Archived: Hales Group Limited - Thetford

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.

Hales Thetford is a domiciliary Care Agency supporting people in their own homes with their personal care needs. At the time of the inspection the service was supporting 136 people. Not everyone using the service was in receipt of the regulated activity 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

Risks to people’s health and well-being were not always assessed and managed appropriately. This included where people needed support with their medicines. Suitable staff were safely recruited to ensure people were supported but some people told us calls were often late. There was an ongoing recruitment round to ensure there were always enough staff. Procedures were followed to ensure people were protected from the risk of infection and when things went wrong the service learnt lessons to reduce the risk of reoccurrence.

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; However, policies and systems in the service were to be improved to support this practice. The service worked with other professionals to meet people’s needs. Staff received a comprehensive induction and regular supervision. When people starting to use the service, they were supported in the transition.

Where people required support with their nutrition and hydration this was provided.

People told us they had not been involved in developing their care plans and we saw some did not include consistent information. However, we also saw people using the service or their representative had signed care plans in agreement to their content. When staff were in people’s homes they treated both the home and people they supported with dignity and respect. We were told people had choices and staff did little jobs in addition to help people remain independent.

Staff did not always have the information they needed in the newly developed care plans. Some people were not happy with the times their support was provided and some told us staff did not arrive on time or stay as long as they should. The provider told us they were in the process of addressing this and could better monitor concerns with the new system for monitoring staff visits. Staff spoke well of the people they supported and showed concern when delivering support. Complaints were managed in line with procedures and were concluded to people’s satisfaction.

A governance system was yet to be implemented and embedded following the introduction of the electronic care planning system. The quality team were aware of improvements that needed to be made. Surveys were completed to gather feedback on the service people received and responses from both people using the service and staff were predominantly positive.

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 (published 17 May 2018) with three breaches to the regulations. The provider completed an action plan after the last inspection to show what action they were to take and by when to improve. At this inspection the service had made enough improvement to meet two of the previous breaches but one remained and a further two breaches have been identified at this inspection.

The last rating for this service was requires improvement (published 17 May 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The service continues to be rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified two breaches in relation to risk assessments and the safe management of medicines and governance and oversight of the service provided.

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

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.

Hales Group Limited – Thetford is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It can provide a service to people who may be living with dementia, younger disabled adults and children. The information supplied to us by the agency, showed that none of the people using the service were under 18 years of age.

At the time of the inspection, 140 people were using the service. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Everyone using the service were being provided with 'personal care'.

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.

At this inspection we found improvements had been maintained and we rated our key questions is the service caring and responsive as being, ‘Good’. However, we rated the key questions is the service safe, effective and well led, as ‘Requires Improvement’. We identified two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the service was in breach of one regulation of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.’

Following the last inspection in November 2016, we asked the provider to complete an action plan to show what they would do to improve the service from Requires Improvement in all areas and to meet four separate regulations. These related to staffing, safe care and treatment, person centred care and good governance.

Risks associated with people's needs had not always been fully assessed to enable staff to have the required information to manage known risks.

Staff had received an induction and took part in a programme of training; however they had not received regular supervision.

The registered person had not notified the CQC of two incidents where a service user suffered abuse or an allegation of abuse had occurred.

Staff followed the provider's safeguarding procedures to identify and report concerns to people's well-being and safety. However, further work was needed to ensure systems; processes and practices always safeguarded people from abuse.

People were supported by a sufficient number of staff who underwent appropriate recruitment checks. However people and relatives had mixed views about the punctuality and the consistency of staff. Systems were in place to monitor this and the provider acted on people's concerns.

The provider had improved their quality monitoring processes to promote the safety and quality of the service. Further development of quality assurance systems and audits were required and planned in order to continue to improve the service.

People received the support they required to take their medicines. Staff were aware of their role and responsibilities to protect people from the risks associated with cross contamination and infection. Accidents and incidents were recorded and responded to by staff and these were reviewed to consider lessons to learn to reduce further risks.

People were involved in the planning and review of their care. Staff delivered people's care in line with their changing needs, preferences and best practice guidance.

People were encouraged to maintain a healthy diet and to have sufficient food to eat and drink. Staff supported people to access healthcare 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. Staff sought people's consent before providing care and treatment.

People received care in a manner that treated them with respect and promoted their privacy and dignity.

People were confident about making a complaint and had received information about how to make their concerns known.

The registered manager sought people's views about the service and acted on their feedback. There was collaboration between the registered manager and other agencies to enhance the quality of care provided to people.

Hales provides domiciliary care services to people in their own homes. At the time of the inspection, the service provided care and support to 186 people.

We last inspected Hales Group Thetford in October 2015 where we rated the service as ‘good’ overall however we rated it as ‘requires improvement’ in well-led due to there being failure in the provider’s systems to make sure that there were always enough staff to meet people’s needs.

We re-inspected the service in November 2016 as we received a number of concerns about people not receiving their care as planned and a high number of late and missed care calls. This meant that people were not receiving the care they required.

There was no registered manager in post in day-to-day charge of the service as required by the provider's registration conditions. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 not employ enough staff to meet people's needs. This meant some people had not always received their planned visits or visits were late. This resulted in risks to people's dignity, welfare and safety. Some people who needed two care staff at each visit had only one staff member arrive. This meant care could not be carried out as required, or safely; or relatives were supporting the care staff to deliver care. This placed people and staff at risk of injury or harm.

There were robust recruitment processes in operation, which contributed to protecting people from the employment of staff who were unsuitable to work in care.

Medicine administration records were not always completed accurately and medicines were not always administered as the prescriber intended.

Risks to people were assessed and there was guidance for staff about how they should minimise these risks while they were delivering care.

People and their relatives were not always positive about the skills, experience and abilities of staff who worked in their homes. Care was not provided in a way that always promoted people's dignity and respected their privacy. Not all people received personalised care and support that met their changing needs and took account of their preferences.

Staff had received suitable levels of initial training but their competence had not always been checked in the delivery of care and support. Supervision and observation of practice had not been completed routinely. Staff did not always receive appropriate support.

The company had a suitable complaints procedure. The procedure had not always been followed but the regional manager was ensuring that any outstanding responses were dealt with.

The staff understood their legal obligations when making decisions on behalf of people who could not make them for themselves. They were also knowledgeable in recognising signs of abuse and were aware of the procedures to follow to safeguard people from harm.

People were complimentary about their regular care workers but felt the care provided by new workers did not always meet their needs.

Management arrangements at the service were inconsistent. There had been a number of management changes meaning a lack of consistent leadership and support. This had affected staff morale and the quality of the care being provided to people who used the service.

We found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us that they were provided with a reliable service that met their needs. They said that the staff assisted them to keep their homes clean and hygienic. They confirmed that the staff used disposable gloves and aprons when visiting them. There were enough domiciliary care staff provided to cover all of the visits and meet the needs of the people using the service.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living in their own home in the community.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). No applications had been submitted but policies and procedures were held. Staff had been trained and relevant staff knew how to ensure that a DoLS application was submitted.

Is the service effective?

People's health and care needs were assessed with them. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. We noted that the staff understood the care and support needs of the people they visited. One person told us, 'I get all the help I need from staff who know what they are doing.' Staff had received training to meet the needs of people using the domiciliary care agency.

Is the service caring?

People told us they were supported by staff who used a kind and attentive approach. Staff said that they used a relaxed approach and encouraged people to be as independent as possible. People told us that the staff were sometimes given additional visits to make but did not rush them and stayed the whole time expected. A relative said, 'I am happy with the care my family member receives. The members of staff are reliable, polite and respectful.'

Is the service responsive?

Care and risk assessments had been completed before people begun to use the service and when their needs had changed. A record was not held of people's preferences and diverse needs. However, plans of care were being reviewed and updated to ensure they were complete. People told us that staff members consulted them and encouraged them to make their own decisions. Some of the people using the service were supported to take part in community activities and events.

Is the service well led?

Staff spoken with had a good understanding of the ethos of the domiciliary care service. Quality assurance processes were in place. People using the service and their relatives told us that they were asked for their feedback about the service provided. They told us that they had filled in a satisfaction questionnaire survey. Staff said that they had felt listened to when they had raised their concerns. People told us that their views and wishes had been taken into account. They confirmed that they were sent a weekly list of the names and times a staff member would visit them the next week.

People using the service told us that they had received the care and support they needed and that staff were excellent.

We saw that the people’s individual medication was available and monitored and found that the provider was taking action to ensure it was administered safely and recorded accurately.

People using the service told us that staff members were kind and respectful towards them.

We found that staff had completed training and that the provider was taking action to ensure all staff had completed updated training. Staff work practise was monitored though regular spot checks, supervision and staff meetings.

People using the service and their relatives told us that their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people using the service.

People spoken with told us that improvements had been made. We found that staff members were trained and were supported to provide an appropriate standard of care through increased spot checks, supervision and staff team meetings.