Alliance Care Ltd was rated Inadequate overall following inspections in August–September 2023, with breaches of Regulations 12, 13, 17 and 18 identified across unsafe medicines management, failure to safeguard people from abuse, ineffective governance, and insufficient staff training and competency oversight. The service was placed in special measures, with enforcement conditions imposed requiring monthly improvement reports to CQC.
Concerns (14)
criticalMedication management: “People's medicine administration records (MAR) showed multiple discrepancies, including doses of medicines being administered at short intervals or double doses recorded.”
criticalSafeguarding: “Alliance Care Ltd staff were investigating safeguarding concerns without the oversight and review of the registered manager. As a result, people were exposed to the potential of ongoing harm.”
criticalSafeguarding: “1 serious allegation of abuse was not fully investigated for several months. This exposed service users to the risk of ongoing harm.”
criticalCare planning: “People who received nutrition and hydration via PEG, did not have care plans in place to guide staff about their needs.”
criticalStaff training: “Only approximately a third of the staff team had received training in the 12 months prior to the inspection, in subjects such as medication administration, moving and handling or infection control.”
criticalStaff competency: “There was no system in place to review how staff managed key risks such as medication administration or moving and handling.”
criticalIncident learning: “The provider failed to review accidents, incidents and safeguarding matters for the purpose of maintaining oversight and identifying any learning for the organisation.”
criticalGovernance: “Quality assurance systems had failed to identify the areas of concern we highlighted during our inspection. Audits had not been effective in finding the issues we established.”
moderateMissed or late visits: “Another person told us, 'I pay for 30 minutes and they stay for 10. Sometimes they don't turn up at all and I still have to pay for the call.'”
moderatePerson-centred care: “Care plans did not always detail people's needs, wishes and goals. 1 person had a desire to work towards greater independence. However, there was no guidance on how care staff could support this.”
moderateRecord keeping: “1 person's care plan stated they had epilepsy, when this wasn't the case. Care plans contained minimal information about people's communication needs.”
moderateConsent / capacity: “Care plans did not consider people's capacity to consent to care. We did not find evidence of capacity being assessed for specific decisions.”
moderateSupervision / appraisal: “The provider had failed to review staff skills and competence. While spot checks were undertaken to observe some aspects of staff practice, there was no system in place to review key risks.”
minorInfection control: “Many staff had not received recent infection control training. However, spot checks showed staff had a sound understanding of good infection control measures.”
Strengths
· People with regular staff spoke highly of their diligence and the caring approach of those workers.
· Staff had a good understanding of people's likes and dislikes and how to support people to eat and drink where regular care relationships existed.
· Pre-employment checks including DBS checks had been carried out and staff had been recruited safely.
· One relative told us how the provider sent care staff who spoke the first language of their family member, supporting a person with dementia.
· Staff generally felt supported by management and felt the management team were approachable.
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and management; Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experience; Assessing people's needs and choicesRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversity; Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersRequires improvement