Alliance SC Ltd received an overall rating of Requires Improvement at its first inspection, with breaches of Regulation 17 (Good Governance) due to inadequate audit processes, inconsistent care plan updates, absent medicines protocols, and an unrecorded fall. The service demonstrated genuine strengths in compassionate, person-centred care delivery, safe recruitment, and effective partnership working with health professionals.
Concerns (7)
criticalGovernance: “There was little evidence of regular audits being undertaken...a lack of regular audits of daily notes, MARs and monitoring charts meant the provider was not checking that the care was delivered as planned”
moderateCare planning: “one person recently had a social care review which noted their risk of choking had increased. Their care and risk support plan had not been updated to say what that meant for the care being delivered”
moderateMedication management: “There were no protocols in place to advise staff when people should be supported to receive those medicines. This meant people were at risk of being given medicine when they should not have been”
moderateIncident learning: “one person recently had a guided fall in their home when carers were present, but this had not been recorded on an incident form”
moderateConsent / capacity: “there was no specific MCA tool being used in the care file to assess decisions and provide guidance to staff”
moderateSupervision / appraisal: “Staff competency checks, spot checks, supervision and appraisals were taking place but there were limited systems in place to ensure these were regular and any identified actions were followed up”
minorRecord keeping: “record keeping needed to be strengthened to ensure that updates from other professionals, and what that meant for people's care, was reflected in the individual care files”
Strengths
· People felt safe and expressed high satisfaction with compassionate, reliable staff who attended on time and stayed for the allotted duration
· Safe recruitment practices were followed with checks to ensure staff suitability for their roles
· Care plans comprehensively covered diversity needs including cultural, religious and equality characteristics
· Good infection control practices in place with PPE available and staff trained
· Staff worked in partnership with health professionals including GPs, district nurses and physiotherapists
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving careGood