Background to this inspection
Updated
9 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
One inspector led the inspection remotely for the duration of the inspection and two inspectors attended the site on the first day. An Expert by Experience spoke with agreed people via telephone over two days. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in the community.
The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period of notice to the inspection because we needed to ensure someone would be in the office available to support the inspection. Inspection activity started on 28 April 2021 and ended on 11 May 2021. We visited the office location on 28 April 2021.
What we did before the inspection
Prior to the inspection we had been working with the local authority, quality monitoring and safeguarding team to assure ourselves the service was safe. We reviewed feedback from professionals, people in receipt of services and staff working at the service to determine the need to inspect.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all this information to plan our inspection.
During the inspection
We spoke with or had email communication with 22 staff. This included the area and regional manager and quality director. We spoke with carers, a care coordinator and quality officers, we also spoke with staff from different provider services who were supporting the service at Thetford. We spoke with or had email communication with 17 people using the service or their family members. We spoke with seven professionals who were supporting the service during the inspection.
We had email communication with the office of the nominated individual to share concerns as the inspection progressed. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a large number of records, including 12 care plans, incident reports, medicine records and records used by the provider to monitor the performance of the service. We also looked at personnel records including information for recruitment, supervision and training.
After the inspection
People using the service and staff continued to contact us to share concerns and we shared this information to support the provider to improve. We continued to seek clarification around the evidence reviewed as part of the inspection up to writing the report and we met with stakeholders of the service to ensure the service was supported to keep people safe.
Updated
9 July 2021
About the service
Hales Thetford is a Domiciliary Care Agency supporting approximately 100 people living in the community. Hales provides personal care support to people to enable them to remain as independent as possible. At the time of the inspection approximately 75% of those supported were supported with their personal care.
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 told us there were not enough staff to ensure they received their care at a time which suited them and met their needs. This included at times they were required to take their medicines. One person said, “My medication is always late, because they are never on time.” Risks to people’s health and wellbeing including their medicines were poorly managed and people were not suitably safeguarded from poor care. Infection prevention and control procedures specific to the management of the current pandemic were not implemented and monitored to ensure appropriate action was being taken by staff and the people supported. The provider’s recruitment procedures were not followed to ensure the suitably of staff was kept under review.
The provider did not have an effective system of quality audit to assure themselves the service delivered was safe and what people wanted. People were not as involved as they would like in how their support was delivered. One person told us, “I have shared my concerns, called and written to them, 28 days, not heard from them, two hours late every time is not acceptable.” Staff told us they ‘loved’ the job, but they were poorly supported, they could not deliver the Rota in the way it was presented to them as it did not contain enough travel time and sensible breaks. CQC did not receive notifications for all incidents of concern, but the provider’s last report was available on their website.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update –
The last rating for this service was Requires improvement (7 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about missed and late calls to people in receipt of services. A decision was made for us to inspect and examine those risks. We received concerns in relation to the management of medicines and people’s needs not being met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well led key question sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider told us both prior and throughout the inspection that they had taken steps to mitigate concerns raised by staff and people using the service. However, on inspection, we did not find the steps taken had been effective in mitigating the risks to people in receipt of services.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hales Group Limited - Thetford on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to staffing and recruitment, medicines management and the management of risk including safeguarding people from the risk of abuse, a lack of suitable audit and quality assurance and oversight at this inspection. We also found we had not received notifications of incidents as required.
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.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.