Archived: Allied Healthcare London North

Not everyone using Allied Healthcare London North receives a regulated activity. CQC only inspect the service 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. At the time of our inspection 400 people were receiving a personal care.

There was a registered manager in post at the time of our inspection. 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.

When we last visited the service on 10, 11 and 12 January 2017 the service was rated as ‘Requires Improvement’, and we identified a breach related to staffing. Therefore, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions 'Safe' and 'Well-Led' to at least good. At this inspection we found action had been taken to make improvements.

At this inspection, we found that significant improvements had been made in relevant areas as detailed throughout this report. Staff punctuality had improved owing to a new IT system that had been implemented to improve staff deployment. Care workers were now mostly allocated according to geographical areas, which reduced travel time and therefore improved timeliness.

There were effective systems and processes in place to minimise risks to people. There were safeguarding, whistleblowing and anti-bullying and harassment policies in place and care workers were aware of how to raise concerns. Care workers had been recruited safely. They underwent appropriate recruitment checks before they commenced working at the service to ensure they were suitable to provide people's care. There were also effective systems and processes in place to minimise risks to people. Care plans contained risk assessments which identified the risks to the person and how these should be managed. Equally, there were robust arrangements around the management of accidents and incidents, medicines and risks associated with poor infection control.

People gave us consistently positive feedback about how the service was meeting their needs, including how they were supported to have sufficient amounts to eat and drink. Their needs had been assessed by the service before they started to use the service. Care plans included guidance about meeting these needs. This was accomplished by working alongside a range of health and social care professionals. People's capacity to make choices had been considered in line with the Mental Capacity Act 2005 (MCA). They told us that care workers asked for permission before carrying out any care. The service had supported care workers to have the skills and knowledge to carry out their role. They had received regular training and support.

People told us care workers were caring and compassionate. They told us care workers treated them with respect and maintained their privacy. People's individual preferences were respected. Their care plans contained detailed information so that care workers were able to understand their preferences. Care workers had a good understanding of protecting and respecting people's human rights. As a result they treated people’s values, beliefs and cultures with respect. The service ensured there were practical provisions for people’s differences to be respected. Although people’s communication needs were considered, this needed to be developed in terms of the requirements of Accessible Information Standard.

People received person centred care. They told us that they had been consulted when their care plans were written. Consequently, by involving people, the service was able to deliver the care that met their preferences. People's diversity and human rights were highlighted in their care plans. This ensured care workers were aware if they needed to make reasonable adjustments to meet people’s needs. We spoke with some people who told us provisions had been made to support their diversity, and this included gender preferences. People and their relatives confirmed that they could complain if needed. There was a complaints procedure which they were aware of.

The management team had continued to improve the quality of service provided. The registered manager had a clear sense of responsibility and had led a management team to embed robust processes to monitor the quality of the service. A range of quality assurance processes, including surveys, audits, management of accidents and incidents, management of complaints had been used continuously to drive improvement. People had derived benefits from constant quality monitoring as we gathered from their feedback. Care workers were equally satisfied with the leadership of the service.

Allied Healthcare London North is a large domiciliary care agency in North London providing personal care and support to people in their own homes in the London Boroughs of Barnet and Islington. At the time of the inspection there were 443 people using the service, of which 394 were receiving personal care. The service employed 190 care staff.

At our last inspection on 18, 19 and 23 May 2016, we found significant shortfalls in the care provided to people. We identified breaches of regulations 9, 11, 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to inadequate risk assessments and medicines management, inadequate care planning, inadequate provision of staff training, supervisions and appraisals, poor staff understanding of the Mental Capacity Act (MCA) and a lack of auditing processes to ensure good governance and overall management of the service provided. We were not satisfied that care and treatment was being provided safely.

We took action to impose a condition to restrict the provider in providing personal care to new people without the prior agreement of the Care Quality Commission (CQC). We imposed a condition that the provider must submit an updated policy to CQC that outlined the quality assurance systems in place at Allied Healthcare London North. We also imposed a condition which required the provider to undertake a monthly audit of care plans, risk assessments, medicines management, staff supervisions and appraisals and submit a monthly report to CQC outlining their findings.

The provider was also placed into special measures. Special measures are designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Its purpose is to ensure that inadequate care significantly improves and provides a clear timeframe within which the provider must improve the quality of care they provide. When a provider is placed into special measures, the CQC will re-inspect within six months.

This inspection was carried out within the six-month time frame to check if improvements to the quality of care had been implemented. At this comprehensive inspection we found the registered provider had taken action to achieve compliance with all of the regulations previously identified as non-compliant during the comprehensive inspection in May 2016. However, we identified further areas for improvement regarding medicines management and monitoring out of hours cover to ensure that people received consistent care at all times.

At this inspection, we found that staff competencies around medicines management were assessed. All staff training in medicines management was now up to date. Audits of medicines records were identifying areas for concern and this was addressed with the staff member involved. Healthcare professionals were consulted when concerns had been identified regarding peoples medicines. However, we found errors in the transcribing of Medicine Administration Records (MAR) charts and a lack of quality monitoring in this area.

We received positive feedback from most people and relatives regarding the support they received from care staff. However, we were consistently told that the quality of care people received altered at weekends as a result of carer changes and late calls which was not always communicated to people or their relatives. Gaps were identified in how missed call alerts were monitored at weekends.

At this inspection, we found detailed current risk assessments were in place for people using the service. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

We found that care plans were person centred and reflected what was important to the person. Care plans provided appropriate guidance to enable staff to deliver person centred care in line with people's preferences.

Significant improvements had been made to ensure that consent to care was obtained from the appropriate person. However, we found some instances where relatives had signed consent forms without the appropriate documented legal authority to do so. Care plan specifying best interests needs were in place. Most staff had received training on Mental Capacity Act 2005 (MCA) and staff understood the importance of obtaining consent from people.

We found that staff training, supervisions and appraisals were monitored and updated regularly. Systems had been implemented to ensure a better oversight of when staff training, supervisions and appraisals were due.

Staff were safely recruited with necessary pre-employment checks carried out.

We found that improved systems were in place to monitor and check the quality of care provided. We received consistently positive feedback from staff regarding the management structure in place and the support they received. Managerial oversight of the service had improved since the last inspection. Good practice had been developed, but further time was needed to address outstanding issues and for the service to demonstrate that the improvements that had already been made had been fully embedded and could be sustained.

At this inspection, we identified a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, as the provider has demonstrated significant improvements and the service is no longer rated as inadequate for any of the five questions, it is no longer in special measures.

Allied Healthcare London North is a large domiciliary care agency in North London providing personal care and support to people in their own homes in the London Boroughs of Barnet and Islington. At the time of the inspection there were 514 people using the service and 240 care staff.

The service is run by 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 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 did not adequately assess risk for all people using the service. We identified seven instances where a risk assessment had not been carried out for people with identified risks. Risk assessments were a lengthy tick box format and did not provide staff with enough guidance on how to recognise risk, actions to take or how to mitigate identified risks.

Medicines were not managed safely and effectively. There were inconsistencies between what consent forms, care plans and medicines risk assessments stated as to what medicines support people required. Daily records completed by staff in relation to medicines support people received differed from what instructions were given. Medicines audits were inconsistent and areas for improvement were not always identified. Staff were not receiving a yearly medicines competency check.

The provider did not always adhere to the Mental Capacity Act 2005 (MCA). Many consent forms were signed by relatives with no authority. There were no best interest decisions or mental capacity assessments highlighting that people did not have capacity to sign their care plan consent forms. Not all staff had received training in the MCA 2005 and staff did not always understand how this legislation impacted on the lives of people they were working with.

Care planning varied. Some people had new style care plans which were well designed and comprehensive. Other care plans were less thorough. We found that some care plans had not been reviewed for many months, and in some cases this meant that significant changes in a person’s condition had not been recorded. We found two instances of where there was no care plan in place and, in other cases, care documents were inaccurate or did not contain important medical information.

Staff did not receive regular effective supervision or annual appraisals. The provider did not always ensure robust recruitment practices by following up on references and during the interview process.

Staff received an induction, although, post induction meetings and support arrangements for staff did not occur.

The provider had quality assurance systems in place, but this was not always effective. The leadership of the organisation had identified issues but appropriate steps to address them had not been taken. Managerial audits of peoples and staff files were not carried out.

The provider had a complaints process and written complaints were investigated and responded to. However, verbal complaints were not always responded to. Feedback received from people was not analysed for trends and concerns were not followed up.

Most people told us staff were caring and kind. However, many people told us they experienced late visits and staff were rushed. Some people told us that they were not consulted about changes to their carers or informed when their carers were going to be late.

Staff had received training on safeguarding adults and staff we spoke with had a good understanding of abuse and how to raise any concerns.

Overall, we found significant shortfalls in the care provided to people. We identified breaches of regulations 9, 11, 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.