Allestree Health & Homecare Services

Allestree Health & Homecare Services is a domiciliary care service. At the time of the inspection they were providing personal care to 18 people who lived in their own homes. Not everyone who used the service received personal care and a further 20 people received support calls. CQC only inspects where people receive personal care. Personal care is help with care related to personal hygiene and eating. Where people do receive personal care, we also consider any wider social care provided.

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

Policies were not always followed to ensure complete good governance of the service. The registered manager was not clear on what events and incidents were required to be notified to CQC.

People received their medicines as required, however medicines’ risk assessments were not always in place. Other risk assessments were in place to help reduce risks to people.

Staff were subject to checks on their suitability to work at the service. However, not all recruitment decisions had been recorded in line with the provider’s policy.

People were not supported to have maximum choice and control of their life and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were enough staff to provide people with timely care. The provider had taken steps to ensure people were protected from the risk of abuse and avoidable harm. Procedures were followed by staff to help prevent and control infection. Lessons were learnt from when things went wrong.

People’s health and care needs were assessed. Staff had been trained in areas relevant to people’s needs. Staff received support from the registered manager. When people needed care with their nutrition and hydration, staff knew how to provide this effectively. The service worked in partnership with other health and social care professionals to ensure people received effective care.

Staff were caring, and people enjoyed their company. Staff involved people in decisions relating to their care and support. Staff respected people’s privacy and dignity and promoted their independence.

Staff knew people’s preferences and abilities and provided personalised and responsive care. People’s choices were respected by staff. People’s communication needs were assessed and met. People knew how to make a complaint or raise or concern. The provider’s complaints process had been followed when a complaint had been received. The service looked to learn lessons and continuously improve. No one received end of life care at the time of our inspection.

The registered manager demonstrated an open and honest management style. People, relatives and staff felt included in the developments at the service; they were provided with opportunities to give their feedback on the service and this was listened to. The service looked to continuously learn and improve and worked well in partnership with others.

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 4 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The provider has given assurances that they have acted on the issues identified at this inspection.

Enforcement

We have identified breaches in relation to regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

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.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Risk assessments were not consistently in place to protect people from risks to their health and welfare. Staff recruitment checks were not always in place to protect people from receiving personal care from unsuitable staff.

People and relatives we spoke with told us they thought the service ensured that people received safe personal care. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

We saw that medicines were, in the main, supplied safely and on time, to protect people's health needs.

Staff had received training to ensure they had skills and knowledge to meet people's needs, though this had not covered some relevant care issues.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives.

People and relatives we spoke with all told us that staff were friendly, kind, positive and caring. They told us they had been involved in making decisions about how and what personal care was needed to meet their needs.

Care plans were individual to the people using the service to ensure that their needs were met though this did not include all relevant information such as all of people's preferences, likes and dislikes.

People and relatives told us they would tell staff or management if they had any concerns, they were confident these would be properly followed up. They were satisfied with how the service was run. Staff felt they were supported in their work by the senior management of the service.

Management carried out audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service.

Allestree Health and Home Care Services provide personal care for people living in their own homes. The registered manager informed us that there were 31 people receiving a personal care service from the agency.

A registered manager was 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.

People using the service and relatives we spoke with said they thought the agency ensured that people received safe personal care. Staff were trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Some people’s risk assessments were in need of improvement to help ensure staff understood how to support them safely.

People using the service and relatives we spoke with told us they thought medicines were given safely and on time.

Staff were not fully safety recruited to help ensure they were appropriate to work with people who used the service.

Staff needed more training to ensure they had the skills and knowledge to be able to fully meet people's needs.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow people to have an effective choice about how they lived their lives.

People told us they had plenty to eat and drink and everyone told us they thought the food prepared by staff was satisfactory.

People's health care needs had been met by timely referral to health care professionals when necessary.

People and relatives we spoke with all told us they thought staff were friendly and caring and they got on very well with them.

People, or their relatives, were involved in making decisions about people’s care and support.

Care plans were not fully individual to the people using the service and did not fully cover their social care needs.

People and relatives told us they would tell staff or management if they had any concerns and were confident they would be followed up.

People receiving the service, their relatives and staff thought that the agency was well run.

Management carried out audits and checks to ensure the agency was running properly, although auditing did not include all issues needed to provide a quality service.