Haven Care Wirral Limited

At our last inspection in October and November 2016, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to the use of systems and processes to assess, monitor and improve the quality and safety of care. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question, ‘is the service well-led’, to at least good. At this inspection we found that the issues we had identified had been addressed and rectified.

However, at this inspection, we found that some statutory notifications had not been made to us in relation to some safeguarding concerns, which is a ratings limiter to the ‘well-led’ question. These concerns had though, been notified to the local authority.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community and supports people with a range of needs. The people whom it supports range from older to younger adults all of whom live in their own homes in either an individual domestic setting or in supported or extra care housing. Haven Care employs approximately 144 staff and supports approximately 130 people in these various settings in the community. These figures vary according to the needs of people needing support.

Supported housing provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support services.

Recently, some other providers had reduced or ceased trading and some of the people they were supporting were transferred to Haven Care. These were the people who lived in the supported living and extra care accommodation. Some of the usual staff who supported them had also transferred to Haven Care, which enabled continuity. The process is colloquially known as TUPE (or Transfer of Undertakings Protection of Employment). The new services which Haven Care provided were to a group supported living community and a service in an extra care housing service. The service to their original service users who lived in their own homes in an individual domestic setting in the community continued to be delivered.

The service requires a registered manager and there were two in post who had been there for several years. 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. One of the registered manager’s for Haven Care is also the provider of the service. The other registered manager was not available for the inspection.

At our previous inspection we found that audit and quality assurance systems were not robust. At this inspection we saw that improvements had been made in relation to these. The provider’s managers had completed spot checks on staff and care record and medication record audits. We found that the auditing and quality assurance processes had improved. The provider was also a registered manager of the service and there was another registered manager who was on long term leave at the time of our inspection. The provider and the other managers of the service (the deputy managers and the care coordinators of the teams) who we talked with, had an open, supportive, accountable and transparent relationship with people who used the service, and the staff. They also had a similar relationship and had had good partnership working, with various organisations.

Recruitment processes were robust which ensured the safe employment of suitable staff. There were sufficient staff to meet people’s needs but recruitment was continual, although the service had a good staff retention record.

Staff were being bought up to date with training although all had had either their previous employers training or that provided by Haven Care; supervisions had been increased and appraisals completed and planned. A schedule of training and supervision dates had been completed for the following year.

People were protected from the risk of abuse. All staff had completed training in safeguarding vulnerable adults, but some needed to be updated. They all knew how and to whom to report any concerns they may have This helped to ensure people’s safety.

People told us that positive relationships had been developed between them and staff. They told us staff were, “Lovely” and “Helpful”. One family member had written in a satisfaction survey, that staff made their relative laugh and other people told us they felt relaxed and at ease whilst being supported by staff.

People told us and we saw, that they were treated with dignity and respect. People told us that staff conducted themselves respectfully and left their homes clean and tidy.

People’s care records contained accurate and up-to-date information about their needs. People were involved in their care planning and their preferences and choices respected. Risk assessments were in place and provided information to staff around how to manage those risks presented to people. This helped ensure that staff had access to information about supporting people and how to keep them safe.

There were sufficient numbers of staff in post. People commented that staff usually arrived on time, or within an acceptable time frame. People confirmed that staff always turned up for their care call. Staff told us they had enough time to spend with people in order to support them and chat with them and did not feel stretched. They told us that travelling time was built in to their schedules and was separate from the call times.

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. This ensured that people’s rights were protected under the Mental Capacity Act 2005. At the time of this inspection there were no people subject to any restrictions.

There was a registered manager in post at the service. 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.

We last inspected this location in August and September 2014 and we found that the registered provider met all the regulations we reviewed.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

Staff had a good awareness of the support and help that people required. Records showed that people’s needs were assessed and basic information was available for staff. However, we found that robust risk assessments were not always in place, care plans did not consistently describe the support required and how best to support people at times of increased risk. Some care plans were task orientated and lacked person centred information.

Quality assurance systems in place were not always effectively used. Issues we raised during our inspection relating to risk assessments and documentation had not been identified or fully addressed through the registered provider’s quality assurance processes.

Staff confirmed that they received regular supervisions, spot checks and appropriate training to ensure that they had the skills and knowledge required to support people. The registered provider did not always maintain up to date records to evidence these areas. We made a recommendation to the registered provider to improve recording systems at the service.

Staff showed a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA). The registered provider did not have a policy and procedure in place with regards to the MCA. Staff practice showed that consent was sought from people prior to care and support being provided.

Policies and procedures contained out of date information and did not reflect current practice, law and legislation. We saw that the registered provider had started to review these documents.

People received their medication as required. Staff confidently described how they would safely manage people’s medication and described how they had completed competency training in the administration and management of medication. However, written records of such checks were not maintained by the registered provider. Medication administration records (MAR) we viewed had been appropriately signed and coded when medication was given.

People felt safe using the service and told us that staff were quick to respond to meeting their needs when they needed help and support. Staff understood what was meant by abuse and they were aware of the process for reporting any concerns they had and for ensuring people were protected from abuse. Family members told us that they felt reassured by staff and that their loved ones were safe using at the service.

People told us that staff always treated them with kindness and respect. They told us that staff were mindful of their privacy and dignity and encouraged them to maintain their independence. People confirmed and observations showed that staff offered support in a kind, caring and respectful approach.

Safe and robust recruitment procedures were completed by the registered provider. A range of checks to ensure staff were suitable to work with vulnerable people were completed. The service ensured that where possible, staff supported the same people. This enabled people, their family members and staff to build good working relationships and develop confidence in the support provided.

People were referred onto the appropriate services when concerns about their health or wellbeing were noted. Staff worked well with external health and social care professionals to make sure people received the care and support they needed.

The service regularly sought feedback from people and their family members. People were encouraged to share their concerns and were aware of the registered provider’s complaint process. The registered provider investigated any complaints or concerns in line with their own policy and procedures.

At the time of our visit, the service was supporting approximately 100 people, across Wirral.

We looked at nine care plans, spoke with six people who used the service, two of their relatives and six care staff, in addition to the registered manager and the human resources manager. The service was in a state of transition, as it had just taken over another agency and was integrating staff and improving and formulating new policies. The service was also staffed with other staff, such as a finance manager and administrators, as well as the carers.

Records were kept both in paper form and electronically, and we were shown both. The electronic system was a software programme designed for domiciliary care. Planning for visits was done with this programme, time sheets were recorded and care notes completed.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported. People told us that they felt their rights and dignity were respected. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

People were able to remain in control of decisions about their care and lives. The registered manager and the care co-ordinators set the staff rotas, they took people's care needs into account when making decisions about the numbers, qualifications, skills and experience of the staff required. This helped to ensure that people's needs were met. Induction of staff was thorough and training was in place to maintain staff skills so they continued to give good care.

Is the service effective?

People's health and care needs were assessed with them, and they and their relatives were involved in writing their plans of care. People said that their care plans were up to date and reflected their current needs.

One person had been suggested another agency by a health care professional but had refused, saying that Haven Care, 'Were wonderful'.

Is the service caring?

We asked people for their opinions about the staff that supported them. Feedback from people was positive, for example, 'The staff do their best', 'They call in extra if they have time' and, "I never have any problem's'. When speaking with staff it was clear that they genuinely cared for the people they supported.

People using the service and their relatives, completed a satisfaction survey twice a year. Where shortfalls or concerns were raised these were taken on board and dealt with.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People were assured that complaints were investigated and action taken as necessary.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The service was managed by a registered manager. In addition, there were a human resources manager and care coordinators, who managed teams of carers. The owner of the agency worked alongside other staff to meet the needs of the people.

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Overall the people we spoke with were happy with their care. One person said the agency was "very good indeed" and another said: "I would definitely recommend the service to other people.' People told us that carers would generally turn up on time and usually the office staff would call them if there were any serious delays. They told us that they were involved in the care planning process and that senior staff regularly checked to make sure there were no problems.

We found the agency had infection control policies and procedures in place and that staff had received infection control training.

The agency employed enough staff to meet people's needs and had contingency plans for when there were unforeseen staff shortages such as staff illness.

There was a complaints system available for people who used the agency for them to express any concerns.