Helmar Care and Community Services Limited

Helmar Care and Community Services Limited is a domiciliary care agency that provides personal care and support to people living in their own homes and flats. At the time of our inspection, 36 people were receiving personal care and support.

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

The majority of the feedback we received was positive about staff’s punctuality to calls. People received safe care. Sufficient numbers of staff were deployed and met people’s needs. Staff knew how to protect people from the risk of avoidable harm. Comments included, “[Person] feels very safe with them as she recognises them.” Staff understood their responsibility to identify and report potential abuse to keep people safe. Risk assessment and management enabled staff to minimise harm to people.

People’s medicines were managed. Staff practiced safe infection control and prevention procedures to reduce the spread of infection.

Safe recruitment practices and robust induction ensured new staff were suitable to provide care. Staff were trained and received support and supervision which enabled them to undertake their caring roles and to meet people’s needs.

People enjoyed positive and meaningful caring relationships with staff who provided their care. They told us, “She feels safe with them because they are regular carers” and “She has the same carers Monday to Friday and two different carers on Saturday and Sunday. They know her well.”

Staff respected people’s privacy, dignity and confidentiality. People were encouraged to live as independently as possible and to make choices about their daily living.

People’s needs were assessed and regularly reviewed to ensure staff delivered appropriate care to them. Staff supported people to access healthcare services when required. People felt confident to raise concerns about their care and knew the process about how to make a complaint.

Regular checks and audits were carried out on the quality of care and improvements made when needed. People, staff and relatives were given opportunities to share their views of the service and felt the registered manager valued their ideas. People received appropriate care due to the partnership working of the provider with other agencies, health and social care professionals and external organisations.

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.

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 the service under the previous provider was good, published on 29 August 2019.

Why we inspected?

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

Follow up

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Helmar Care and Community Services is a domiciliary care agency providing support with personal care to 42 mainly older people who live in their own houses or flats.

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

People and their relatives told us they were happy with the support they received from Helmar Care and Community Services.

People were safeguarded from the risk of abuse. Risks relating to people’s support were well-managed through the use of thorough risk assessments with appropriate guidance for staff. Medicines were managed safely and there were enough staff to meet people’s needs.

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. People’s needs were assessed when they started using the service. Staff were trained and supported through regular supervision and appraisal. Staff facilitated access to healthcare services and ensured people had adequate food and drink in line with their preferences.

Staff supported people to maintain their independence and provided support with dignity and respect in mind. Staff were aware of people’s specific individual needs.

Helmar provided personalised, person-centred support and had improved their care planning framework since the last inspection. People knew how to complain and were confident the managers of the service would address issues they raised. Staff supported people to maintain relationships where appropriate.

The service had a long-standing registered manager in place, and their positive vision and values were shared throughout all levels of the organisation. Regulatory requirements were met and the service also provided information and advice to the local community. The service used technology to ensure information and concerns about people were shared and quickly acted upon.

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 requires improvement (report published 20 June 2018).

Why we inspected

This was a planned inspection based on the previous rating. 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.

A registered manager was 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.

The last inspection of Helmar Care and Community Services Limited took place in May 2017 when we found four breaches of Regulations relating to risk assessments, medicines management, quality assurance and recruitment checks. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

At this inspection we found the provider had made improvements to meet the Regulations but further improvements were required to attain an overall good rating. Some people using the service continued to experience inconsistencies in the way the service was provided and work was on-going to improve the quality of care documentation kept by the service. This view was shared by commissioners of the service.

People using the service told us they felt safe and the majority of people spoken with said they were supported by familiar staff who knew their needs well. They said that they were treated with dignity, respect and kindness by staff.

Staff had access to training and supervision and were supported by the service. They received safeguarding training and understood how to help protect people from abuse. Safeguarding and whistleblowing policies also gave guidance to staff on how to identify and report concerns they might have about people's safety.

Staff were organised in geographical areas and staffing rotas showed that care staff were consistently allocated to the same people using the service. However we received mixed feedback from people and/or their relatives about the timekeeping of staff. The registered manager told us they were experiencing difficulties in recruiting suitable staff with the right skills and experience.

Improvements had been made to care documentation with new computerised assessment and care plan formats being introduced. This work was on-going.

The service helped to protect people from the risk and spread of infection. Staff told us that they were supplied with the personal protective equipment (PPE) they required and staff members were supplied with gloves, aprons and shoe covers.

Safe recruitment practices were in place to help protect people from the employment of unsuitable staff.

Staff had received training in the MCA (Mental Capacity Act 2005) and understood the importance of gaining people’s consent before assisting them.

People and their relatives felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues.

Helmar Care and Community Services Limited provide domiciliary care and support to 30 people living in Kingston and the surrounding area. This service includes assistance with bathing, dressing, eating and medicines, home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by CQC.

The service had a registered manager at the time of the 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.

We found the service was not as safe as it could be. People did not have individual risk assessments in their care files. The forms we looked at had not been totally completed; they were not dated or signed by staff or the person receiving care. Where risks had been identified risk management plans were not in place.

We found the recruitment processes were not safe. Not all the checks made before a person started to work for Helmar Care had been completed. Specifically, criminal records checks were not in place for staff before they started work and nor had the provider obtained two references from people’s former employers before they started working for the agency. Without these checks the provider could not be assured that people would be kept safe by the people they employed.

Medicines were not administered safely. Medicines administration records [MAR] were not completed correctly. Staff had not always signed MAR charts correctly to evidence they had administered the person’s medicines. The recording errors we saw could mean people did not receive their medicines as prescribed by their GP.

The support plans we looked at did not detail people’s dietary requirements. They were no details about what a person liked to eat or any allergies they may have. The daily notes we looked at only detailed if a person had been given food or drink during a visit and not what they had actually eaten. This lack of information about people’s dietary needs could not ensure people were kept hydrated and nourished by staff when required.

We found the support plans were not as comprehensive as they could be. They did not describe who the person was, the daily support they needed and how they would like to receive that support. None of the support plans we looked at had been signed by the person receiving the support or their representative to show they had agreed to these plans.

The provider did not have effective quality monitoring systems in place so as to identify the issues we found during our inspection. The registered manager had not submitted to CQC the notifications of relevant events and changes as they are required to do by law.

Despite our findings above we received positive comments from people using the service and their relatives. Comments included “Staff are good at their job,” “Staff have been absolutely brilliant,” “They are professional and know what they are doing” and “Staff are caring professionals, they are like part of our family.”

We found the service had taken steps to help ensure staff were aware of how to safeguard adults at risk. All the people and relatives we spoke with said they felt safe with the service they received.

Staff told us they felt well supported by the registered manager and office staff and had appropriate training to carry out their roles. Staff files we looked at contained numerous current certificates of training courses completed.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. The service had up to date policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and consent. These policies and procedures gave staff instructions and guidance about their duties in relation to the MCA and consent.

People and relatives we spoke with felt that their privacy and dignity were maintained by staff when personal care was being given. The provider had a complaints policy that people and relatives we spoke with understood.

We found staff were committed to the support and care of people. The registered manager told us they encouraged a positive and open culture by being supportive to staff and by making themselves approachable.

We found four breaches of the Health and Social Care (Regulated Activities) Regulations 2014 in relation to person centred care, staff recruitment, safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Relatives of people using the service told us that they were very happy with the care delivered and felt that their relatives were treated with dignity and respect by friendly and caring staff. Comments included, "Very respectful" and "More off a friend than a carer".

We saw that individualised care plans were developed following care need and risk assessments. These assessments documented the care and support needs people required. Relatives told us they had been involved in the planning of care. One person said, 'Yes I was involved in my husband's care plan'.

We found that the provider had a safeguarding of vulnerable adults policy and guidelines were in place. Staff had received safeguarding of vulnerable adults training. Prior to employment staff were screened through the Disclosure and Barring Service check (formerly known as Criminal Record Bureau checks).

Appropriate arrangements were in place for the recording of medication administration and we saw that records were signed and dated. There were effective recruitment and selection processes in place and documentation was appropriately collected, completed and recorded in staff files. We saw that staff received regular training and that a staff training log was maintained. Quality assurance systems were maintained including service satisfaction questionnaires and quality audits.

We found that there were procedures in place for ensuring people were involved in the assessment and delivery of their care and this was supported by a comprehensive Service User Guide. People were also involved in providing feedback about a care worker's work by signing a record of care provided on a daily basis.

We found that care workers were provided with support and training prior to taking on their own clients and that training included safeguarding, moving and handling and medication.

Recruitment checks were carried out prior to employment. We found that in some cases the provider had not adequately documented the recruitment decision making by the agency, making it unclear as to why some gaps in employment history, gaps in application forms or other issues were dealt with by the agency.

We found that there was close and regular communication between the agency and the board which governed the provider. We also saw that regular contact was made between the registered manager and people who use services. However, we were not able to see evidence of systems in place to enable the provider to formally assess the quality of performance by the agency or to assess the experience and feedback of people who use the service.