Alters Recruitment Limited t/a Alters Nursing - London

Alters Recruitment Limited t/a Alters Nursing – London is a domiciliary care service providing personal care to children and adults. 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 60 adults and no children receiving a personal care service.

People’s experience of using this service

People using the service had risk assessments carried out to protect from the risks of avoidable harm or abuse. Staff knew what actions to take if they suspected somebody was being abused. People’s medicines were managed safely and they were protected from the risks associated with the spread of infection.

Staff were supported in their role with training, supervision and appraisals. People’s care needs were assessed before they began to use the service. Staff supported people with their nutritional and hydration needs. People were supported to maintain their health.

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.

People and relatives thought staff were caring. Staff knew people well and how to support them. The service involved people and relatives in making choices and decisions about their care. Staff understood how to provide an equitable service. People’s privacy, dignity and independence were promoted.

Care plans were detailed, personalised and contained people’s likes and dislikes. Where required, people were supported to participate in activities of their choosing. The provider understood how to meet people’s communication needs. The provider had a system to deal with complaints appropriately. The service had a policy in place to provide people with end of life care if required.

People, relatives and staff spoke positively about the leadership in the service. The provider had systems in place to capture feedback from people about the quality of the service in order to identify areas for improvement. Staff had regular meetings to be updated on service development. The provider had various quality checks in place to identify areas for improvement. The service worked in partnership with other agencies to provide good outcomes for people.

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 6 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager at the service. 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.

At the last inspection in November 2015, we found one breach of the regulations because risk assessments were not robust and did not identify or address all risks faced by people receiving a regulated activity. We asked the provider to take action to make improvements and this action has been completed.

At the last inspection, we also found that people’s medicines were not always managed safely to ensure that people received their medicines as prescribed. The provider took action to improve this during the last visit and these improvements had been sustained.

Support needed to meet nutritional and hydration needs was not always clearly recorded. However, during this inspection, we found this had improved. At the last inspection, the service did not always respond to complaints appropriately but at this inspection we found this had also improved.

Quality assurance systems were in place but were not always effective. During this inspection we found improvements had been made and quality checks showed the action taken to resolve identified issues.

During this visit we found staff were knowledgeable about safeguarding and whistleblowing procedures. The provider had safe recruitment procedures in place to ensure appropriately skilled and experienced staff were employed. Staff were offered regular training to make sure their skills were up to date and staff received regular supervisions and appraisals.

People’s care plans showed the service worked with healthcare professionals and staff were aware of people’s nutritional needs. Staff worked within the requirements of legislation and obtained consent from people before delivering care.

People and relatives thought staff were caring and they felt listened to. Staff demonstrated they were aware of how to respect people’s privacy, dignity and independence. The provider had a complaints policy and dealt with complaints in accordance with this policy. The provider also kept a record of compliments made about the service.

The provider asked people to give feedback on the quality of the service provided and people and their relatives thought the manager was approachable. Staff regularly attended staff meetings and the provider carried out spot checks on the work staff carried out.

The service had a 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People gave us mixed feedback about the service, some were happy while others felt that communication with the office was poor. People felt safe and the service had safeguarding policies and procedures which were understood by staff. Care files contained risk assessments, but these were not always robust and did not provide staff with the information they needed to reduce the risk of harm to people. The provider took action to address this during our inspection. Where the service supported people with their medicines this was done by trained staff, however the recording systems in place were not sufficient to ensure that people were taking their medicines as prescribed. The provider took action to address this during our inspection.

People received support from the same staff, however they told us that cover arrangements were not always made or communicated to people and their families. We have made a recommendation about staffing levels.

Staff recruitment was safe, with appropriate pre-employment checks being completed by the service. However, the service employed staff who were unable to provide two employment references and this was not addressed by the recruitment policy. We have made a recommendation about recruitment practices.

Staff received a thorough induction, on-going training and supervision and told us they felt supported in their roles.

Records showed that people consented to their care in line with legislative requirements. People and staff told us that people were supported to eat and drink enough to maintain a healthy, balanced diet and where necessary were supported to access health care professionals. However, this was not always clearly recorded in people’s care plans and records of care. We have made a recommendation about care files.

Staff developed positive relationships with the people they supported, and people described their staff as caring. The service provided staff who could meet the cultural and linguistic needs of people using the service. Staff demonstrated a good understanding of people’s cultural and religious needs.

People had regular reviews of their care and were given the opportunity to provide feedback about their care at regular intervals. The service did not always respond to complaints or provide feedback to people in a way that was understood.

The quality of care records varied. Some were highly personalised while others were task focussed. The service was taking action to address the inconsistencies.

The service did not consistently demonstrate good leadership and management. Some people and staff were very positive about the registered manager, whereas others were not able to identify who they were. The quality assurance and audits completed had led to action plans, however, the plans had very long timescales which meant that change was not achieved in a timely manner. We have made a recommendation about improvement planning.

We identified one breach of the regulations during our inspection. You can see what action we have told the provider to take at the end of the report.

One person told us their carer was "delightful, she is really lovely." One relative we spoke with told is their parent's carer was a "good" carer. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People and relatives we spoke with told us they felt staff had sufficient training to undertake their roles and responsibilities. There was documentary evidence that staff had an induction before they delivered care to people. We found staff received appropriate professional development.

People we spoke to told us they felt safe with the agency's care workers. We found staff had safeguarding vulnerable adults training and understood they should report any concerns they had regarding people's safety and risk of abuse.

At our last inspection in November 2012 we found the provider did not have an effective system to regularly assess and monitor the quality of service that people receive because the views of people who used the service and those acting on their behalf had not been regularly sought. At this inspection we found there were sufficient improvements in place to adequately obtain the views of people and their relatives who used the service.

Staff were supported by management and had supervisions and appraisals. We found they had attended relevant training to fulfil their roles and responsibilities. There was evidence the provider had undertaken the necessary and appropriate checks into the good character of care workers hired to deliver care in people's homes.

People told us they knew how to make a complaint if they needed to. One person told us "if I wasn't happy, I know how to raise it."

However we found the agency did not regularly seek the views of people who used the service or those acting on their behalf about the quality of the service and they did not regularly assess and monitor the quality of care provided by care workers.