Archived: Hales Group Limited - Lowestoft

Updated 7 December 2018

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.

This inspection took place on 5 and 6 September 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be available. The inspection team consisted of two inspectors, and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

As part of our inspection planning we reviewed all the information we held about the service. This included previous inspection reports and any notifications sent to us by the service including safeguarding incidents or serious injuries. This helped us determine if there were any particular areas to look at during the inspection. We spoke with the local authority team prior to, during, and following the inspection.

To help us assess how people's care needs were being met we reviewed eight people's care records and other information, including risk assessments and medicines records. We reviewed three staff recruitment files, and a selection of records which monitored the safety and quality of the service.

During the inspection we spoke with 11 people who used the service, (four of whom we visited in their home) six relatives, the registered manager and regional operations manager. We also spoke with five members of care staff.

Updated 7 December 2018

This inspection took place on 5 and 6 September 2018, and was announced.

At our last inspection in 13 and 20 December 2017 and 4, 11, and 15 January 2018, we found breaches of legal requirements in relation to safe care and treatment, staffing and governance of the service. We met with the provider to confirm what they would do and by when to improve the key questions to at least good. They sent us an action plan detailing how systems and processes would be improved to enhance the delivery of care.

At this inspection in September 2018, we found that although new systems and processes had been implemented, sufficient improvement had not been made, and people continued to receive care which was not responsive and did not always meet their assessed needs. We found three repeated breaches of regulations in relation to safe care and treatment, staffing, and governance. We also found two new breaches in relation to safeguarding and notification of events.

Hales Group Limited - Lowestoft is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to older adults, people living with dementia, mental health conditions, and physical and sensory impairments. At the time of this inspection, the service was supporting 69 people. Not everyone using Hales Group Limited – Lowestoft receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post. 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.

Since our last inspection, the service had made changes to the Lowestoft branch and how they delivered care geographically. The Lowestoft branch now delivers care only to people living in the Waveney area. This means they now support a reduced number of people (69 at the time of this inspection). At our previous inspection on 13 and 20 December 2017 and 4, 11, and 15 January 2018, they were supporting 230 people.

Despite the reduction in the number of people they supported, we found that people were still receiving late visits. Some people had cancelled their care as they couldn’t wait any longer for the carer to arrive. Since our last inspection there have also been missed visits. This meant that people did not always receive the care they needed to keep them safe.

Some people required two staff to attend to their needs, but in some cases, we found that only one carer had attended. This placed people and staff at risk of harm and did not meet the person’s assessed care needs. Some relatives told us that they helped the carer to deliver the care their relative needed in the absence of the second carer.

Feedback we received from some people using the service and their relatives indicated that they did not have confidence in the service delivering the care as planned. Others felt that the care was safely delivered. People told us that carers delivering their care were kind and caring, but they did not feel that office staff and management could be relied upon.

New auditing processes had been introduced, though not all quality checks were effective, and some concerns had been missed such as the recording of medicines and length of care visits.

Safeguarding procedures were not understood or followed when one person was found to be at risk of harm. Staff had not reported obvious risks to the person, and others who may visit them in their home. The service had not understood their duty of care.

There was a complaints process in place, however people and relatives told us that they did not always feel assured that they would be listened to and action would be taken to address their concerns.

Staff provided support to people to eat and drink as stated on their care plan. This included assistance with food preparation and providing people with snacks and drinks between calls. However, one persons’ care plan needed more detail about diabetes to ensure staff had clearer guidance.

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.

Care staff received supervision and training to support them to perform their role. Recruitment procedures ensured staff were safely employed and did not pose a known risk to people who used the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.