This was an unannounced inspection, which took place on 9, 10 and 12 May 2017. This meant the service did not know we were coming on the first day. We returned to the service’s offices for a second day of inspection. On the third day, with prior consent, we visited people in their homes. The service was last inspected in January 2016 and rated ‘Requires Improvement’. Human Support Group – Didsbury, also referred to as Homecare Support, Didsbury (HSG – Didsbury) is a domiciliary care service which provides personal care and support to people in their homes to help them remain independent. The service also offered practical care tasks such as sit-in services, domestic support and sleeping/waking night services. HSG – Didsbury supports people living within the Greater Manchester. Prior to this inspection the service supported people in living in Manchester and Stockport. The care manager told us due to recruitment issues and concerns about the quality of care suffering as a result, the provider made the decision to stop service provision in Stockport from 31 March 2017. The provider facilitated the smooth transfer of 16 people being supported to suitable alternative providers with the support of the Stockport Council. This helped to ensure people supported were not adversely affected. At the time of our inspection, the service supported 109 people.
At the time of this inspection, the service had not had a registered manager since September 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 current care manager had been in post since November 2016 and was in the process of registering with the CQC.
People told us they felt safe with the care and support provided by the service. They told us there was a regular team of care staff who visited them during the week but that this was variable at the weekend. This meant people were not always supported by people who knew their specific care needs.
We noted the provider had systems in place to help ensure suitable candidates. Where adequate references were not collected, we saw no evidence that had potential risks had been considered and appropriate steps taken to mitigate these.
Risk assessments did not always provide clear and specific information to help staff deliver care and support safely. This meant people were potentially at risk of harm.
Staff were aware of safeguarding principles and knew what to do in the event they suspected abuse was taking place. We noted the provider’s safeguarding policy referred to outdated legislation which meant staff were potentially referring to documents that were not completely fit for purpose. The care manager showed us they referred to current local authority safeguarding policies and procedures.
People and relatives told us care staff demonstrated good hygiene practices by using personal protective equipment (PPE) such as gloves and aprons, and washing their hands as required. If used appropriately, this practice should help to prevent cross contamination and the spread of infection.
Where required people and relatives told us they were safely supported to take their medicines. The service used a medication support plan and risk assessment which helped staff to support people in a safe and effective way.
We noted there was an effective system of reporting and monitoring accidents and incidents that took place within the service. We saw that lessons learnt were shared across the provider’s network of services.
People and relatives told us staff were competent in delivering care and support.
We checked to see how the service ensured the principles of the Mental Capacity Act 2005 were adhered to. In some people’s care plans we saw relatives had signed, consenting to care on their behalf without evidence that they had the legal authority to do so. It is important to note that relatives may, and usually should, be consulted about the proposed care and support, and their views taken into account, but this is not the same as consent. They do not have automatic legal authority to provide permission for the proposed care or treatment.
We advised the provider to record when they had requested information from the local authority about a person’s capacity and to record changes to capacity when reviews were done. This should help to ensure people’s care and support were delivered in their best interests.
People and their relatives told us care staff always sought their permission before supporting them and that they had the chance to explain to staff how they preferred to be supported.
The service had formal systems in place to train and support staff. We noted not all staff had undertaken required refresher training according to the provider’s policy. There were gaps in key areas such as moving and handling, safeguarding and mental capacity awareness. This meant some care staff were not up to date with the knowledge and skills needed to support people safely and effectively.
Care staff told us if they observed that people needed healthcare support they would report these concerns to the office and record them in people’s daily comments book. In the event of an emergency they said they would telephone the most appropriate agency, for example, the paramedics. People and relatives told us they knew care staff would support them if they needed any medical attention. This showed staff could be proactive in making sure people received the right health care when they needed to.
People and their relatives told us care staff were kind and considerate to them. Staff demonstrated they knew people well and people said they had developed a good relationship with their care staff. This meant people were supported by people who understood their care needs. People said they were treated with dignity and respect and encouraged to maintain their independence depending on their abilities. This helped to promote their continued wellbeing.
People and relatives told us they had been involved in care planning decisions and care plans we looked at confirmed this. They said care staff supported them to maintain their independence according to their abilities. Care staff were able to give us examples of how they did this.
Each support plan contained personal and medical information about people, their preferences, personal goals and how they wanted to be supported. Plans we looked at contained detailed descriptions of support provided. Care and support was not consistently provided in a responsive way. Support plans had not been reviewed in accordance with the provider’s policy which meant that people’s support may not have been appropriate to their current needs.
Everyone we spoke with knew how to raise a complaint and most people were satisfied with how their complaint was managed. There was a robust complaints process in place which meant complaints were managed effectively.
People told us they provided feedback on the service they received through a satisfaction survey sent every six months. We noted the overall response was positive but the number of responses returned was poor, meaning the response was not reflective of all the people receiving care.
We received mixed responses from people and relatives regarding the management of the service. Some people and relatives raised concerns about the continuity of care because two care coordinators were leaving the service. We saw that senior management had addressed this issue and had organised support from other services to assist. A new coordinator had been recruited into the post and was undergoing their induction and the other role had been advertised. This demonstrated the provider was proactive in ensuring people receiving services were not affected as a result.
The provider had quality assurance systems in place to monitor, for example, staff performance, care plans and medication administration. These did not consistently identify areas requiring improvement. This meant the care manager and provider could not be assured that all aspects of the service provision was safe and effective.
Since the appointment of a care manager, staff meetings had resumed. We saw two meetings had been held since their appointment with further meetings scheduled for the rest of the year 2017. This meant care staff had the opportunity to discuss issues relating to their work and ensure they were always kept up to date on matters affecting the service provision.
We made two recommendations that the provider ensures recruitment processes are robust and fit for purpose and operational policies and procedures are reviewed and updated as appropriate.
During this inspection we identified three breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.