Harbour Home Care

Updated 9 November 2022

Inspection team

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

The inspection was carried out by one inspector

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a manager registered in post.

Notice of inspection

We gave the service three days’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

Before the inspection, we reviewed information we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

We reviewed three people's care plans and risk assessments. We looked at one staff file in relation to recruitment. We reviewed staff training and supervision. We also reviewed other records relating to the management of the service. We spoke with six staff including the registered manager, the deputy manager and the operations manager. We spoke with two people who received a service and one relative. We also spoke with a visiting healthcare professional

Updated 9 November 2022

About the service

Harbour Home Care is a domiciliary care agency. The service provides personal care to people living in their own homes. At the time of our inspection there were five people using the service. The service is located in the building of Harbour House, a residential care home. Both services have the same registered manager.

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

Harbour Home Care is a small service providing support and care to five people, many of whom staff know very well. The staff team who visited people had been very stable. This had led to very person-centred care and support being provided. The deputy manager oversaw the day to day running of the service and along with the registered manager stepped in to cover any short notice sickness absence in the staff. However, there was a lack of robust systems to ensure consistent recording and monitoring of service provided.

Risks were identified, assessed and recorded. However, we could not see any evidence of regular reviews of identified risks. The registered manager stated they had made visits to people’s homes and carried out reviews, but it was not possible to find the records of these visits.

Care plans were completed for each person and contained details of some people’s needs and preferences. However, care plans did not have a consistent format. Each one we reviewed included slightly different documents. Information was not held securely, with pages found loosely in a folder of card. This meant it was easy for pages to fall out, get mislaid or misfiled. Some important information was not always included in care plans, to direct and guide staff. For example, if the person was living with a long-term condition such as diabetes or had an increased risk of injury.

Confidential personal information was held in care plans, some presented a security risk. For example, the combinations to the key safes, used by staff to access keys to a property where the person was unable to open the door themselves. We asked the registered manager to take immediate action to remove this information and re-set all the combinations for safety reasons.

Harbour home care had a stable team of four staff. Recruitment procedures were in place. However, personnel files were also not held in an organised consistent format, with loose pages not securely held together. This meant information was difficult to find and could easily become mislaid.

Some people received support from staff to buy things. For example, staff regularly purchased food and general shopping for some people. There was not a robust process in place for staff to follow when recording these transactions. There was no management oversight of these financial records.

We were told staff supported some people to take their medicines. We asked to see the Medicine Administration Records (MAR) which staff completed to evidence their actions. The MAR’s were not completed in an appropriate manner; however, it became evident upon further discussion that the staff were not actually prompting or administering any medicines, merely checking if medicines had been taken. We advised the provider to amend these care plans.

There was no evidence in any care plans of the registered manager having obtained signed consent from people, who had capacity, to indicate they agreed to receive care, and to the content of their own care plan. There were no records in the care plans of any Lasting Power’s of Attorney (LPA’s) held by people they supported.

When staff arrived at a planned visit but unexpectedly found no one at home, there was no consistent process in place for staff to escalate this concern, to help ensure the person was safe and well.

The service had not implemented any quality assurance systems to monitor the quality and safety of the care provided. One relative told us, “Since we started the visits, several months ago, no one has been in touch with us to check how it is going." One person who received a service from Harbour Home Care confirmed that “I have not met the registered manager. No-one has been to ask me how things are going. Although I am quite happy.”

The registered manager did not have a robust system in place to manage information. Some paper care records were held in people’s homes and there were some copies in the office, although these records did not always tally. There were also electronic copies of care plans and assessments, but this information was inconsistently organised and could not be provided for review. Throughout this inspection the registered manager struggled to find information requested.

People were supported by staff who had been appropriately trained and were skilled in their role. However, staff did not receive formal supervision or appraisal in accordance with the providers policy. Staff told us they felt well supported. Comments included, “(Deputy Manager) is amazing. We don’t have formal supervision, but I can get what support I need” and “I can’t recall having had any supervision but we can talk on the phone if needed.”

Staff understood the importance of respecting people's diverse needs and promoting independence. Some people using the service, had issues with their capacity. However, no assessments had been carried out or best interest meetings held when decisions were made on behalf of another person. 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; although the policies and systems used in the service did not always support this practice.

Spot checks were carried out by the deputy manager to monitor staff performance.

People told us they felt safe with staff. There were systems to help protect people from abuse and to investigate any allegations, incidents or accidents.

People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported to maintain a balanced diet where this was part of their plan of care.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

We re-registered this service on 20 August 2021, and this was the first inspection. The last inspection of this service, under the same provider, was rated good (published 11 April 2019)

Why we inspected

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

Follow up

We found breaches of the regulations at this inspection. 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.