Archived: Hales Group Limited - Lowestoft

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.

This announced inspection took place on 13 and 20 December 2017. On 13 December we visited three people, with their permission, in their own homes and the office location. On the next three dates we spoke with people by telephone in their own homes. This was the first comprehensive inspection we had undertaken at this location since the service was registered at this location with the Care Quality Commission (CQC) in January 2017.

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.

People and their relatives raised concerns with both late and missed visits. The care visit monitoring system was not effective to check if allocated visits were being completed as required and that staff were on time. Missed visits had also occurred, with family members being required to deliver care and this included personal care.

Staff had not always been deployed effectively to provide people with the support they required to meet their assessed care needs. During times of higher than expected staff sickness the senior staff managing the on-call service had not been able to meet everyone’s needs, despite attending care visits themselves. The result was late calls when staff arrived up to two hours late or missed calls when staff had not attended.

People did not always receive support to keep them safe. The late and missed visits meant that people were at risk of not receiving meals, medication or assistance with personal care.

Each person had a care plan and risk assessments were in place. Staff had received training in the administration of medicines. A duplicate copy of the records was maintained and kept securely at the service office. People’s care plans had been updated following changes to people’s care needs and reviews of their care.

Staff had received training in order that they had knowledge to meet people’s assessed needs and were supported with an appraisal and supervision.

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.

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.

People informed us the staff were kind and caring. Staff provided understanding to people when providing care but the service overall did not demonstrate that they cared for the people they supported at all times because of late and missed care call visits.

The service sent satisfaction questionnaires to people who used the service and their relatives, asking them for their views and opinions of the service they received.

There was a complaint’s procedure in place, this procedure enabled people to state if they were unhappy with the service. The people we spoke with were aware of how to make a complaint. The service also collated positive compliments that had been made based on people’s experiences.

The service had quality assurance systems in place that were not working well. The registered manager had introduced a new system for monitoring staff sickness in order to support staff and in time reduce staff sickness. The registered manager had also investigated and identified reasons for a number of late and missed visits in September 2017 and put into action monitoring the care co-ordinators workload to support them with their work.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.