The Care Quality Commission

Archived: Hillgreen Care Limited

Hillgreen Care (Supported Living) Limited, 70 Upper Street, Islington, London, N1 0NY (020) 7226 8989

Provided and run by:
Hillgreen (Supported Living) Limited (Roger Goddard)

All Inspections

26 April 2013

During a routine inspection

As a result of this inspection we found that the provider had made some improvements to their care plans and risk assessments, however we concluded that these were not sufficient to ensure that each person using the service was protected against the risks of receiving care that was inappropriate or unsafe.

We found that the provider had not taken appropriate steps to ensure that at all times there were sufficient numbers of suitably qualified, skilled and experienced staff to provide care. Suitable arrangements were not in place to ensure that people using the service were protected against the risk of abuse.

The provider had taken steps since the last inspection to improve the supervision arrangements for staff. However, suitable arrangements were not in place to ensure that staff received appropriate training and professional development.

We found that some improvements had been made in the records contained in peoples personal files. However, appropriate records relating to the management of the service were not maintained. The provider did not have an effective system in place that took account of the views of everyone involved in the persons care to regularly assess and monitor the quality of the service provided.

7 September 2012

During an inspection looking at part of the service

At the time of this inspection a service was being provided to three people in their own homes. Five care workers were employed by the agency to provide this care. We visited and spoke with one person receiving a service and also spoke with three care workers. In addition we spoke to the commissioners for one person receiving a service.

We also visited the offices of the provider and spoke with the nominated individual and acting manager and examined a range of documents.

At a previous inspection in March 2012 we had found that the provider was not compliant with several outcome areas. As a result of this we had made compliance actions and taken enforcement action requiring the provider to achieve compliance by the 1st August 2012. We carried out this inspection to review the provider's progress in becoming compliant. At this inspection we found that the provider had made progress in some areas, but that further improvements were needed in others.

During this inspection we found that the care plans for the three people using the service had been reviewed in July 2012. The provider could not show that stakeholders such as care professionals were involved in this review, or that sufficient information was provided to the people funding or monitoring the persons care about the service being provided. This lack of co-ordination meant that there was a risk that people using the service would not receive effective, safe and appropriate care that met their needs.

We examined the care plans of people already using the service and of one person who had recently been referred for a service. We found that the provider could not show that the needs of people using the service, or those people referred for a new service had been appropriately assessed. We found that the care people received or were due to receive, was not planned and delivered to ensure that their needs were met and their welfare protected. We also found that potential risks had not been appropriately assessed to ensure that a plan was in place to ensure the risks were addressed. This meant that people who use the service were at risk of receiving unsafe or inappropriate care.

We spoke with three care staff and examined a sample of training records. We found that the provider had not ensured that all care staff understood the signs of abuse, or aspects of safeguarding processes that were relevant to them. This meant that the provider could not be sure that people who use the service were protected from abuse or the risk of abuse.

We examined the recruitment records for two new members of staff who had recently joined the service. Whilst these records were available we found that for the second staff member the provider had not implemented effective recruitment procedures to ensure that the staff member would not place vulnerable adults at risk.

During this inspection we found that the provider had added autism awareness and communication in learning disability, which reflected the needs of the people using the service, to its training programme. Some staff had completed first aid and Mental Capacity Act training. We looked at the supervision records for care staff and spoke with the acting manager regarding supervision arrangements. We found that as staff worked across more than one service the provider could not be certain that all care staff working with the supported living service had been supervised and were clear about their lines of accountability.

We found evidence that the provider had developed an appraisal system to review care staff performance, but that this had not been implemented for all staff. This meant that professional development was not being promoted and their performance was not being monitored or reviewed.

We asked the provider and people using the service about the systems that were in place to monitor the quality of service provided. The provider could not show that appropriate systems were in place to gather, record and evaluate information about the service provided from all relevant sources. We also spoke with the provider about the systems it had in place to record incidents that affect the safety and wellbeing of people who use the service. We could not be confident that the systems in place would appropriately capture, record and share information about these incidents.

We looked at a range of records maintained by the provider. The provider did not have an appropriate system in place that allowed records to be stored in a secure, accessible way that allowed them to be located quickly.

13 March 2012

During a routine inspection

At the time of this inspection nine people were receiving a service from the provider, however they ceased to provide a service to six of these people shortly afterwards when the supported living service contract was awarded to a different provider.

One inspector visited the offices of the provider on the afternoon of the 13th March 2012. On the same evening we visited a supported living project that was managed and staffed by the provider where six people with learning difficulties were living.

Whilst most of the people receiving support from the agency were unable to tell us about their experiences we were able to observe some interactions with staff at the supported living project and seek the views of their relatives. We also spoke to other families whose relatives were being supported in community placements. In addition we spoke with staff and looked at a range of records including the personal files of people who use the service and personnel records of staff.

Family members we spoke to told us that the privacy and dignity of the person receiving a service was respected whilst being supported with personal care. However we found that some staff were not able to describe the practical steps taken to promote privacy and dignity whilst providing personal care and this meant that we could not be confident that this care was being provided in a sensitive and appropriate manner.

There was little information in the record's of people using the service about their capacity to make decisions for themselves and this meant that important decisions about their care might not be taking place in an appropriate manner. We found that people living at the supported living service were supported to access healthcare appointments.

Relatives we spoke to told us that their family members received regular carers who were only changed when necessary, for example holiday cover.

We found that people referred to the service were not comprehensively assessed and that there was no clear process to refer back to commissioner's when there were issues about the provider's ability to meet the needs of people using the service. This meant that people were potentially being supported where the provider could not meet safely meet their needs.

Each person using the service had an individualised care plan. Some care plans were not regularly reviewed or updated, and not all areas of need were addressed in them. This meant that carers could potentially be unclear about what care was to be provided. Some potential risks had not been assessed, and records detailing the contact between care workers and people using the service were not available in some cases. We were concerned that this could affect the safety, quality and continuity of service provided.

We saw training records that showed that safeguarding training was provided to staff. The staff we spoke with demonstrated an understanding of safeguarding issues and their responsibilities should they have any safeguarding concerns. However, we noted that recent safeguarding concerns had been raised by family members and we were concerned that staff had failed to identify and report potential safeguarding issues. The provider did not inform the Care Quality Commission of safeguarding concerns, and could not readily identify people who use the service who had been subject to safeguarding proceedings.

The provider did not have clear records relating to care workers who held keys for people using the service and this posed a potential safety risk.

There was no manager identified for community based users of the service which could impact upon the quality and continuity of service provided. The provider carried out appropriate pre employment checks on staff and had developed a core training programme. We noted that training on supporting people with a learning difficulty was not included in programme and that some staff had failed to attend training with no indication of how this was being followed up. Whilst staff received regular supervision this did not include direct observation of how they actually delivered care to people who used the service.

The provider had developed quality assurance measures for people using supported living services, however there was no process for reviewing the quality of services provided for people using the service who lived in the community. We found that quality assurance measures did not seek the views of relatives or other professionals.

Where we have concerns we have a range of enforcement powers we can use to protect the safety and welfare of people who use this service. When we propose to take enforcement action, our decision is open to challenge by a registered person through a variety of internal and external appeal processes. We will publish a further report on any action we have taken.