saw that some staff used terminology and language when referring to people that did not promote their dignity. Care plans did not fully reflect people’s life histories and preferences, and staff reported this impacted their ability to meet their needs. Some people did not feel the provider and management team were kind and caring towards them, requests from people for more information about who would be supporting them in their own homes were refused.

Complaints were not managed so that outcomes could be provided and any cause for concerns investigated to improve practice. Some outcomes from complaints had not been actioned, some complaints had not been responded to.

End of life and palliative care needs were not planned for, and staff had not received training to provide this, although the provider advertises that they provide this type of care. Peoples preferences were not always met, this included preferred gender of care staff and call times. The provider and registered manager had failed to audit and check if people received their care on time and for the duration agreed.

People were not supported by a service with effective management and governance systems in place. The provider and registered manager had not ensured that areas of improvement required and risk to people were identified and mitigated. The registered manager was aware of the decline in the quality of care and oversight since expansion of the number of people supported took place, but had failed to take action to address this. This failure exposed people to the ongoing risk of harm.

We have made a recommendation that all staff complete training in end of life and palliative care.

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 Good (27 October 2016)

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Allicare on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe management of people’s medicines, staff training and recruitment, current governance systems, consent to care and treatment, the management of complaints, and the number of staff employed.

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.

Special measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 is registered to provide personal care to people living in their own homes. At the time of the inspection there were 66 older people using the service.

There was no registered manager in place at the time of our visit. 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 current care manager had recently begun the application process with the Care Quality Commission.

Our previous inspection on 9 September 2015 found a breach of three legal requirements. We asked the provider to make improvements to ensure staff employed had relevant safety checks in place and that there were effective auditing systems for quality. We also asked the provider to ensure effective systems were in place to obtain lawful consent in accordance with the Mental Capacity act 2005 (MCA), and that staff understood these.

We found at this inspection that sufficient improvements had been made regarding these areas. This meant that at this inspection we concluded that the provider was no longer in breach of any legal requirements.

People and their relatives told us that people were safe using the service. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. Risk assessments recorded what action staff should take if someone was at risk and referrals were made to appropriate health care professionals to minimise risk going forward.

There were sufficient staff to keep people safe and meet their needs, and the management team had in place safe recruitment procedures. Staff were competent with medicines management and could explain the processes that were followed. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. The management team understood that there should be processes in place for ensuring decisions were made in people’s best interests. Staff sought consent from people and recorded this.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff maintained people’s privacy. People and their relatives felt that staff were understanding of people’s needs and had positive working relationships with people.

The service provided individualised care according to each person’s needs and preferences. People and their relatives were involved in assessment and reviews of their needs. Staff had knowledge of changing needs and supported people to make positive changes to their care plans.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people, relatives, health and social care professionals were sought as part of the quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.