Archived: Allwell Care Company

Allwell Care Company is a domiciliary care service providing personal care to people in their own homes in Ipswich and surrounding area. 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. At the time of this inspection there were 8 people using the service who were in receipt of personal care.

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

The provider was unable to demonstrate they had robust systems in place to identify and manage risks or sustain improvements. The service was significantly smaller than at our previous inspection but learning had not been embedded across the service or a positive culture promoted. Safeguarding concerns were not always escalated or subject to sufficient scrutiny.

Systems to support medicine and risk management did not always identify shortfalls. Risk was not always recognised, minimised or acted on. As a result, people were not protected from the risk of harm.

Relatives told us that staff were generally on time and stayed for the time that had been previously agreed. However, staffing levels lacked resilience which meant that when things went wrong or not as planned, the provider did not always have sufficient capacity or an effective plan in place.

Recruitment processes had been strengthened and pre employment checks were undertaken on staff prior to their employment. We have made a recommendation about risk assessments for staff.

Staff received training but the arrangements to check their understanding of what they had learnt, and their competency was not fully effective.

Care plans outlined the professionals who were involved in the wider care and support of the person. We saw that staff made referrals to health professionals such as the district nurse and falls team.

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

Supervisions and appraisals were undertaken with staff to discuss their performance. Spot checks to monitor staff performance were completed.

There had been 3 managers in the last year and a new manager had recently been appointed. However, management responsibilities were unclear, and relationships strained and there was no shared understanding of organisational risk. Quality and safety monitoring processes were in place but failed to identify the shortfalls we found.

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 09 March 2023). There were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since the last inspection, and it remains in special measures as it continues to be rated inadequate in well led. This means we will keep the service under review, and if we do not propose to cancel the providers registration, we will re-inspect to check for significant improvements.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements and found breaches in relation to safeguarding, the management of risk and governance. You can see what action we have asked the provider to take at the end of this full 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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Allwell Care Company is a domiciliary care service providing personal care to people in their own homes in Ipswich and surrounding area. 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. At the time of this inspection there were 26 people using the service who were in receipt of personal care.

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

Relatives told us that staff were often late, with some people being left until almost midday to be supported. Staff did not always support people for the length of time that had been previously agreed and people felt rushed.

Medicines were not managed in a safe way and we found significant gaps or omissions in these records. We could not be confident that people were receiving their medicines as prescribed. The risks to people from receiving support or their medicines at a different time had not been adequately assessed and relatives told us that this impacted on their family members wellbeing and health.

Risks to people’s safety and wellbeing were not always identified or escalated promptly to reduce the risk of harm. There was a lack of guidance for staff on how to manage risk which was compounded by a lack of oversight.

Recruitment processes were not robust. Recruitment checks had not been completed on all new staff to check their suitability or competence to work with people prior to commencing employment. There were gaps in staff training and knowledge in key areas such as safeguarding, and we were not assured staff would recognise and respond to abuse.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

We found that staff had not had training in learning disability and autism or were clear about their roles and responsibilities in relation to the Mental Capacity Act (2005). People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

Since the last inspection the provider had been receiving support from the Local Authority to make improvements. Despite this quality and safety monitoring processes had not been embedded, which meant when the previous manager left, they had not been continued and the provider had failed to identify the shortfalls we found.

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 requires improvement (published 17 June 2022). There were breaches of regulation. The service has deteriorated to inadequate. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well led.

The overall rating for the service has deteriorated to inadequate.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

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 Allwell Care Company on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing, safeguarding, recruitment and the management oversight of the service at this inspection.

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.

Follow up

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.

Not everyone using Allwell Care Company receives the regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

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

People’s care calls were not well planned and could put people at risk. Staff sometimes needed to be in different places at the same time. One person told us, “I don’t know when they are coming, I would prefer to know but they say they can’t tell me.” A relative said, “I have noticed a few calls recently it’s about 11 to 11.15 am, well that’s nearly getting to lunchtime, so that’s a long time to wait (to get up). We don’t know who is coming, it’s been a lot of different people recently.”

Staff recruitment processes needed to be improved and ensure they were in line with their company policy.

Medicine administration records were not consistently recorded, and for medicine prescribed as to be given as required, there were no instructions for staff on when or how they were to be given.

The manager had not yet re-applied to be registered with the commission. The provider was working with the local authority and had put in place an auditing system which was not yet embedded and had failed to identify some of the areas we identified that needed improvement.

Staff were aware of how to recognise potential abuse and report it. People and their relatives were positive about the caring nature of staff. Comments included; “I do feel safe with (staff), they do know what they are doing.” And “I do have to say that the carers are very good.”

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 (published 17 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, records and quality monitoring. A decision was made for us to inspect and examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to staffing and the quality assurance system not being robust at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This service was registered on 13 December 2017. This was their first inspection.

At the time of this announced comprehensive inspection of 7 December 2018, there were 11 people who used the service and received ‘personal care’. The provider was given 48 hours’ notice because we wanted to be certain the manager and key staff would be available on the day of our inspection.

A registered manager was not in post. 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 provider had recently appointed a manager to run the service and confirmed their registration application would be submitted to CQC.

The service was in transition, the manager was implementing systems to monitor the quality and safety of the service provided. Where we identified gaps in the recruitment processes and recording of people’s medicines the manager took swift action to address this. They were working closely with social care professionals to implement improvements in the service, such as person-centred care plans, complaints process and audit system. This was a work in progress. Recording, auditing and documentation in these areas had recently been developed. However, these were not yet fully embedded into practice and at the time of the inspection we were unable to assess their effectiveness.

Feedback from people who used the service and their relatives was positive about the approach of the care workers and the service provided. They told us that the care workers were kind and compassionate, promoted people’s independence and respected their privacy and dignity.

Systems were in place to minimise risks to people’s safety, including from abuse and in relation to mobility, nutrition and with accessing the community. Care workers understood their roles and responsibilities in keeping people safe.

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

Improvements had been made and were ongoing to ensure people’s care records reflected individualised personalised care.

Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment. Where required people were safely supported with their dietary needs.

Recruitment checks were carried out with sufficient numbers of care workers employed, to maintain the schedule of visits and provide continuity of care for people. Care workers received supervision and training to support them to perform their role.

People received their medicines as prescribed. Care workers were provided with training in infection control and food hygiene and understood their responsibilities relating to these areas. Systems were in place to reduce the risks of cross infection.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on.