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Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Allied Healthcare (Newtown)
5 Turners Lane
Broad Street
Newtown
SY16 2AU
Type of Inspection – Baseline
Date(s) of inspection – Wednesday, 18 February 2015
Date of publication – Thursday, 9 April 2015
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Page 1
Summary
About the service
Allied Healthcare Domiciliary Care Agency is registered to provide care at home to older
people, people with mental infirmity, those with mental health problems, sensory loss or
impairment, physical disability and learning disability. The agency also provides care to a
number of people on a 24 hour basis. The provider is Nestor Primecare Services Ltd.
Allied Healthcare Agency operates from an office in Newtown. The Responsible Individual
is Jodi Turner and the Registered Manager is Helen Scotford.
What type of inspection was carried out?
We, The Care and Social Services Inspectorate Wales (CSSIW), carried out this
inspection as part of the annual inspection programme. We undertook a baseline
inspection which means we looked at aspects of the management and operation of the
home across all four themes.
In order to collect information for this inspection we examined information we held about
the agency, carried out a semi announced visit to the office, spoke to managers and staff
and interviewed 5 people using the service by phone. During our visit to the office we
looked at a number of clients care files, a number of staff files, looked at evidence of
training and supervision of staff, looked at pertinent procedures and spoke to the
Registered Manager (and other visiting senior managers from the agency who were
present) about various aspects of the running of the agency.
What does the service do well?
The provider runs an efficient system of monitoring the training needs of staff which
ensures that no staff member can work if their training is overdue. The system flags up
when training should be arranged and will not allow a staff member to be put on the call
rota if this has not been accomplished.
What has improved since the last inspection?
At the last annual inspection we were concerned that care plans had not always been
comprehensively completed. We looked at this aspect again and are satisfied that the care
records we viewed are complete and regularly reviewed in line with Regulation 14(4)(a)
and 14(2)(b).
What needs to be done to improve the service?
We did not issue any non-compliance notices at this inspection. This is because we were
able to discuss our concern in detail with the Registered Manager and other senior
managers present and understand that it will be addressed to the benefit of people using
the service.
We note that we have received no communication in line with Regulation 26 from
the agency since the last inspection. This means that the agency has not reported
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any incidents or accidents that have happened in the intervening period of 18
months. When we discussed incidents and looked at records it became evident that
there was a misunderstanding about what required to be reported. The Registered
Manager and senior managers present agreed that they would re examine their
processes and report events which affect the well being of people receiving the
service to the CSSIW in the future.
The Registered Manager is advised to ensure all staff who complete care records
properly sign and date each record as they update it.
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Quality Of Life
At the time of the inspection the agency was providing a service to 16 clients. The clients
were either being provided with care on a private basis or were receiving direct payments
which means they had been able to choose who provided them with the service.
We looked at the care records of five clients and found these to be generally
comprehensively completed. We were able to quickly establish people’s assessed
needs, care requirements and plan of care. We saw evidence of frequent reviews and
the agency response to a change in condition. We noted with the Registered Manager
that not all records are signed and dated and she agreed that she would ensure staff do
this at all times.
People who are provided with the service, and who we contacted and spoke to, told us
that Allied Healthcare are reliable, provide a team of carers who are known to each client
and perform the tasks agreed at the initial needs assessment. People told us that they
are happy that they see the same team of carers and usually know who is coming to visit
as they receive a weekly roster. This provides consistency and relatives of people
receiving the care were confident in the service.
People told us that they understand their care plan and are involved in any changes
made to it. They told us that they know how to contact the agency if they have any
concerns and that they always get a positive and quick response from the people they
speak to in the office. People informed us that they had not had a missed call and that if
a carer is detained and may be late they are generally informed of this at the time.
We asked about documentation kept in the home and established that people have a
Service User Guide and all care documentation including daily care records. We saw
archived records of these in the office. Carers are good at recording their daily activity
and report comprehensively on the service provided and any changes to the condition of
the person they are caring for. Contact with the office is good as evidenced in daily
records which showed when and why they might contact the managers on behalf of a
service user
People can be confident that they will be treated with dignity and respect. This is
because of the five people we spoke to as part of this inspection all reported that they felt
that care was provided by a friendly and patient staff group who demonstrate good basic
care skills and that they had come to like their carers and look forward to their visits. It is
testimony that during the changes made to the way domiciliary care is commissioned in
Powys, the clients now looked after by Allied Healthcare chose to stay with the agency
because they were privately funded or opted for direct payments in order to continue to
receive care from this agency.
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Quality Of Staffing
We looked at the records of five members of staff during our office visit. We found that
there is evidence of good recruitment practices including records of previous employment
and references, records of interview discussions and storage of documents related to
personal checks and assurances.
We saw that all staff complete initial induction following the Care Council for Wales
Induction framework and a four day training programme including subjects such as
effective communication, person centred support, supporting people to eat and drink well
and security and lone working. The agency also provides training in specialist areas
pertinent to the people they provide care for. This includes Multiple sclerosis, palliative
care, diabetes and Parkinson’s Disease. A computer database shows records of when
training has been completed and, in relation to mandatory training flags up when training
is required so that this can be arranged. It is noted that the system also precludes staff,
whose training has expired, from being included in the rota. In reality this very
infrequently happens as the system alerts staff well before expiry. Staff training including
moving and handling, basic food hygiene and infection control as well as other
mandatory subjects. We also saw evidence of an on-going vocational training
programme and the majority of staff have been trained at least to Level II.
People can be assured that they will be provided with care by a well supported team of
carers. This is because we saw that one to one supervision sessions are arranged for all
carers usually within 3 months and an on-going arrangement for supervision and practice
observation is in place.
There are quarterly staff meetings which are minuted and other meetings are arranged
where necessary to discuss the needs of individuals using the service.
People we spoke to were happy with the staff attending to their needs and spoke highly
of individual staff. They told us that staff always behave professionally, wear uniforms
(except where they live in at a person’s home) and carry identification.
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Quality Of Leadership and Management
Recently Allied Healthcare has responded to changes in the way that domiciliary care
provision is commissioned in Powys. This has meant a drop in the number of people for
whom it provides care in the short term as the agency took the decision not to tender for
a social services contract or subcontract to other agencies in the county. This means that
care is provided to privately funded individuals or to people who have elected to receive
direct payments so that they can choose who provides their care.
The Registered Manager and senior managers present at the office on the day of our
visit explained that they have negotiated to take clients previously provided on a private
or direct payment basis with care by another care agency. This will roughly double their
number of clients and carers. Arrangements have been made with the clients who are
transferring to make the choice of whether they wish to transfer or to consider an
alternative provider. The Registered Manager informed us that arrangements are also in
place for all documentation to be transferred to Allied Healthcare and that staff will
transfer with them which will assist in provision of a seamless transition between the two
providers. They aim that clients will retain the same carers who know them although it is
acknowledged that there are likely to be some changes.
People can be confident that they are cared for by an agency which has sound
management processes in place. The Registered Manager is an experienced senior
carer who has several years experience of managing the agency. She is currently
supported by field care supervisors who carry out care assessments and reviews and
spot checks on staff and care coordinators who also carry out checks on carers but are
more involved with rosters and ensuring people get calls from staff at the correct times.
Recently the Responsible Individual has changed but continues to be a senior manager
of the organisation. The Registered Manager receives supervision and support from
another individual who visits the agency at least monthly.
We looked at incidents, accidents and complaints. We note that there were records of
three complaints which had been dealt with internally. The process for recording and
dealing with these was clear and people can be assured that they will receive a prompt
response and detailed outcome of any concern they raise. However we note that
incidents, whilst apparently being properly recorded and appropriately responded to are
not being reported to the CSSIW in line with Regulation 26. We discussed this with the
Registered Manager and the Operations manager for Quality and Systems who was
present at the time. We understand that this has happened because of a perceived
difference in the threshold for reporting and have advised that the Registered Manager
reports any incident to us if she is in any doubt.
The CSSIW has received no complaints or concerns about Allied Healthcare since the
last inspection.
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Audits and checks of quality are assisted by the client Early Warning System (EWS).
This is designed for carers to report concerns and the system clearly states that carers
should phone through any issue before they leave a clients home as well as record it in
the daily notes. This assists the agency to monitor a person whose condition may be
changing and to immediately act on any incident.
The service carries out audits of missed and late calls. These are currently very small in
number and carers are very aware that they must contact the office or the individual
directly if it becomes clear that they will be late. People we spoke to told us that they had
not had a missed call and that, if a carer is likely to be late, they are usually contacted.
We were provided with the stakeholder’s survey completed in 2014. This stated that it
was carried out over a 2 year period from May 2012 and is on-going. The results show
general satisfaction with the service by both clients and staff. We noted that managers
had responded to a number of issues for clients around communication if a call was
going to be late or if a care worker was going to be different from that on the rota.
Information provided to us by the five clients we spoke to suggested that they are
satisfied that they are effectively communicated with following these issues being
addressed.
The organisation also has a document telling staff what will be done to address any
concerns they have raised. The issues were listed in the “You said, We did” document
and included improvement in information and communication, continuation of a monthly
recognition scheme and providing information on promotion opportunities.
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Quality Of The Environment
The agency is situated in a small office in the centre of the town of Newtown. The office
itself is on the first floor which is not accessible to people who have limited mobility.
However there is a meeting room downstairs also used for training where staff can meet
a client in private. The premises are secure and records for staff, service users and those
relating to the running of the business are kept in lockable storage cabinets in the
Registered Manager’s office.
There is no dedicated parking at the agency although there is some parking spaces for
short term use a few metres away.
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How we inspect and report on services
We conduct two types of inspection; baseline and focussed. Both consider the experience
of people using services.
Baseline inspections assess whether the registration of a service is justified and
whether the conditions of registration are appropriate. For most services, we carry out
these inspections every three years. Exceptions are registered child minders, out of
school care, sessional care, crèches and open access provision, which are every four
years.
At these inspections we check whether the service has a clear, effective Statement of
Purpose and whether the service delivers on the commitments set out in its Statement
of Purpose. In assessing whether registration is justified inspectors check that the
service can demonstrate a history of compliance with regulations.
Focused inspections consider the experience of people using services and we will
look at compliance with regulations when poor outcomes for people using services are
identified. We carry out these inspections in between baseline inspections. Focussed
inspections will always consider the quality of life of people using services and may look
at other areas.
Baseline and focused inspections may be scheduled or carried out in response to concerns.
Inspectors use a variety of methods to gather information during inspections. These may
include;
Talking with people who use services and their representatives
Talking to staff and the manager
Looking at documentation
Observation of staff interactions with people and of the environment
Comments made within questionnaires returned from people who use services, staff
and health and social care professionals
We inspect and report our findings under ‘Quality Themes’. Those relevant to each type of
service are referred to within our inspection reports.
Further information about what we do can be found in our leaflet ‘Improving Care and
Social Services in Wales’. You can download this from our website, Improving Care and
Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW
regional office.
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