Alliance Care Ltd

Alliance Care Ltd is a domiciliary care service providing personal care to people in their own homes. 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. The service is also registered to provide treatment of disease, disorder and injury although this was not being provided at the time of the inspection. At the time of our inspection 51 people were receiving personal care from the service.

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

People were not always protected from the risk of harm; we found systems were not effective in reducing risks to people that resulted from their health needs and the use of prescribed medications. Systems in place to safeguard people from abuse were not robust and processes for learning lessons were not established to drive improvements.

Quality assurance systems were not in place to ensure people received consistent, high-quality and safe care. There was a lack of oversight over safeguarding people from harm, assessing people's needs and the management of the service.

People did not always feel they were supported in a caring and compassionate way. People and relatives experienced inconsistencies in the caring, respectful approach of staff. However, people with regular staff spoke highly of their diligence. People experienced limited input into the design and review of their support.

People's person-centred needs were not effectively identified and planned for by the service. This meant people sometimes experienced support that wasn't in line with their needs and preferences.

People were not always supported to have maximum choice and control of their lives although staff generally supported people in the least restrictive way possible and in their best interests; although the policies and systems in the service were not in place to support good practice.

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 25 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the safety and quality of the service, including concerns about the management of medicines, care calls being missed and people being neglected. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to how people's safety was managed, how people were safeguarded from abuse, staff training and how the service was run 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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Alliance Care Ltd provide care to people in their own homes. Nine older people were in receipt of personal care at the time of our inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community.

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 service was managed by the registered manager who also part owned the service.

People received safe care and were supported by staff who knew how to protect them from harm. Staff had received training and understood who to report any concerns they had to. Risk assessments were completed for staff to refer to support them in providing safe care. These were reviewed and updated as appropriate.

People received the support they needed at times that suited them. The registered manager was working towards developing a call monitoring system so that they could better review call times for people. The registered manager reviewed potential care packages and whether they had sufficient staff to attend calls to ensure they had safe staffing levels. People’s medicines and how staff supported them were reviewed by the registered manager to ensure people received the correct support. Staff recruitment included background checks so that the registered manager understood if staff were suitable to work at the service. Improvements needed to people’s care were shared with staff to develop the service and people’s care further.

People were supported by staff that understood how to protect and support them in line with their human rights. People were offered choices of meals and drinks. Staff shared important information about how to support people with other staff to enable people to receive consistent care which was effective in meeting their needs. People were supported to access additional advice from healthcare professionals where this was relevant to them.

People knew and liked the staff supporting them because they had regular staff who they had built up relationships with. Staff supported people to make decisions about their day to day care needs so that they were involved in their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were treated with dignity and respect. Staff understood what it meant to individual people in terms of maintaining their dignity.

People were involved in discussions about their care so that they received care that met their own specific needs. Where changes were needed the registered manager worked with people and their families to embed changes to their care. People understood how to complain and there was a process in place for dealing with complaints. The registered manager spoke with people regularly to try and anticipate issues before they occurred.

People were assured that if they called the administration office they could speak with the registered manager and senior management and make amendments they needed. The registered manager was working to improve quality assurance systems and was working to continually improve how they recorded information. The registered manager worked with stakeholders to better understand and improve people’s experience of care.

Further information is in the detailed findings below.