Background to this inspection
Updated
1 September 2018
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 registered 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.’
The inspection was prompted in part by a notification related with the death of a person using the service. This incident is subject to the investigation of the local authority safeguarding team and as a result this inspection did not examine the circumstances of the incident. Our inspection was also prompted by several safeguarding concerns received in relation to missed care visits. The information shared with CQC indicated potential concerns around the management of risks therefore we decided to do a responsive inspection.
This inspection took place on 26 and 27 June and 3 July 2017 and was announced. We gave the service 24 hours' notice of the inspection visit because the location provides a domiciliary care service and we needed to be sure management would be available to talk with us.
Inspection activity included visiting the office location to see the registered manager and office staff, and to review care records, policies and procedures and quality assurance documents. We carried out telephone interviews with people who used the service, their relatives and staff.
The inspection was completed by two adult social care inspectors on the first day, one inspector on the other two days and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had experience as a family carer of a person living with dementia who used domiciliary care services. The expert by experience carried out telephone interviews with people who used the service, their relatives and staff.
Before the inspection, we reviewed all the information we held about the service including previous
inspection reports and notifications received by the CQC. A notification is information about important events which the service is required to tell us about by law. We used this information to help us decide what areas to focus on during our inspection. The registered provider was not asked to complete a Provider Information Return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We discussed this information during the inspection. We requested feedback on the service from the local safeguarding teams and commissioners.
We spoke with five people using the service and five relatives of people using the service. We spoke with ten staff; this included the regional director, registered manager, four care workers, two deputy managers, one care supervisor and two specialist nurses who were also part of the team. We looked at records for eight people using the service including support plans and risk assessments. We also looked at specific parts for care plans for another five people. We analysed three medicine administration records and twenty incident forms. We reviewed training records for seven staff and looked at recruitment and supervision records for four staff, including competencies and recent spot checks. We looked at minutes of team meetings, various policies and procedures and reviewed the quality assurance and monitoring systems of the service.
Updated
1 September 2018
This announced inspection took place on 26 and 27 June and 03 July 2018. At the time of our inspection 181 people were receiving support from the service. At our last inspection on 29 March 2017 this service was rated good in all key areas; at this inspection we found the quality of the service had deteriorated and required considerable improvements in particular in the safe domain.
Allied Healthcare Doncaster/Rotherham is a domiciliary care agency. It provides personal care to people living in their own houses, flats and extra care housing in the community. It provides a service to older adults, including people living with dementia, younger disabled adults and children living in the areas of Rotherham, Doncaster, Barnsley and North Lincolnshire. Not everyone using Allied Healthcare Doncaster/Rotherham receives a service which is a 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.
On the day of our inspection a registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
During this inspection we found six breaches of regulations in relation to safe care and treatment, safeguarding, consent, person centred care, good governance and registration regulations. You can see what action we have asked the registered provider to take at the end of the full version of this report. Overall, we have rated the service as Requires Improvement. This is the first time the service has been rated Requires Improvement.
Most people told us they felt safe using the service. Safeguarding procedures were in place however we found some people using the service were being restricted of their liberty without the appropriate legal authorisations or risk assessments in place. We found the registered provider was not always following their own policy in relation to dealing with missed care visits and some incidents were not being identified as safeguarding concerns. The registered provider was not always informing CQC when safeguarding concerns were being investigated.
The management of risks and care planning was inconsistent. We found some people had very comprehensive and detailed risk assessments and care plans, while other people had very succinct or even non-existent risk assessments.
The registered provider was not always following their own medication policy in relation to the correct management of ‘as and when required’ medicines. We also found medication audits were not being consistently completed.
We found people who had started the service with end of life needs did not have any assessment of their needs, risks involved in their care or records of care to be provided. The lack of information and guidance could put people at the end of their life at risk of receiving inappropriate care and treatment.
People’s needs in relation to the protected characteristics under the Equalities Act 2010, were taken into account in the planning of their care. People's communication needs were assessed.
People's rights under the Mental Capacity Act (2005) were not supported through recorded mental capacity assessments to assess their ability to make decisions about their care and treatment. This is important to ensure people are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible.
People and their relatives told us staff were kind and caring.
People were supported to eat a balanced diet that met their individual dietary needs. They were supported to access healthcare services in order to maintain their health.
Staff were supported through a comprehensive induction, regular supervision and annual appraisals. However, we could not be certain all staff supporting children had the specific training required.
There was a complaint policy and procedure in place but two people told us they had raised concerns to staff and no action had been taken.
Staff told us they felt supported by the management team and people spoke positively about staff.
There were several systems in place to monitor the quality of care; however these were not always effective in identifying the issues found at this inspection.
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.