Archived: Help at Home (Leicester)

Updated 10 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection visits took place on 21 December 2016 and 3 January 2017 and were announced. We gave 48 hours’ notice of the first inspection visit to make sure a manager was available at the provider’s office. On the second visit we planned to talk with people in the provider’s Extra Care schemes and wanted to make sure this was acceptable. We therefore telephoned the Extra Care manager before the second visit. The inspection team included three inspectors and an expert by experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.

Before our inspection visits we reviewed the information that we held about the service to plan and inform our inspection. This included information that we had received and statutory notifications. A statutory notification contains information relating to significant events that the provider must send to us. We also contacted Healthwatch (the consumer champion for health and social care) and the local authority who has funding responsibility for some people who were using the service to ask them for their feedback.

We spoke with 20 people who used the service and with the relatives of two other people. We spoke with three senior managers, the manager of the Extra Care schemes, the deputy manager, a care co-ordinator, the training officer, four senior carers and ten care staff We visited the two Extra Care schemes to ask people about their experiences of care.

We looked at the care records of 14 people who used the service. We also looked at records in relation to people’s medicines, health and safety as well as documentation about the management of the service. These included policies and procedures, training records and quality checks that the provider had undertaken. We looked at five staff files to look at how the provider supported their employees and how they had recruited them.

The month prior to our inspection Help at Home (Leicester) had secured a large contract to provide care packages to people who had previously received their care from other providers. This meant that they were providing over double the care calls in the second week of November than they had the previous week. As part of this process Help at Home (Leicester) had transferred a number of staff from other providers to be employed by them.

We asked a senior manager to submit documentation to us after our visit. This was in relation to accidents and incidents management as well as documentation about the quality checks the provider had undertaken. They submitted these to us in the timescale agreed.

Updated 10 February 2017

We carried out announced inspection visits to the service on 21 December 2016 and 3 January 2017. We gave 48 hours’ notice of the first inspection visit because we needed to be sure somebody would be available at the provider’s office. We also planned to visit people in the provider’s Extra Care schemes and wanted to make sure this was acceptable.

Help at Home (Leicester) provides personal care and support to people living in their own homes. It also provides this support to people living in two Extra Care schemes. Extra Care schemes enable people to live in private flats or apartments within a shared building with support available on site should they require it. At the time of our inspection 56 people were using the Extra Care services and 531 people were receiving support in their own homes.

There was not a registered manager in place at the time of our inspection. The service had been without a registered manager for ten months. It is a requirement that the service has a registered manager. 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 provider told us they were trying to recruit a manager for the part of the service that supported people in their own homes. They also told us that the manager within the Extra Care schemes would be applying to register as the registered manager of those schemes in January 2017.

People were not always supported in line with the Mental Capacity Act 2005 (MCA). The provider had not assessed people’s mental capacity to make specific decisions where this was necessary. Decisions had not taken place in line with the MCA. This meant that people may have received care that was not in their best interest. A senior manager told us that they would review people’s care records and complete mental capacity assessments where these were required. An application to deprive a person of their liberty had not been made although the provider was seeking the support of the person’s social worker to review their care needs.

Staff did not always understand their responsibilities under the MCA. The provider told us that staff would receive additional guidance.

People did not always receive their care and support at the times that were agreed with them and sometimes they experienced missed calls. The provider was taking action to make improvements including their plan to use their electronic systems more effectively to understand why calls to people were sometimes late or missed.

The provider’s quality checks were not always suitable to ensure people received good care. We found concerns during our visit that had mostly been identified by the provider but action had not commenced when we visited in order to make improvements.

Risk to people’s health and well-being were not always assessed. For example, there was no assessment where one person might have shown behaviour that challenged. Guidance was not in place for staff to follow should this have occurred. The provider told us they would review people’s risk assessments.

The provider had a system to respond to accidents and incidents. However, the investigation and analysis of these by a manager did not always take place. This meant that there was a risk that measures to help people to remain safe were not always considered.

People told us that they received their medicines where staff provided this support. However, the recording of the administration of people’s medicines was not always accurate. The provider told us they would offer additional guidance to staff.

There was not always enough staff recruited to provide safe care and support to all of the people receiving care. The provider was taking action and followed their contingency plan. This included recruiting more staff and the provider stopping any new referrals to the service people received in their own homes until their staffing numbers improved.

People’s care plans did not always focus on them as individuals. There were some gaps in people’s care records which meant staff might not have had all of the information they required to be responsive to people’s specific requirements.

People had mixed views about how the service was run. Some people and staff felt that improvements could be made, particularly with communication within the provider’s office. The provider had made available opportunities for people, their relatives and staff to give suggestions about how the service could improve.

Staff members understood their responsibilities to protect people from harm and to remain safe. This included reporting to staff at the provider’s office where there were concerns about people’s well-being. At the time of our inspection the local authority were investigating five allegations of abuse against the provider.

The provider had a safe recruitment process in place for prospective staff which included relevant checks. People felt safe with the care and support given by the staff members who were employed.

People received care and support from staff who received training and guidance on their work. Staff undertook training in topic areas such as assisting people to move and in food safety. New staff received an induction when they started working for the provider so that they were aware of their responsibilities. Staff members also met with a manager so that they could gain feedback on their work. Staff felt supported and were aware of their responsibilities.

People received support to maintain their health and were confident that staff would support them to contact a doctor should they need to.

People were satisfied with the food and drink available to them. Their likes and dislikes were known by staff. Where there were concerns about people’s eating and drinking, staff took action to make sure they had enough.

People received support from staff who were kind and compassionate. Staff protected people's privacy by, for instance, carefully storing their private and sensitive records. Staff knew the people they supported including things that were important to them.

People were involved in and contributed to decisions about their care and information on extra support to help them with this had been made available to them. People’s care requirements were reviewed to make sure staff had the most up to date information on people’s support requirements and preferences. People were supported to be as independent as they wanted to be in order to retain their skills and abilities.

People and their relatives knew how to make a complaint should they have need to. The provider took action when they received a complaint and this included apologising for a poor service where this was experienced by people.

We found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.