Hales Group Limited - Leicester

Hales Group Limited - Leicester is a domiciliary care agency providing personal care to 34 people living in their own homes at the time of the inspection.

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

People told us they felt safe and confident with the care and support they received from staff. People were safeguarded from abuse and neglect by a staff team who were trained in safeguarding procedures.

Risk assessments had been completed to ensure people were supported to remain safe. There was clear guidance for staff on how to manage people’s risks.

There were enough staff to meet people’s needs. People told us the staff who provided their care were consistent and knew them well. The provider had implemented an electronic monitoring system to help with planning, implementing and monitoring rotas.

People received their medicines safely and as prescribed by staff who had been trained and assessed as competent to administer medicines.

Infection prevention and control (IPC) was well managed and staff were trained in safe IPC practices whilst providing care. Appropriate Personal Protective Equipment (PPE) was made available and worn by staff.

Quality control systems were effective in identifying issues within the service. When issues were identified during audits, the provider developed effective action plans to improve care and drive continuous learning.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

The provider had systems in place to encourage and respond to any complaints or compliments. People told us they were aware of the complaints policy and would feel comfortable approaching the registered manager if they had a complaint.

People and their relatives told us they were involved in the planning of their care. People, their relatives and staff members were given opportunities to provide feedback on the service. The management team acted on the views of people, their relatives and staff members.

The provider and management team had good links with the local communities within which people lived.

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 at 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 this service was good (published 17 October 2018).

Why we inspected

We received concerns in relation to missed and late care calls and a lack of management oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hales Group Limited - Leicester on our website at www.cqc.org.uk.

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.

When we last visited in July 2017, the provider was found in breach of three legal requirements. These were Regulation 11, Consent to care and treatment; Regulation 12, Safe care and treatment; and Regulation 17, Good Governance. We asked the provider to complete an improvement action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive, and Well-led to at least good. During this inspection visit we found the provider had improved.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to both older and younger adults with a range of needs. At the time of our visit, the service supported 44 people.

The service had a registered manager. 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.

There continued to be some people who experienced calls not at the time they expected, but the provider had recently recruited new staff and they hoped this would improve staff attending calls at the expected times. There had not been any recent missed calls.

Medicines were administered as prescribed although staff did not always complete the medicine administration records correctly.

Staff understood the importance of good hygiene and used personal protective equipment such as disposable gloves and aprons to keep people safe from infection.

The provider ensured the risks to people’s health and welfare were identified and staff understood the actions required to reduce any risks to people's health.

Staff recruitment processes reduced the risk of employing staff unsuitable to provide care to people.

The registered manager and their staff team understood the importance of safeguarding people from harm, and how to notify the safeguarding authorities if they were concerned people were not safe.

People received care from staff who were trained to support people’s health and welfare; and who understood the provider’s policies and procedures. Staff understood the importance of confidentiality.

Staff received support in their work through regular meetings with their line manager and through team meetings.

The service was working within the principles of the Mental Capacity Act. People had been assessed to determine whether they could make, and understand the decisions they had made. Staff did not carry out care unless people or their representatives agreed to care provided.

People were satisfied with the support they received from staff in heating and preparing their meals and drinks.

Staff ensured people who were unwell received support from medical services.

People thought staff were kind and caring. Staff were trained to ensure people received care in a respectful way, and one where their dignity was maintained.

People and their advocates were involved in their initial assessments, care planning and care reviews. Care plans provided staff with detailed information about what people’s care needs were, and how they would like staff to support them in their delivery.

People knew how to make complaints, and had opportunities to inform the provider of their views of the service through entries in log books, returns of quality assurance questionnaires, and through care reviews.

The management of the service had improved. The provider had sent an action plan to the CQC following the previous inspection visit, and had worked to the action plan to improve the service provided.

The registered manager met their legal obligations to notify us of events which impacted on people who used the service; and to have their inspection rating easily accessible to people.

At our last inspection on 5, 6 and 7 December 2016 we found seven breaches of legal requirements. After this inspection the provider wrote to us to say what they would do to meet legal requirements in relation to a breach in Person centred care, Need for consent, Safe care and treatment, Safeguarding service users from abuse and improper treatment, Good governance and Staffing. The service was also in breach of the registration regulations failing to notify the Commission of events affecting people. At this inspection we found that provider had made some of the required improvements. However, we found that further improvements were required and three continuing breaches of the Regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Hales Group Leicester provides personal care for people aged 18 years or over who need care or support at home. At the time of the inspection there were 44 people using the service. The majority of people who used the service had their care funded by the local authority.

There was a registered manager at the service. There was also a branch manager in post who had submitted an application to become the registered manager to take over this role from the current registered manager. 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 not consistently protected from risks relating to their health and safety. Assessments of people’s needs had not been completed fully. There was a lack of consistency in the information that had been recorded in assessments of need, care plans and risk assessments. We found that risks associated with some people's care needs had not been assessed. Where people had risk assessments these were not always specific to the person and their individual needs. Guidance for staff was not detailed enough to ensure that staff knew how to meet people’s needs safely.

Staff could identify the potential signs of abuse and knew how to report any concerns. Where incidents had occurred that may cause concern these had been reported appropriately.

People told us that there were usually enough staff to meet their needs. However they told us that the staff were still sometimes late for calls. There was a system in place to record if staff were late or missed a care call. This had not consistently identified where a person’s call had been missed except for when an alert had been put on the system. Alerts were used when people had received a high number of missed calls or needed their care at a specific time. This is a significant reduction from the amount that had happened at the time of our last visit. However this is still a high number of missed calls.

People were at risk of not receiving their medicines as prescribed. The medicine administration record charts were handwritten and the information recorded in these was not always consistent with the prescriber’s instructions. Where people had medicines to take as and when required there was no guidance as to when these could be given. People’s care plans did not always give staff guidance on how people should be given their medicines.

People received care from staff who had not always undergone the appropriate pre-employment checks. We found that appropriately robust references were not always sought to show that staff had displayed good character in previous employment.

The service was not working within the principles of the Mental Capacity Act 2005. People had been recorded as having the capacity to make decisions by the member of staff who had completed the assessment. However the assessment had identified that the person may not have the capacity. We also found that assessments were not carried out in relation to specific decisions that people may need to make. Relatives were recorded as being able to make decisions on behalf of someone without evidence having been seen of their legal right to do so.

Staff received support through an induction to the service and supervision. There was an on-going training programme to provide staff with guidance and update them on safe ways of working.

People were supported to access healthcare services. People had been referred to health professionals for assessments where this was needed. People were usually supported to maintain a balanced diet. Where someone needed to follow a specific diet such as low sugar there was no guidance in the care plan for staff on how to provide this.

People were asked to make choices about their care and staff asked people for consent before they supported them.

People told us that staff were caring. However, some people felt that there was a lack of consistency in the staff who supported them. This impacted on people’s experience of the support that they received. Where people had the same staff regularly they felt they had built a good relationship with the staff and thought the staff understood their needs.

People were usually treated with dignity and respect. They felt that staff asked them before carrying out any tasks. However, one person felt that staff let themselves in without knocking or using the bell despite them asking that this did not happen.

People had been involved in reviews of their care plans to make sure information about them was current. We found that care plans contained some information about what people liked, disliked and what was important to them. However, for some people this information was limited. People felt that staff did not always have the time to provide all of their support.

There was a complaints procedure in place. People and their relatives had used this. Most people had received a response to their complaints. Some people felt that they were not always listened to. Where people had raised concerns about late calls these had not always been recognised as a complaint or responded to.

People’s views about the quality of the service had been sought by the provider twice and the feedback had been given to people as to what actions would be taken as a result of their feedback.

The provider had developed an action plan to address the concerns that we found. They had recorded all actions as being complete. However, there were still concerns with the care plans, risk assessments, needs assessments and medicine records. The quality of the actions had not been fully reviewed. Audits had been undertaken. However these did not always identify and address the concerns that we found as part of our inspection. Where actions had been identified these had not been fully addressed and similar errors were still happening.

There had been 17 missed calls since our last inspection. This is a significant reduction. However, it was still a high number of missed calls. The provider had identified that the calls had been missed and had reported each one to CQC and the local authority as potential neglect.

People told us that the service had improved since our last inspection. Staff agreed this and felt supported in their roles.

The service was led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

We identified that the provider continued to be in breach of three of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see at the end of this report the action we have asked to provider to take.

The inspection took place on 5, 6 and 7 December 2016 and was announced. We gave the provider of the service 48 hours’ notice of the inspection. This was because the location provides a domiciliary care service. We need to be sure that the manager would be available to speak with us. Prior to our visit we had received information of concern about the quality and safety of the service provided. This information prompted our visit.

The month prior to our inspection Hales Group Limited - Leicester had secured a large contract to provide care packages to people who had previously received their care from other providers. This meant that they were providing over double the care calls in the second week of November than they had the previous week. As part of this process Hales Group Limited Leicester had transferred a number of staff from other providers to be employed by the,. We had received feedback from people using the service, their relatives and staff that there were concerns about the quality of the care provided and significant disruption to people's care packages.

There was a registered manager at the service however they had submitted an application to de-register. The registered manager was on leave at the time of the inspection. There was a branch manager in post who had submitted an application to become the registered manager. 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 not protected from abuse. People told us that staff were often late for calls and that they had missed calls completely. We found that there was a high number of missed calls. The irregularity of visits meant that people did not receive care that was vital to their physical health and did not receive food or drink. This is neglectful practice but had not been recognised as such. Incidents of missed calls had not been reported or investigated appropriately. The provider had not checked on people’s welfare to make sure that they were safe when they had not received their care.

Some people had been left in degrading situations, for example, not having their continence needs met.

People were not consistently protected from risks relating to their health and safety. Risks had not always been assessed. People had not had their needs assessed or plans of care put in place to enable staff to understand and meet their needs safely.

There were not enough staff to meet the needs of the people who used the service. There was a system in place to record if staff were late or missed a call however this was not being used to monitor that people were receiving the care that they required.

People were at risk of not receiving their medicines as prescribed. Due to the missed and late calls medicines were not given at the agreed times. We also found that staff had not all received training to administer medicines. People’s care plans did not always give staff guidance on how people should be given their medicines.

People received care from staff that had not always undergone the appropriate pre-employment checks. Staff had not received appropriate training and support to enable them to fulfil their roles.

The service was not working within the principles of the Mental Capacity Act 2005. People had been determined to not have the capacity to make a specific decision without appropriate assessments having been carried out. Relatives were being asked to make decisions on behalf of people without the legal right to do so.

People were supported to access healthcare services.

People told us that staff were mostly caring and that they did their best. However people’s experiences of care were affected in a negative way by the lack of sufficient staff to meet their needs and by the way that the management responded to concerns about their care.

People were not always treated with dignity and respect.

There was a complaints procedure in place. However people and their relatives felt that their concerns were not listened to. Where people had raised concerns these had not been recognised as a complaint, investigated or responded to.

People’s views about the quality of the service had not been sought by the provider as they told us that they felt the responses would be negative. There were no effective systems and processes in place to monitor the quality of the service or the safety. The provider had failed to monitor, assess and mitigate the risks to people using the service.

The provider had taken on a new contract to deliver care to a significant number of people. They had not planned how to do this effectively. The provider did not have plans in place to manage transition. Resources were not adequate to provide a high quality service to people.

People’s packages of care had been transferred to other providers as part of a sub-contracting arrangement. People had not had their needs assessed before the transition. This meant that the provider did not ensure that the new provider was able to meet people’s needs. They also did not transfer people’s packages of care safely.

We identified that the provider was in breach of six of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see at the end of this report the action we have asked them to take.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.