Extra Hands of Heacham Limited - Broadland Office

Extra Hands of Heacham Limited is a domiciliary care service. They provide personal care and support to people living in their own homes. 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. At the time of our inspection the service was providing the regulated activity to 140 people, 34 of whom were supported with medicines.

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

The provider had not developed full, accurate contemporaneous records relating to all relevant aspects of people’s care. This included full records with guidance and risk assessments around people’s needs, health conditions and medicines. They were developing a new electronic care planning system to include all areas of people’s care.

Improvements were needed around the recording and administration of people’s medicines.

People received care from staff who were knowledgeable about the risks associated with people’s care and received effective training related to keeping people safe, including managing risks associated with their health and safeguarding people from harm.

Staff were recruited safely and cared for a consistent group of people they knew well. People received a responsive, person-centred service from competent and caring staff, and they knew how to raise concerns.

There were infection control measures in place which contributed to protecting people from, and managing risk of infection, including from COVID-19. This included staff wearing full personal protective equipment (PPE) during care visits.

There was a strong positive working culture in the service and good teamwork amongst the staff. People, their families and staff felt involved in the ongoing service delivery and were informed about changes.

We have made two recommendations in relation to care planning around risk and end of life.

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 02 October 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

This was a focused inspection to look at Safe, Responsive and Well-led. This report only covers our findings in relation to these three key questions. We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

We found no evidence during this inspection that people were at risk of harm from this concern. You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service and no areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Extra Hands of Heacham Limited 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 have identified a continued breach in relation to good governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Extra Hands of Heacham Limited - Broadland Office provides support and personal care to people in their own homes in Norwich, Holt, Sheringham, Broadlands and surrounding villages. On the day of the inspection there were approximately 151 people using the service who received 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

Some areas of the service had deteriorated since our last inspection, and the quality assurance systems in place had not identified this. This meant there was a breach of regulation relating to the governance in the service.

Staff supported some people with medicines, but the support they needed was not always recorded in their care plan. Care records did not always contain accurate, detailed, up to date support around people’s needs. Despite this, people in the main received the care and support they required.

Staff supported people safely and were aware of safeguarding processes. There were enough staff to meet people’s needs, although some visits were not at always at agreed times. Staff were safely recruited. There were risk assessments in place around people’s own environments and any equipment they used, for example to move around.

Staff had access to a variety of face to face training relevant to their role, as well as a thorough induction and supervisions. Staff supported people to eat and drink enough when associated with a care package, and to access healthcare professionals. They ensured consent was gained before delivering care. 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; the policies and systems in the service supported this practice.

There was a caring ethos and people were treated with dignity and compassion. Staff supported people to remain as independent as possible, and involved people and family in their care appropriately.

There was a complaints process and any complaints were investigated, responded to and resolved appropriately.

There was a clear management structure within the service and staff, in the main, felt supported and valued. The registered manager was approachable and available to people and staff. The service was building strong links with the local community which included going into a local school, and hosting events which people could access.

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 overall with Requires Improvement in responsive (published September 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have identified a breach in relation to the governance systems in place and accuracy of records.

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

The service had a registered manager in place at the time of our inspection. 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.

People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent and risks were mitigated in the least restrictive way possible.

People were supported by a regular staff member or group of staff who they knew. People who required support to take their medicines received assistance to do so when this was needed.

People were provided with the care and support they required by staff who were trained and supported to do so. People’s human right to make decisions for themselves were respected and they provided consent to their care when needed.

People were supported to consume a sufficient amount of food and fluids that promoted their wellbeing. People received support from staff who understood their health needs.

People were treated with respect by staff who demonstrated kindness and understanding. People were involved in determining their care and support. They were shown respect and treated with dignity in the way they wished to be.

People could not rely on their plan of care containing all the required information to ensure their care and support was delivered as needed. People were informed on how to express any issues or concerns they had so these could be investigated and acted upon.

The management team provided leadership that gained the respect of care workers and motivated them as a team. When issues were indented within the service action was taken to address these. There were systems in place to monitor the quality of the service and make improvements when needed.

We saw that care records had been written in a professional manner, detailing the care given at each visit and also recorded other relevant information. We looked at care plans and found that in each case the planned care matched the commissioning agency's requirements and was based on an assessment of the person by a senior staff member. One staff member said that the care plans, introduced in January 2013, enabled 'a more person-centred approach to care.' People told us that they were able to read their care notes whenever they wished. This showed us that the provider had taken steps to ensure that each person received effective, safe and appropriate care.

People told us they felt safe when being cared for. One person said that staff were "more like friends than workers." Staff had up-to-date safeguarding training and policies were in place for financial transactions. We saw that the provider's recruitment process ensured that unsuitable people were not recruited and that their complaints procedure was clear.

There were systems in place to help protect people from abuse and staff knew how to raise any concerns they may have. People felt safe using the agency. Staff also had access to development and training opportunities to ensure they were able to support people safely. However, we found that guidance in individual care records about how this was to happen needed to be clearer to avoid the risk that staff may overlook aspects of care that were required or be unsure about how to deliver it safely.

There were good systems for monitoring the quality of the service and ensuring that improvements were made where necessary.