Archived: H & S Care & Medical Professionals

H & S Care & Medical Professionals is a domiciliary care agency which provides personal care to people living in their own homes in the community. 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 this inspection the service was providing personal care to 10 people.

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

Some improvements had been made since our last inspection which took place in August 2019. However, we found examples when records of care and support provided to people were not completed. Also, governance arrangements were not as effective or reliable as they should be. Further improvement was needed in the quality assurance processes to identify shortfalls and to drive improvement. Also, people who used the service and their relatives told us they had not been given the opportunity to give feedback to the service via a quality assurance process. We found no evidence people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed. This could place people at risk of harm.

At the last inspection we found when people were first receiving the service, there were delays in care plans and risk assessments being made available in people's homes. This meant staff did not always have access to clear guidance to assist in the reduction of potential risks or to ensure people's care was managed safely. There had been times when staff had been expected to lift or move people without appropriate instruction in the use of people's equipment. This meant staff had had to rely on verbal instruction about people's needs and preferences.

At this inspection some improvements had been made. Although some people spoken with were not sure they had a care plan in their home, we saw evidence of detailed care plans and risk assessments in place. These set out the actions needed by staff to ensure people were cared for according to their assessed needs and wishes. Staff told us care plans and risk assessments were in people's homes and they were able to look at these and see where changes or updates had been made.

People spoken with who required assistance with moving and handling said they felt safe whilst being moved by staff. Relatives also said they had no concerns about the moving and handling of their family member. Staff told us they had received training in moving and handling people and healthcare professionals were on hand to give guidance and advice. People and relatives spoken with told us they felt safe whilst being cared for by the staff at H & S Care Professionals.

There were enough staff available to meet people's needs whilst adhering to the current restrictions due to the COVID-19 pandemic. The registered manager had managed the current COVID-19 pandemic well, although records of such things as staff testing were not fully completed.

People and relatives spoken with were very happy with the way staff had cared for them during the pandemic. They said staff always wore the appropriate Personal Protective Equipment (PPE) and had very high standards of personal hygiene.

People were happy with the quality of care and support they or their family member received. A small number of people told us newer staff could be better trained and visit times could be improved.

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 03 December 2019) and there was one breach of regulation.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the staffs understanding of COVID-19 protocols and guidance. A decision was made for us to inspect and examine those risks.

During this focused inspection we checked they had followed their action plan and checked to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for H & S Care & Medical Professionals 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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

H & S Care & Medical Professionals is a domiciliary care agency which provides personal care to people living in their own homes in the community. 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 this inspection the service was providing personal care to 21 people.

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

At the last inspection it was identified that, when people were new to the service, care plans and risk assessments were not always made available in people’s homes in a timely way. At this inspection there was evidence that some improvement had been made regarding this. However, some staff told us there were still times when they had had to rely on word of mouth information until care plans were put in place. This meant staff did not always have the written information they needed to provide people’s care and medicines safely.

The registered manager had employed an office manager to help them to deliver improvements in the service. There was evidence of better management oversight and the checks and audits of the quality and safety of the service had been strengthened, and this helped to drive improvement. Although there remained a need for these systems to be embedded into practice. The records kept of people’s feedback had been improved and showed their opinions were sought on a regular basis, so that they could contribute to improvements in the service. Improvements had been made in the way risks and medicines were assessed and in the way people’s care was planned for.

Records had been improved in relation to staff training and support. They showed staff received training and support to make sure they had the skills and knowledge to carry out their role effectively. However, some staff told us there were times when they felt they needed better training and instruction in the use of the moving and handling equipment people used.

Records had been improved in relation to people’s capacity to make certain decisions and better reflected the consent given for their care. 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.

Feedback about the service from people and their relatives was positive. People were protected against the risk of abuse and staff underwent pre-employment checks to make sure they were of good character and suitable to work in care.

Where part of their care package, people were appropriately supported meals and drinks, and in gaining access to health care service.

People were happy with the staff and said the same staff usually provided them care, maintaining consistency and helping establish good relationships. People told us staff were helpful, caring and friendly. They felt they were involved in decisions about their care and staff respected their wishes. People told us they were treated with dignity and respect.

Rating at last inspection:

The service registered with CQC in 2017. At the first inspection in 2018 the service was rated Requires Improvement (inspection report published August 2018). and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the previous breaches had been met. However, enough improvement had not been made and sustained, and we found a new breach of regulation. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

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

H & S Care & Medical Professionals is a domiciliary care agency which provides personal care to people living in their own houses and flats in the community. At the time of the inspection the service was supporting 13 people with varying needs, this included older people, people living with dementia and children with a learning disability.

The service had a registered manager in post 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 and associated Regulations about how the service is run.

Most of the people we spoke with told us they were satisfied with the way the service was run. However, they identified some areas they thought could be improved. People said their privacy and dignity was respected and staff were caring and helpful. However, written records did not always reflect the positive aspects of the service people told us about.

Systems were in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. However, guidance on how staff should manage each area of risk was not always as detailed as it could be and appropriate staff training in this topic could not be evidenced.

Recruitment processes to help the employer make safer recruitment decisions when employing staff had been carried out, but documentation was disorganised. Staff told us the registered manager had worked with them to help them understand people’s needs, but documentation did not demonstrate staff had received a structured induction to the company, or timely training in all essential topics.

Staff received regular group support from the registered manager at weekly meetings, but regular one to one sessions had not been incorporated into routine practice. The registered manager had begun to meet with staff on a one to one basis to appraise their work performance and offer support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, there was room to improve the written information in people’s records in relation to their capacity and consent interest. Not all staff had completed training in this topic.

Where possible, people were encouraged to manage their own medication, with some people being supported by relatives. Where assistance was required support was provided by staff. They told us they had completed medication training and their competency in this subject had been checked by the registered manager, but there was no documented evidence to support the latter.

People’s needs had been assessed before their care package commenced and we found they, and/or their relatives, had been involved in these assessments. People told us their needs were being met by staff. However, not all the people we spoke with had a written care plan in their home to inform and guide staff. Where plans were in place they provided information and guidance to staff, which assisted them to deliver the care people needed, in the way they preferred.

The registered manager told us the complaints policy was provided to people using the service along with other information about how the service intended to operate. However, some people said they had not received this information. When people had raised concerns, these had been addressed by the registered manager.

The service had only been supporting people in the community since February 2018, therefore the process for consulting with people about their satisfaction in the service was still being formalised and embedded into practice. In the meantime, the management team were speaking with people on a regular basis and had begun to record comments made during telephone conversations.

The registered manager was checking some processes to make sure staff were following company policies, such as the completing of visit records. However, the system needed to be refined and embedded into practice.

During this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.