Harrogate Home Support

Updated 10 August 2022

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 Health and Social Care Act 2008.

Inspection team

This inspection was completed by one inspector and an Expert by Experience. 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 their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave a short period notice of the inspection. This was because it is a small service and we needed to be sure the provider or registered manager would be in the office to support the inspection. Inspection activity started on 15 June 2022 and ended on 7 July 2022. We visited the location's office on 16 and 21 June 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager and two staff members. We reviewed four care plans, medication records and three staff files. We reviewed records associated with the management of the service, which included policies, procedures, audits, and checks. We looked at staff recruitment details.

After the inspection

We spoke with three care staff, three people in receipt of the service and six family members. We reviewed staff rotas, information about staff support, and feedback about the service with details of activities provided.

Updated 10 August 2022

About the service

Harrogate Home Support is a domiciliary care agency which is registered with the Care Quality Commission (CQC) to provide regulated activities of personal care to older and younger people living with sensory impairment, learning disabilities or autistic spectrum disorder and physical disability in their own homes. At the time of the inspection, regulated activity was provided to eleven people.

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 were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Some staff were unsure about what they should do to make sure that any decisions were made in people’s best interests and to ensure appropriate record keeping was implemented and reviewed for relevance.

Care plans in place did not include information to support safe access in and around people’s homes. We have made a recommendation for the provider review guidance to ensure all environmental risks are assessed with supporting actions to keep everyone safe.

Staff received undocumented observations whilst carrying out their roles to ensure they followed best practice. We have made a recommendation for the provider to review best practice for implementation and feedback of observed practice.

People’s needs had been assessed and care records were in place. However, information was not always person centred or up to date. People’s views and preferences were not always recorded through required decision-making processes resulting in generic task-based guidance for staff to follow.

Systems and processes used to manage and drive improvements at the service had failed to identify or drive forward the required improvements we found during the inspection.

People told us they felt safe with the staff who supported them. Staff were clear on types of abuse to look out for and how to raise their concerns when required. Processes ensured any incidents were routinely investigated with outcomes and actions implemented to help keep people safe

Staff had access to recorded information to ensure people received information in a way they understood. Staff understood the importance of communicating with people. For example, to support them with their abilities and to respond to their wishes and preferences.

Staff had good access to personal protective equipment to manage the risks associated with the spread of infection including COVID-19 and adhered to government guidance to protect people.

Where people required support to take their medicines, this was done safely as prescribed with appropriate record keeping checked for accuracy.

Staff received appropriate induction, training, professional development, supervision and appraisal to enable and support them to carry out the duties they were employed to perform.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Records were not always up to date and decisions made on behalf of people under the Mental Health Act 2005 were inconsistently applied or reviewed to ensure they continued to be the least restrictive option and in the persons best interest. The registered manager was responsive to our feedback and acted immediately. Associated health professionals were contacted to review all outstanding decision making and review records to ensure they included up to date person centred information..

Right support: Model of care and setting maximised people's choice, control and independence;

People were supported to make choices about where to live and with whom. Staff were creative with supporting people to live their best lives as independently as possible. Support was provided which promoted daily living skills and access to a range of activities and events. People told us they received care and support from staff who they knew and had their preferences respected.

Right care: Care was person-centred and promoted people's dignity, privacy and human rights;

Where restraint was used it was not always recognised, less restrictive options had not always been considered with appropriate levels of input to ensure decisions were in the persons best interest. People and their relatives were involved in planning their care. However, care records included generic information and staff did not always have access to up to date information.

People told us staff were respectful, caring and understanding around their emotional and physical needs.

Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives;

The culture of the service was open and empowered individuals to express their views. People spoke positively about the service they received and the way the service was managed. The new manager was passionate about providing people with a personalised service which promoted their independence.

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

This service was registered with us on 20 April 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to consent and governance. We have made recommendations in staffing and safe care and treatment.

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