Archived: Hales Group Limited - Peterborough

This inspection was carried out on the 3rd, 4th, 5th and 6th July 2017 and was an announced inspection. At the last inspection on 4th and 5th August 2016, the service was rated as ‘requires improvement.’ We found that the service had made improvements since the last inspection; and was now rated good.

People were looked after by enough, suitably qualified staff to support them with their individual needs. However, some people experienced late care calls or an inconsistent group of staff to support them.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The CQC is required by law to monitor the operation of the mental Capacity Act 2005 (MCA) and report on what we find. The registered manager had an understanding that people being supported by the service who lacked mental capacity to make day-to-day decisions should have an application to the Court of Protection made on their behalf. Staff were able to demonstrate a basic understanding of the MCA. Any decisions made on people’s behalf by staff were done in their best interest and as least restrictive as possible.

Staff demonstrated their knowledge of how to report incidents of poor care and harm. Staff helped people in a way that maintained their safety and people were looked after by staff in a caring manner. Staff supported and encouraged people to make their own choices and live as independently as possible. People were treated with respect and people’s dignity were promoted by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff enjoyed their work and understood their roles and responsibilities in meeting people’s needs They were trained to provide effective and safe care. Staff were supported to maintain their skills by way of supervision, spot checks, competency checks, and appraisals.

The provider had a process in place to make sure that staff were only employed to look after people once all pre-employment checks had been completed and were found to be satisfactory. However, this process was not always followed.

People’s care arrangements took account of people’s wishes and aspirations, including any likes and dislikes and how they wanted to be supported. People’s care plans recorded their individual assessed needs and any assistance they required from staff. Risks to people were identified, and plans were put into place by staff to monitor and minimise these risks, as far as possible, without limiting people’s independence.

People were supported to take their medicines as prescribed and medicines were safely managed by staff who were trained, and whose competency had been assessed. Where there had been any errors in the administration of people’s medicines, these had been identified and dealt with to reduce the risk of recurrence.

People were supported to eat and drink sufficient amounts of food and fluids. People’s choice about what they wished to eat and drink was promoted and supported. Staff monitored people’s health and well-being needs. They acted upon issues identified by referring people to access a range of external health care services.

There was a process in place to manage any concerns and complaints received. The registered manager had identified areas for improvement with this process and had implemented improvements so that people and their relatives felt listened to and their concerns resolved to their satisfaction.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. People and staff were encouraged to share their views and feedback about the quality of the care and support provided. Actions were taken as a result to drive forward any improvements required.

We carried out an announced comprehensive inspection on 9, 10, 14 and 15 September 2015. Breaches of four legal requirements were found. This was because the provider did not take reasonable steps to make sure that people received person-centred care that reflected their personal preferences. The provider did not make sure that they respected people’s preferences about who delivered their care, such a request for a staff member of a specific gender. Complaints were not always resolved to people’s satisfaction. There was no robust quality monitoring system in place that took account of people’s feedback and audits findings to make the improvements necessary to improve the quality of the service. After the comprehensive inspection, the provider wrote and told us to say what they would do to meet the legal requirements in relation to the breaches.

We undertook this announced inspection on 4 and 5 August 2016 and found that the provider had followed their plan and made the necessary improvements.

During this inspection we saw that the provider had displayed their previous inspection rating on the communal notice board within the office. The provider had to take some remedial action as there was an error fault with their website. However, during this inspection we found that the provider had resolved this problem and that their website now displayed the rating from the previous inspection.

There was no registered manager in place during this inspection. A manager had been recruited and was working as the branch manager. They were in the process of applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The manager had an understanding that people being supported by the service who lacked the mental capacity to make day-to-day decisions should have an application to the Court of Protection made on their behalf. Staff were able to demonstrate a sufficiently robust understanding of the MCA. This meant that any decisions made on people's behalf by staff would be in their best interest and as least restrictive as possible.

People had care records in place which documented their support and care needs and any assessed risks. Plans were put in place to minimise people’s identified risks and to assist them safely whilst promoting their independence. People’s care records included detailed information on how they wished to be supported, and what was important to them. These records and reviews of these, documented that people and/or their appropriate relatives had been involved in and agreed this process.

Arrangements were in place to ensure that people’s medicines were administered safely. Records regarding the administration of people’s prescribed medicines were kept.

People’s nutritional and hydration needs were met. People were assisted where required, to contact and access a range of external healthcare professionals to maintain their health and well-being.

People who used the service and their relatives said that staff respected their choices about how they/their family member would like to be supported. People were supported by staff in a kind and respectful way. Staff promoted people’s privacy and dignity.

There was a sufficient number of staff to provide people with safe support and care. Some people had experienced care calls that were later than the agreed time. People who used the service and their relatives told us that this was not their preference and had made them anxious.

Staff understood their responsibility to report any suspicions of harm or poor care practice. There were pre-employment essential checks in place to ensure that all new staff were deemed safe and suitable to work with the people they supported.

Staff were trained to provide care and support which met people’s individual needs. The standard of staff members’ work performance was reviewed during supervisions, competency checks and appraisals to make sure that staff were competent and confident to provide the agreed care and support.

People’s complaints were listened to and resolved where possible. The manager sought feedback about the quality of the service provided from people who used the service and their relatives. Staff meetings took place and staff were encouraged to raise any concerns or suggestions that they may have had. Quality monitoring processes to identify areas of improvement required within the service were in place. Improvements identified around the improvement of staff punctuality when attending people’s care calls were currently on-going.