Human Support Group Limited - York

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People and their relatives spoke positively about the service they received. Safeguarding policies and procedures were in place and staff had a good understanding of them. Safe recruitment checks took place before staff started work. There were enough staff to meet people's needs appropriately. Risks to people were assessed and there were systems in place that ensured medicines were managed safely. Procedures were in place to reduce the risk of infections and staff had enough personal protective equipment.

Assessments of people's needs and wishes were completed and reviewed. People received support to maintain good health and to access services when required. 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 knew how to make a complaint if they were unhappy with the service.

There were systems in place that provided oversight and good management of the service to monitor the quality of care that people received. The service worked in partnership with health and social care professionals. People's views were taken into account and the provider used feedback to help drive service improvements.

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 6 April 2018)

Why we inspected

We undertook this focused inspection as part of a random selection of services rated Good and Outstanding. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Human Support Group York on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

At the last inspection on 18 and 24 November 2016, we found the provider had not done all that was reasonably practical to assess, monitor and improve the quality and safety of the service provided. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 17, Good Governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the breach of regulation. At this inspection we checked and this action had been completed; the provider had achieved compliance with this regulation.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It is registered to provide a service to people living with dementia, learning disabilities or autistic spectrum disorder, mental health and older people. The service also supports people who misuse drugs and alcohol, people with an eating disorder, people with a physical disability and people who may have sensory impairment.

Not everyone using Human Support Group Limited - York received a 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.

At the time of our inspection 75 people received a reablement service and 20 people received a domiciliary care service. Reablement is a short and intensive service, usually delivered in the home for up to six weeks. The purpose of reablement is to help people who have experienced deterioration in their health and/or have increased support needs to relearn the skills required to keep them safe and independent at home.

There was a registered manager in place. 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.

Quality assurance checks including audits provided oversight at provider level. People and their care workers were consulted and action plans formulated that aimed to improve the quality and delivery of the service.

Staff had access to a policy and procedure that provided with them guidance on working with people who might lack capacity under the Mental Capacity Act (MCA). Staff had completed training on the MCA and were able to discuss the importance of supporting people with their independence.

Care plans evidenced that individuals or their legal representative had been involved in their care planning. However, signed consent was not robustly recorded. Where a person was deemed to have lasting power of attorney to consent on the persons behalf checks had not been completed by the provider. Actions including checks were implemented during our inspection to improve this process.

Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised which helped to keep people safe from avoidable harm and abuse.

Associated risks for staff attending people’s homes and for providing care and support to people were assessed and managed through individual risk assessments and support plans. These provided staff with information to help keep both people and themselves safe from avoidable harm with minimal restrictions in place.

The provider had systems and process in place to ensure sufficient skilled staff were appropriately recruited into the service to meet people's individual needs.

Procedures were in place to guide staff on the safe administration of medicines and staff had received medicines training. People confirmed, and the records we checked showed, that people had received their medicines as prescribed.

Staff had received support through a regular system of supervisions and observation. The process of appraisals had been improved and dates scheduled. Competency observations had also been completed to monitor staffs performance and ensure they were providing safe and effective care and support.

People had received an assessment of their need to ensure they were suitable for the service. Care plans were centred on the individual and reviewed monthly. Updates were added in ‘real time’ and staff confirmed that information was always up to date. We saw care plans included information regarding people’s cultural and spiritual needs.

People were supported to maintain a healthy and balanced diet. We found that care plans contained details of people’s preferences and any specific dietary needs they had, for example, whether they were diabetic or had any allergies.

The provider ensured they had close working relationships with other health professionals to maintain and promote people’s health.

Staff had a good understanding of people's needs and were kind and caring. They understood the importance of respecting people's dignity and upholding their right to privacy.

There was information available on how to express concerns and complaints. People were encouraged to raise their concerns and these were responded to.

The provider worked effectively with external agencies and health and social care professionals to provide consistent care.

Everybody spoke positively about the way the service was managed. Staff understood their levels of responsibility and knew when to escalate any concerns.

We inspected this service on the 18 and 24 November 2016. The inspection was announced. The registered provider was given 48 hours’ notice of our visit, because the location provides a domiciliary care service and we needed to be sure that someone would be in the location offices when we visited. At the time of our inspection, 83 people were using the reablement service and 37 people were using the domiciliary care service.

The service was last inspected in September 2015 when it was rated ‘Requires improvement’ overall. This was because we had concerns about the management of medicines, found that records were not always well-maintained and the registered provider's quality assurance systems were not robust enough.

The registered provider is required to have a registered manager as a condition of registration for this service. 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 service did have a manager who had been in post since June 2016. They became the service’s registered manager in October 2016.

We identified concerns regarding late visits from staff. We found that reablement care plans were not consistently kept up-to-date and identified issues with staff’s recording around the support provided to take prescribed medicines. Issues with record keeping were an on-going concern from out last inspection demonstrating that the registered provider's systems to monitor and improve the quality and safety of the service provided were not robust enough.

We found a breach of regulation in relation to the registered provider's governance and quality assurance systems. You can see what action we told the registered provider to take at the back of the full version of this report.

People who used the service told us they felt safe with the care and support staff provided. The registered provider had a robust recruitment process to ensure only staff considered suitable were employed. Staff we spoke with showed a good understanding of their responsibility to safeguard vulnerable adults from abuse.

Staff received training and supervisions and spot checks were completed to monitor and support staff’s continual professional development. Staff we spoke with demonstrated that they understood the importance of seeking consent and people were asked to sign their care plans to record that they consented to the care and support provided. However, we have made a recommendation about recording people’s mental capacity to make decisions.

People who used the service told us they were happy with the support staff provided to ensure they ate and drank enough and we saw that systems were in place to monitor people’s food and fluid intake if there were concerns. People were supported to meet their health needs and staff liaised with healthcare professionals where necessary to promote people’s health and wellbeing.

People who used the service told us staff were kind and caring. People told us staff listened to their opinions and respected their decisions. Staff supported people who used the service to maintain their privacy and dignity.

People’s needs were assessed and person-centred care plans were put in place to support staff to meet their individual needs. We saw evidence that care plans for people who used the domiciliary care service were reviewed and updated to ensure they reflected people’s current needs. However, we found that care plans for people who used the reablement service had not always been updated and did not consistently reflect people’s current needs.

The registered provider had a system in place to gather feedback about the service provided and to manage and respond to complaints. People who used the service and relatives we spoke with told us they had the information they would need to complain if necessary.

We found that the service had not always been well-led, but we received positive feedback about the new registered manager and their management of the service. We saw that systems were in place to monitor the quality and safety of the service provided, however, work was on-going to address outstanding issues with late visits and recording issues in people's care plans and medication administration records.

People we spoke with said they received the help and support they needed. One person said 'The staff have helped me to regain my independence.' We saw that people had support plans and risk assessments in place. to help staff to meet people's needs.

There were policies and procedures in place to help to protect people from abuse. Staff we spoke with knew what they must do if they suspected abuse was occurring. We were informed that any issues raised would be offered to the local authority safeguarding team. This helped to protect people.

Staffing levels were monitored by the management team. We saw there were enough staff to be able to meet people's needs in a timely way. One person we spoke with said 'The staff are friendly and skilled. There are enough staff.' Staff had the skills they needed to be able to look after people.

People told us that their views about the service were asked for. The manager monitored all aspects of the service. We saw that action was taken to maintain the quality of the service being provided for people.