Alters Nursing - London was rated Good across all five key questions at its January/February 2017 inspection, demonstrating sustained improvements from the previous inspection where breaches around risk assessments and medicines had been identified. The service provided personalised, safe care to 81 people with robust governance, staff support systems, and responsive complaint handling.
Strengths
· Risk assessments were comprehensive, reviewed regularly, and identified specific mitigation actions for individual risks such as falls and pressure sores.
· Medicine administration records were properly maintained with MAR sheets, dose details, staff signatures, and documented reasons for non-administration.
· Safe recruitment procedures included DBS checks, two references, proof of identity, right-to-work checks, and health questionnaires.
· Staff received regular supervision, annual appraisals, spot checks, and access to a wide range of training including the Care Certificate.
· Care plans were personalised, documenting individual preferences, routines, dietary needs, and communication requirements.
Alters Recruitment Limited t/a Alters Nursing – London received a Good rating across all five key questions at its October 2019 inspection, maintaining the same rating as its previous inspection in 2017. The service demonstrated consistent strengths in safeguarding, personalised care planning, staff support, medicines management, and leadership, with one minor observation that diabetes guidelines could be more detailed to help staff distinguish between high and low blood sugar symptoms.
Strengths
· People and relatives consistently reported feeling safe and well cared for, with staff demonstrating strong knowledge of safeguarding procedures and whistleblowing responsibilities.
· Medicines were managed safely with weekly audits of medicine records returned to the office and assessments carried out when people began using the service.
· Staff received regular supervision, annual appraisals, induction training including the Care Certificate, and role-relevant training such as dementia and moving and handling.
· Care plans were detailed and personalised, recording people's likes, dislikes, cultural and religious needs, communication needs, and levels of independence.
· The provider had robust quality assurance systems including telephone monitoring, spot checks, home care monitoring visits, and regular staff meetings.
Alters Nursing - London was rated Requires Improvement overall following an announced inspection in November 2015, with one regulatory breach identified relating to unsafe risk assessments under Regulation 12. Caring was the sole Good domain, reflecting consistent staffing, strong cultural competency and positive staff-client relationships, while governance, record keeping, medicines management and leadership required improvement.
Concerns (9)
criticalCare planning: “Risk assessments were not robust and did not identify or address all risks faced by people receiving a regulated activity. Regulation 12 (2)(a)(b)”
moderateMedication management: “Records were not clear and care plans listed the names and dosages of medicines but not the form or the time at which they should be taken.”
moderateStaffing levels: “One family member told us they had to provide support to their relative at weekends as the service had been unable to provide cover for the regular member of staff.”
moderateGovernance: “The timescales the service had set itself were very long. For example, the December 2014 report identified that care plans should be updated to promote independence by January 2016.”
moderateRecord keeping: “The standard of the recording of care delivered varied. Some log books were well completed... Other records were very basic, recording minimum details of care delivered.”
moderateCommunication with families: “Changes were made to their relative's care without them being informed. They said, 'They always make changes but we are not always informed.'”
minorComplaints handling: “Concerns were responded to, however, this was not always within the timescales dictated by the policy.”
minorLeadership: “Another member of staff did not know her name. People talked about the staff at the office, rather than the registered manager specifically.”
minorPerson-centred care: “One person located their care plan while speaking to us and expressed surprise at its contents, telling us, 'Well, they've never done that [specific care task] before!'”
Strengths
· Staff received a thorough induction, on-going training, supervision and appraisal and felt supported in their roles.
· Staff recruitment was safe with appropriate pre-employment checks including DBS checks.
· The service provided consistent staff enabling positive ongoing relationships to develop with people.
· Staff demonstrated a good understanding of people's cultural and religious needs and the service matched staff with shared cultural backgrounds.
· People felt safe and safeguarding policies and procedures were understood by staff.
Quality-Statement breakdown (22)
safe: SafeguardingGood
safe: Risk assessment and care planningRequires improvement
safe: Staffing levels and cover arrangementsRequires improvement
safe: Medicines managementRequires improvement
safe: Recruitment practicesRequires improvement
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Consent and Mental Capacity ActRequires improvement
effective: Nutrition and hydration recording
Requires improvement
effective: Access to healthcare professionalsGood
caring: Relationships and consistency of staffGood
caring: Cultural competency and language supportGood
caring: Dignity and privacyGood
caring: Involvement in care planningRequires improvement
responsive: Personalised care planningRequires improvement
responsive: Record keeping qualityRequires improvement