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«Ratings Overall rating for this service Requires Improvement Is the service safe? Requires Improvement Is the service effective? Good Is the service ...»

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Nestor Primecare Services Limited

Allied Healthcare


Inspection report

2 Thorp Street Date of inspection visit:

Macclesfield 23 March 2016

Greater Manchester 24 March 2016

SK10 1LJ

Date of publication:

Tel: 01625611112 24 May 2016

Website: www.nestor-healthcare.co.uk/ Ratings Overall rating for this service Requires Improvement Is the service safe? Requires Improvement Is the service effective? Good Is the service caring? Good Is the service responsive? Good Is the service well-led? Requires Improvement 1 Allied Healthcare Macclesfield Inspection report 24 May 2016 Summary of findings Overall summary This inspection took place on 23 and 24 March 2016 and was announced. The provider was given 48 hours' notice of the inspection, because the location provides a domiciliary care service and we needed to be sure that someone was available in the office as well as giving notice to people who used the service that we would like to visit them at home.

Allied Healthcare Macclesfield is a domiciliary care agency that provides domiciliary care and support to a range of people in their own homes. The range of support provided includes assistance with personal care, domestic duties, laundry tasks, shopping, and meal preparation.

We previously inspected the service in May 2013 when we found they were meeting all the regulations we looked at.

At the time of the inspection there was a manager at Allied Healthcare Macclesfield but she had not yet been registered with the Care Quality Commission. The manager started her post in October 2015 and provided evidence to the inspection team that she had applied to be the registered manager, however this process had not yet been completed.

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.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take as the back of the full version of the report.

At the time of our inspection the service was providing the regulated activity of personal care to 53people.

The provider did not have an effective recruitment and selection procedure in place and did not carry out relevant checks when they employed staff.

The service lacked governance systems to assess, monitor and improve the quality of the service. For example, effective systems to seek feedback of the experience of people who received the service were not in place and auditing systems were not robust.

The provider had guidance in place for customer quality and care reviews. However, we found the provider did not always follow their own guidance in relation to customer quality and care reviews.

We spoke with knowledgeable staff who could tell us the signs of abuse and what they would do if they 2 Allied Healthcare Macclesfield Inspection report 24 May 2016 suspected any form of abuse occurring. Risks to people were managed well to give people freedom, whilst keeping them safe.

There was a policy and procedure in place for the administration of medicines. We observed how people stored and managed medicines.In the main we found that the medication administering process was safe.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and was aware of the best interest process. People who used the service spoke highly of the staff that provided the service and said it was carried out to a very high standard.

Care was provided in a way that promoted people's dignity and respected their privacy. People received care and support that met their needs and took account of their preferences. Staff were knowledgeable about people's preferences, routines and personal circumstances.

Staff encouraged people who used the service to make decisions and choices in their lives to maximise their independence and enhance their life skills.

3 Allied Healthcare Macclesfield Inspection report 24 May 2016 The five questions we ask about services and what we found We always ask the following five questions of services.

–  –  –

The registered provider had not ensured that recruitment procedures were established and operated effectively.

Systems were in place for recording and managing risk, safeguarding concerns, whistle blowing and incidents and accidents.

Risk assessments were centred on the needs of the individuals and provided clear instructions for staff to follow.

–  –  –

Staff had received a thorough induction, on-going training, regular supervision and performance appraisal to ensure they were effective in their role.

Staff had an awareness and knowledge of the Mental Capacity Act 2005, which meant staff could make decisions in people's best interests if people did not have the capacity to make their own decisions.

–  –  –

People gave a very positive reflection of the care they received.

People were treated with respect. Staff understood how to provide care in a dignified manner and respected people's right to privacy and choice.

Staff involved people in the support they received and maximised people's independence and life skills.

–  –  –

4 Allied Healthcare Macclesfield Inspection report 24 May 2016 People received individualised and person centred care which had been discussed and planned with them.

People were able to raise any concerns and felt confident these would be addressed promptly through regular meetings with the registered manager or senior staff.

–  –  –

Auditing systems were not in place, it was evident that there were gaps in the home's care planning system and significant scope for improvement.

We found the provider did not always follow their own guidance in relation to customer quality and care reviews.

Some of the people who received the service were not informed of the changes to management made by the provider.

The provider did not seek feedback from the people using the service, relatives or staff.

5 Allied Healthcare Macclesfield Inspection report 24 May 2016 Allied Healthcare Macclesfield Detailed findings Background to this inspection We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the 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.

At the time of this inspection the manager confirmed 53 people were receiving the Allied Healthcare Macclesfield service. The inspection was undertaken by one adult social care inspector and an expert by experience. The expert by experience made the phone calls to people using the service. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. This expert had experience of using care services to provide care for relatives.

Before the inspection we reviewed the information we held about the service including notifications and information received from members of the public. We also invited the local authority to provide us with any information they held about Allied Healthcare Macclesfield. We used information from a Provider Information Return (PIR) which the service had returned in June 2015. This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. We used this information to help to plan our inspection.

We used a number of different methods to help us understand the experiences of people who used the service. We visited two people in their homes and we spoke with nineteen people on the telephone that used the service. We attempted to speak with the other thirty two people who used the service but some declined and others were not available when we made our calls.

During the inspection we spoke to the office staff in the branch office, including the branch manager, operations support manager, care delivery manager, administrator and four care support staff.

6 Allied Healthcare Macclesfield Inspection report 24 May 2016 In the office we looked at a range of records including: four care plans; four staff files; staff training; minutes of meetings; rotas; complaint and safeguarding records; medication; maintenance and audit documents.

7 Allied Healthcare Macclesfield Inspection report 24 May 2016 Requires Improvement Is the service safe?

Our findings People told us that they felt safe when staff provided support. "I definitely feel very safe with the staff keeping an eye on me"; "The staff makes me feel safe living on my own, because they are always visiting me."; "The staff are reliable, they let themselves in to my home using a key safe, I trust them."; "If they are running late, it's always because of a valid reason, they rarely let you down."

Through examination of records we found that recruitment and selection procedures did not meet the requirements of the current regulations.

We looked at a sample of four staff records for staff recently recruited. In three of the four files we found that there were shortfalls, such as: gaps in previous employment were not explored, and references obtained did not capture the employment details of the person providing the reference. For example we found in one file the two references obtained did not disclose the referees employment. We could not be confident the references obtained were the person's previous employees. In the second staff file, we found gaps in previous employment were not accounted for and again the references obtained did not disclose the referee's employment details.

This was a breach of regulation 19 (3) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). The registered provider had not ensured that recruitment procedures were established and operated effectively.

We noted the four staff records contained photographic and documentary submissions to confirm the applicant's identity. An enhanced Disclosure and Barring Service (DBS) check had been completed. A DBS check provides information to employers about an employee's criminal record and confirms if staff have been barred from working with vulnerable adults and children. This helps support safe recruitment decisions.

The staff rota, our own observations and what people and staff told us confirmed that there were sufficient suitably qualified members of staff on duty to provide the agreed level of support to the people who used the service. Staff said there was "enough staff to provide the care to people" and one commented, "Sometimes staff will phone in unavailable for work, but there is always someone on the team that will pick up overtime".

Staff told us their workload was manageable and they were able to support people safely. The provider covered absences with personnel from other schemes connected to the branch.

A corporate policy and procedure had been developed by the provider to offer guidance for staff on 'Safeguarding service users from abuse or harm'; and 'Whistleblowing'. A copy of the local authority's adult protection procedure was also available for staff to refer to.

Allied Healthcare used a computer based system called 'CIAMS' to record and monitor incidents. This stands for "complaints, incidents and accidents management system". We checked the safeguarding records on 8 Allied Healthcare Macclesfield Inspection report 24 May 2016 CIAMS at Allied Healthcare Macclesfield and CIAMS stored a clear audit trail of any safeguarding concerns that had been raised. The branch manager informed the inspection team that there had been one safeguarding incident in the last 12 months. Evidence for this safeguarding incident was provided and confirmed the provider dealt with this issue in a timely manner and notified CQC.

Staff had received up to date safeguarding training and had a good understanding of the procedure to follow if they witnessed abuse or had an allegation reported to them. Staff were able to describe the signs of abuse and what actions to take to ensure people remained safe.

Staff we spoke with demonstrated a good awareness of their duty of care to protect the people in their care and the action they should take in response to suspicion or evidence of abuse.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce the risks to people and appropriate guidance for staff to follow. Risks were scored to alert staff when people were at high risk of particular harm. Risk assessments took account of people's environment, history of falls, levels of pain, balance, cognition, skin integrity and equipment in place.

The CIAMS system was in place to record incidents, accidents and falls and to maintain an overview of incidents. We noted two incidents had been recorded in the last 12 months. The branch manager explained once an incident was logged on the CIAMS system they had a deadline to respond to the issue.

Staff we spoke with confirmed there were systems in place to report any accidents or incidents; they said that these were acted upon very quickly by the management team.

As part of our inspection we looked at how the service managed people's medicines. We found that the service had a medication policy and procedure in place entitled 'Medication Management Policy', dated August 2014. We saw that people's medicines were stored safely in their homes.

There were clear policies and procedures for the safe handling and administration of medicines.

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