Alpha health and care services is a domiciliary care agency; at the time of our assessment, they were supporting 1 person with a regulated activity. The assessment took place on the 10 September 2024 till 16 September 2024. The assessment was completed to follow up on the last inspection to see if improvements had been made. We found the service had made improvements and are no longer in breach of regulations. Staff now assessed and mitigated risks and care plans now guided safe practice. The registered manager now had systems in place to monitor the service and provide good oversight to monitor and improve outcomes for people.
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Alpha Health & Care Services Limited was rated Requires Improvement overall following a focused inspection of Safe and Well-led, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) identified, including inadequate care planning, unsafe medicines management, and insufficient governance oversight. This is the third consecutive inspection at which the service has been rated Requires Improvement, with requirement notices served for both breaches.
Concerns (12)
criticalCare planning: “Health needs people may need support with, such as diabetes had no supporting documentation, care plans or risk assessments for staff to follow.”
criticalMedication management: “Where people were being supported by staff to receive their medicines there was not always a medicine administration chart (MAR) and accompanying risk assessment in place.”
criticalRecord keeping: “Care documentation did not contain all the details staff needed to support people safely. This placed people at risk of receiving unsafe care and support.”
criticalGovernance: “There had not been robust governance systems in place at the service over the previous 12 months.”
moderateMedication management: “Audits of medication records lacked detail of any actions taken for example to explain gaps in recording, excessive use of PRN or if time specific medicines were administered.”
moderateMissed or late visits: “Sometimes staff are late which means my medicines can be late, there may only be an hour gap between the morning and lunch call because the morning call is so late.”
moderateMissed or late visits: “The time between calls can be over 14 hours especially if there has been an early evening call then a late morning call, the next day.”
moderateSupervision / appraisal: “We found limited evidence of staff supervision, or spot checks being completed consistently, and staff did not have an induction to the service recorded.”
moderateStaff training: “One member of staff told us they had not received practical moving and handling training until a few months after they commenced work.”
moderateStaff competency: “Staff training had not always been consistently completed or their competency checked.”
moderatePerson-centred care: “Care had not been planned in a person-centred way, with people being given 2-hour call windows of when they may receive care.”
minorCommunication with families: “People told us they did not know which carer would be coming to provide care as they were not given any rota or timings for care calls.”
Strengths
· Safeguarding concerns had been raised appropriately with the local authority and the registered manager worked with them to investigate concerns.
· Staff had received training in infection prevention and control and PPE was available for use during care visits.
· The registered manager had improved notifications of safeguarding incidents since the last inspection, now raising these in line with regulations.
· The registered manager held staff meetings to discuss issues and used phone applications to allow staff to send alerts if needed.
· Management demonstrated a good understanding of their duty of candour responsibilities.
Alpha Health & Care Services remained Requires Improvement in Safe and Well-led, with continued breaches of Regulation 18 (failure to notify CQC of safeguarding incidents) and a new breach of Regulation 17 (good governance) due to ineffective quality assurance. Inspectors found inadequate risk assessments, unsafe medicines management with no ongoing staff competency checks, and late care call visits, though recruitment, infection control and staff culture were positive.
Concerns (7)
criticalGovernance: “There was a lack of robust quality assurance meaning people were at potential risk of receiving poor quality care.”
criticalIncident learning: “two safeguards had been raised against the service. The provider had failed to submit the relevant notifications to CQC.”
moderateCare planning: “Care records lacked detailed information and/or guidance for staff to follow to mitigate individual risks to people.”
moderateMedication management: “one person's care records contained conflicting information as to whether the person was being prompted or assisted to take their medicine.”
moderateStaff competency: “Staff had received training in the administration of medicines, but no on-going competency checks had been completed.”
moderateMissed or late visits: “twice we had calls so late they were positively a nuisance.”
moderateRecord keeping: “Another person had a catheter, but no care plan or risk assessment was in place to identify the risks associated with their catheter care.”
Strengths
· Safe staff recruitment processes were in place, including DBS checks via a new pre-employment checklist.
· Staff received safeguarding training and people consistently said they felt safe with staff in their homes.
· Staff had infection control training and access to sufficient supplies of PPE.
· New electronic care planning system enabled quicker updates and family access to care notes.
· Staff felt valued, supported and able to contact management 24/7.
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering