Alina Homecare Specialist Care - Hertfordshire was rated Requires Improvement overall following a May 2023 inspection of this supported-living domiciliary service for 12 people with learning disabilities, with a breach of Regulation 17 identified for ineffective governance and monitoring of quality and safety. Key concerns included absent or unclear DoLS authorisations, lack of annual staff competency reviews, insufficient oversight of care plans and risk assessments, and inadequate incident-learning processes, though the service was rated Good for safety.
Concerns (10)
criticalGovernance: “The provider's systems and processes to monitor the quality and safety of the service were not always effective. This was a breach of Regulation 17.”
critical
Consent / capacity
: “For people assessed as lacking mental capacity for certain decisions, DoLS were not in place. We were told there were 3 in progress but the status of these was unclear.”
moderateCare planning: “The registered manager did not have full oversight of people's care plans and risk assessments. Reviews were completed by the team leaders, but we saw little evidence these had been audited.”
moderateStaff competency: “Competencies were completed during induction but not completed again unless there was an issue, this is not in line with NICE guidance which state staff should have an annual review.”
moderateStaffing levels: “People's relatives did not feel there were always enough staff. They described people not going out or being supported by different staff which could be unsettling.”
moderateIncident learning: “We reviewed some incident reports and found they did not reflect on what led to the incident and what could be done to prevent it in future.”
moderateRecord keeping: “The registered manager tended to monitor the service informally; there was limited documentation of this. The frequency of spot checks and what was to be checked at each visit was unclear.”
minorPerson-centred care: “People's care plans included language which was childish, such as describing them as 'playing' or 'being cheeky'. A person's care plan stated a person 'Played with their toys.'”
minorCommunication with families: “People's families did not always feel involved in planning their care. A relative told us, 'We had very little input with the support plan.'”
minorMedication management: “People's PRN protocols were not always clear. We reviewed one which stated a person would 'communicate they had pain' but did not say how.”
Strengths
· Staff had training on how to recognise and report abuse and knew how to apply it; families confirmed people felt safe.
· Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
· People were supported in a safe, clean, well-equipped, well-furnished and well-maintained environment meeting sensory and physical needs.
· Staff learned from incidents, including arranging Makaton training following a communication-related incident.
· Effective infection prevention and control measures were in place and PPE was used appropriately.
Quality-Statement breakdown (16)
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Adapting service, design, decoration to meet people's needsGood
effective: Supporting people to live healthier lives and access healthcare servicesGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staff; continuous learning and improving careRequires improvement