Archived: Allcare Community Care Services

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

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 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 was the first inspection of the service. The inspection was prompted in part by intelligence we had received from the police and a whistle blower. We made the decision not to announce the inspection due to the potential level of risk involved.

There was no registered manager in post. The operations director was referred to by staff and people who used the service as ‘the manager.’ The nominated individual for the provider organisation was preparing to apply to become the registered manager. A nominated individual is a ‘registered person’ with CQC. They can also be the registered manager where services are small but it is not usual practice. 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 and the nominated individual told us that quality assurance and monitoring systems were in place. During the inspection, we did not find adequate evidence to corroborate that checks on the quality and safety of the service had consistently taken place or that they were completed robustly enough to identify the issues we highlighted during this inspection.

Record keeping was poor throughout the service. We found there was a lack of accurate and thorough details recorded which meant we could not ascertain if issues had been correctly identified and followed up properly with the necessary action. We found multiple incidents had not been fully investigated, escalated or reported to the relevant external authorities as required.

Accidents and incidents, some of which were of a safeguarding nature had been identified by staff and recorded on a central system, however they had not been considered by the provider as reportable events and therefore people had been placed at risk because proper safeguarding procedures were not followed. Deaths and more serious incidents which are required by law to be notified to CQC were also not reported. Furthermore, due to poor record keeping and auditing, incidents were not properly monitored to look for trends or to reduce the risk of similar occurrences.

Assessments were not always carried out for all risks which people faced in their daily lives. Risk assessments did not contain comprehensive information about the risks or explain what action staff should take to reduce risks. We also found examples of individual people’s homes which did not have a support plan in place for staff to refer to whilst visiting people. This meant people were at risk of harm through not receiving the appropriate care and support.

People told us they received their medicines safely and when they expected it. However, we found there were gaps in staff training around medicines and no practical competency checks had been carried out to ensure staff remained competent to manage people’s medicines safely.

Staff training was overdue for some staff and refresher courses in other key topics had not been routinely carried out. Staff who should have completed a robust induction programme, such as the ‘Care Certificate’ had not achieved this. This demonstrated that the provider had not assured themselves that people were supported by staff who had the skills and competence to provide safe care. In addition, multiple staff supervisions were overdue. This meant that staff had not been formally supported in their role or given a formal opportunity to talk about their issues, learning needs or any plans for development.

Complaints were not managed in line with the provider’s complaints policy. Although some complaints had been briefly recorded on the central system, they were not properly investigated and detailed investigation notes were not made. We found that the procedures were inconsistently followed meaning some complainants were not aware if their complaint was being addressed or if there had been an outcome. We also found that complaints were not responded to in a timely manner and they had not been monitored to identify any trends.

Staff were not safely recruited. We found 17 staff files which contained references from inappropriate people or no references at all. Some staff had disclosed information on their DBS check in relation to previous cautions or convictions and no risk assessments were completed to show this had been investigated or control measures had been put in place to reduce any potential risks to people.

Staff felt there were enough of them employed at the service to look after people safely and to meet their needs. People said the staff did not rush them. Most people also told us that overall, they had regular care workers who were reliable and punctual.

People told us they felt safe with the care staff who visited them. Most relatives confirmed this. Most staff had been initially trained in the safeguarding of vulnerable adults and those we spoke with were able to demonstrate their responsibilities with regards to protecting people from harm. However, most staff were overdue a refresher course. Policies and procedures were in place to support staff with the delivery of the service, although we found that office staff did not always work in line with company policies.

People told us their care workers used personal protective equipment. This was to protect people from the risks of infection and cross contamination as staff sometimes visited multiple people in one day.

People and relatives told us their care workers treated them with dignity and respect. They said staff displayed kind and caring attitudes. Everyone we spoke with said the staff were friendly and nice to them and were there had been minor issues, the office staff had dealt with it.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We found care plans contained some individual specific information, however the information we reviewed for six people was mostly generic without in-depth person-centred details. The documentation focussed on tasks rather than on how people preferred their care to be delivered.

Care workers encouraged people to maintain a healthy and balanced diet. People told us their care workers made meals of their choice in line with their likes and dislikes and respected their preferences. External health professionals were involved with people’s care needs to ensure their ongoing well-being.

We have identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.