Archived: Allcare Community Care Services

Updated 5 April 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection site visits took place on 8 and 9 August 2018. Our arrival was announced. We gave the provider short notice of the inspection to ensure senior management would be present at the office location. The inspection consisted of two adult social care inspectors, an assistant inspector and one expert by experience. The assistant inspector conducted telephone interviews with care staff on 22 and 23 August 2018 and the expert by experience contacted people who used the service and relatives on 10 August 2018. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

On this occasion we did not ask the provider to submit the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

Prior to the inspection we reviewed all the information we held about Allcare Community Care Services including any statutory notifications that the provider had sent us and any safeguarding and whistle blowing information we had received. Notifications are made to us by providers in line with their obligations under the Care Quality Commission (Registration) Regulations 2009. These are records of deaths or incidents that have occurred within the service or other matters that the provider is legally obliged to inform us of.

Additionally, prior to our inspection we liaised with two local authorities who commission services and two local NHS clinical commissioning groups (CCG) to gather their feedback about the service.

During the inspection we spoke with 11 people who currently, or until very recently had used the service, and six relatives to gain their opinions. We spoke with staff including the operations director, two care coordinators and four care workers. The nominated individual (the provider’s representative) was present for half of the first day of our site visit.

We reviewed records related to the quality and safety of the service which included looking at nine people’s care records. We also checked 12 staff files for recruitment references and 8 staff files for training certificates.

During the inspection and afterwards we asked the operations director and the nominated individual to send us further information in relation to investigation reports and outcomes, specific staff records, an updated action plan and any provider audits. After three weeks of waiting for the information, we had only received a very small amount of what we requested. We gave the provider a final 24 hours to send us what we needed to conclude the report but this was not adhered to.

Updated 5 April 2019

This comprehensive inspection took place between 8 and 23 August 2018. This service is a domiciliary care agency based in North Tyneside. It provides personal care to people living in their own homes throughout North Tyneside, Newcastle and Gateshead. Services were provided to adults with a range of health and social care needs, predominantly older adults and people approaching the end of their lives. At the time of our inspection there were approximately 45 people receiving a service in their own homes.

Following the last inspection in May 2018, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least ‘Good’. We found the provider had failed to achieve this.

Whilst we received the initial action plan in May 2018, the provider did not share an updated version with us at this inspection, which we asked them for, so we could see what improvements had been made.

There was still no registered manager in post. The nominated individual for the provider organisation had applied to become the registered manager. The application was still in progress at the time of this inspection. A nominated individual is a ‘registered person’ with CQC. They can also be the 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. The operations director was referred to by people, relatives and care staff as ‘the manager’.

At the last inspection the service was rated ‘Inadequate’. At this inspection the rating remained the same. Therefore, the service remains in ‘special measures’. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider’s registration of the service, it 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.

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.

This inspection was carried out to follow up on the urgent action we asked the provider to take following the serious concerns raised in May 2018. After the last inspection, we imposed a restrictive condition on the provider’s registration which meant they were unable to accept any new care packages. This restriction is still in place. We also issued the provider with a fixed penalty notice for failing to notify us of a specific incident. Other enforcement action is still in progress which we will report on when all representations and appeals processes have been concluded.

Following our last inspection, one local authority placed this service into organisational safeguarding due to the amount of serious concerns around the safety and governance of the service. This meant that health and social care professionals from the contracting local authorities and Clinical Commissioning Groups (CCG’s) attended periodic meetings with the provider and CQC. The local authorities continued to have serious concerns about the service and at the time of this inspection one local authority had given the service notice to terminate their contract. Both local authorities were conducting urgent reviews of people’s care needs and one local authority had begun to arrange a transfer of care packages to other providers.

During the inspection, we did not find sufficient evidence to show that robust checks on the quality and safety of the service had consistently and properly taken place. The documents given to us did not reflect all the issues we highlighted during this inspection and they failed to adequately explain what action, if any had been taken to properly address matters.

Record keeping remained poor throughout aspects of the service. There continued to be a lack of accurate and comprehensive details recorded which meant we could not be certain that issues had been identified and followed up properly. We found more incidents had not been fully investigated, recorded in detail, escalated or reported to the relevant external authorities if necessary. Incidents were not appropriately monitored to identify trends or to reduce the risk of repeated events.

Policies and procedures were available to support staff with the delivery of the service, although we found that staff did not always work in line with company policies and procedures. There was limited information available about what action had been taken when staff failed to follow procedures.

After the last inspection we asked the provider to retrospectively send us statutory notifications with regards to incidents or deaths which we identified had occurred at the service and had failed to be notified to us. We have not received all the information we asked for. At this inspection, we found more deaths which were not notified to the CQC as required by law.

The provider was also required by law to display the most recent performance ratings at their premises and we had asked them to share a summary of the last inspection report with people who use the service and staff. This had not been carried out.

The provider had employed a registered nurse in a clinical lead role since we last visited the service. However, they had not prioritised conducting care staff clinical competency checks and as such, care staff had still not been assessed as competent to carry out clinical care tasks. This meant people’s safety remained at risk.

Complaints were still not being managed in line with the provider’s complaints policy. Although some complaints had been briefly recorded, detailed investigation notes were not made. We found that the complaints procedure was still inconsistently followed. We also found more complaints were not responded to in a timely manner and they had not been monitored to identify any trends.

At the last inspection we found staff were not safely recruited. We asked the provider to ensure staff recruitment was robust and where necessary carry out further checks on specific members of staff. We found this had not been achieved. Whilst the provider now had one or two printed-out references for each member of staff, these documents were not sufficient enough to show that thorough checks had been made, verified or obtained from appropriate sources. This meant people continued to be at risk because in-depth vetting checks had not been completed.

Existing care staff training had been reviewed and where necessary care staff had received training or a refresher session in key topics which included a theoretical awareness into end of life care and catheter care. However, other topics such as diabetes awareness and choking awareness had still not been delivered to a small number of care staff working with people with those specific needs. We were told that no new care staff had started employment since the last inspection, but we were shown evidence of some existing care staff refreshing their knowledge in nationally recognised induction standards and the operations director talked us through the induction process should they employ new care staff.

Staff supervision sessions and appraisals had been carried out and were scheduled in advance to give staff an opportunity to talk about their issues, learning needs or any plans for development. Some care staff raised issues with us which they felt were not properly addressed. Staff told us of low morale amongst the team and said they felt the management had not openly communicated with them about the findings of the last inspection and the action taken by the CQC.

The newly implemented support plans were an improvement on the previous ones. They contained more person-centred information. However, we found a number of inaccuracies or omissions within the new paperwork which the office staff addressed during the inspection.

Improved risk assessments were also in place. However, we found examples of missing risk assessments and we found that some of the risk assessments in place had information omitted. The risk assessments were not as person-centred as they could have been and we discussed this with the office staff for future improvements.

People were supported by their care workers to have choice and control of their lives and care staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, we found the office staff did not fully understand the principles of the Mental Capacity Act 2005 and best practice. Support plans did not always contain comprehensive information about capacity. In some cases, consent was not recorded from the person or a person acting legally on their behalf.

We received mixed feedback from people and relatives about the service they received. Some people told us they felt safe and were happy with the care provided whilst others told us of issues and complaints and a general decline in the quality of the service over the past few months.

People told us they received their medicine wh