Archived: Human Support Group Limited - Liverpool

Human Support Group - Liverpool is a domiciliary care agency providing personal care to 53 people with different health and care needs in their own homes at the time of inspection.

People’s experience of using this service and what we found

People’s experience of using the service varied. Although we heard compliments and praise, particularly for staff that regularly visited people, there were also inconsistencies. Staff and managers were honest about the fact that the last six months had been unsettled and difficult. There had been several changes in managers, which meant issues, including with staffing, concerns, person-centred planning and quality of care, had not always been addressed. We found breaches of regulation with regards to nutritional and hydrational needs, as well as record keeping and quality monitoring. Staffing had much improved, but the planning and deployment of staff needed further review to meet people’s needs consistently. We made a recommendation regarding this.

However, we heard consistent agreement that a new care manager had already made significant, positive changes in the few weeks they had been in post. Staff felt the service was now improving and was the most settled it had been in a long time. The new manager was honest and clear about the fact there was much work to do and they had recognised the improvement needs we identified. They explained to us how they would work to achieve safer, better person-centred care and ensure people, relatives and staff were reengaged and listened to. The care manager brought a unique passion and dedication to their role, which we considered would help them to achieve this.

Although feedback varied about how well staff met people’s needs and listened to them, we also heard much praise. People commented that staff on balance were kind and very helpful. We heard concerns from relatives but also at times very positive comments about their delight with care. The service worked effectively with other professionals and we received some compliments about this.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 July 2017).

Why we inspected

This was a planned inspection based on the previous rating. The inspection was prompted in part due to concerns received from different sources, including the provider’s notifications, about people’s safety, staffing, person-centred care and planning, as well as service management. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to meeting people’s nutritional and hydration needs, as well as record-keeping and other aspects of service governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was last inspected in October/November 2015 where we rated the service good. At this inspection we found the service remained good.

The Human Support Group Limited Merseyside branch office is located in Widnes and provides personal care and support to individuals who reside in Runcorn, Widnes and Liverpool. At the time of our inspection the service was providing personal care and support to 107 people in their homes.

A registered manager was in post at the time of the inspection. 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.

We saw that staff were recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care. Staffing levels were observed to be sufficient to meet the needs of the people receiving support from the company.

We saw that the service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

People told us that staff were caring. During home visits we observed positive interactions between staff and people. People said they felt comfortable with staff supporting them. Staff treated people in a dignified manner.

Staff had a good understanding of people's likes, dislikes, interests and communication needs. This meant that people were supported by staff who knew them well.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005. This meant that the staff members were aware of people's rights to make their own decisions.

The care plans were person centred and reviewed when needed, so staff knew if any changes in care provision had been made. This helped to ensure that people’s needs continued to be met.

Staff members we spoke with were positive about how the service was being managed. The staff members we spoke with were positive about the service and the quality of the support being provided.

Medication administration record sheets (MAR) were not always clear as to when medication had been administered, however daily diary records confirmed that medication had been administered as directed.

The service had a complaints procedure and whilst no-one had raised any complaints, people knew who they could complain to and were confident this would be dealt with effectively.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the services, staff meetings as well as spot checks on staff and to gain the views of the people receiving a service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

Staff had received training in safeguarding and felt confident in being able to maintain people's safety.

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

In house training events had been arranged which included moving and handling, risk assessment and dementia care. This enabled staff to minimise risk and undertake safe care practices.

Policies and procedures had been developed by the provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). This is a legal requirement that is set out in an Act of Parliament called The Mental Capacity Act (MCA 2005). This was introduced to help ensure that the rights of people who had difficulty in making their own decisions were protected.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People told us they were happy with the care that had been provided and they felt their needs were being met. People told us that there was good communication and interaction between staff and people who used the service. Comments included: "I have great faith in the staff who are so nice and caring", "staff are very good and help me a lot", "staff assist me with all my personal care and never let me down", "the staff provide very good care" and "they usually turn up on time but if they have been delayed they always ring me to let me know they will be a bit late". One relative told us that in the past the staff were not very reliable but now things had changed very much for the better. Another person told us that the service was most effective in meeting people's needs.

People told us that staff always read the care plans before carrying out any duties. Staff discussed the individual needs of people they supported. Staff described the support they provided on a day to day basis including daily choices and they were knowledgeable about people's needs and requests.

Is the service caring?

We asked people about the staff members who visited their homes. Their comments included; "X is an excellent worker and nothing is too much trouble", "Y calls here most of the time and we have no complaints whatsoever; good kind staff", "all very good, don't know what we would do without them", "staff are very caring and respectful" and "staff are very good".

Is the service responsive?

People who used the service had a detailed care plan in place to help to show how their needs would be met. These records were detailed and showed that people's choices and diverse needs were identified and care plans were regularly reviewed. The people we spoke with who used the service appeared to be happy and relaxed with their care. Those who were able to discuss arrangements made for their care told us that they were happy and content with the manner in which their care and support was provided. Feedback from people's relatives also confirmed that people were pleased with the services provided. One relative told us that the service had greatly improved over the past few months.

The manager told us that the agency had implemented a new system to monitor the times and frequency of home visits to people who used the service. Records showed that this system had identified any late calls. Senior staff had been able to quickly act to ensure calls were made and where appropriate apologies were given to the people who used the service in respect of any disruption they may have encountered. Actions had also been taken against staff in respect of late calls to minimise this from happening again.

Is the service well-led?

People who used the service and their relatives told us they were always kept informed and updated regarding all support and care needs and discussions, spot checks and reviews were in place to see if any changes were needed.

Audits were carried out regularly; these included audits on care plans, medication records and staff rotas. If there were any issues identified following an audit these would then be dealt with immediately and any issues would be discussed openly within the staff team and with the manager.

We had asked the provider to take action to resolve the issue and this inspection found that appropriate measures had been put in place.

The manager that we spoke with had now successfully completed the process to become the registered manager for the service.

As part of her role she was continuing to review and update systems of work, policies and procedures and staff training.

Staff that we spoke with were positive about the service and told us that they felt supported in their roles.

One relative told us that there had been some issues that they had needed to raise and that these were being looked at.

One person who used the service said that they had no problems but would phone the office if they did. Another had recorded in a feedback form that they got on well with the carers and had no problems and another person stated that the staff were very polite and did their job.

The manager that we spoke with was currently going through the registration process to become the registered manager for the service. As part of her role she was reviewing and updating systems of work, policies and procedures and staff training.Peole who used the service and their relatives that we spoke with were positive about the service and both they and the manager acknowledged that progress had been made in resolving issues that had been raised.

We asked people if there was anything that they would change about the service.

A relative told us that ideally they would prefer an earlier visit slot for their relative but understood that this could not be accommodated at this time.

Another relative told us ''no because the staff are brilliant!''

We were told by a person who used the service that the staff were ''very cheerful and competent.''