Background to this inspection
Updated
24 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection. We also wrote to people who used the service to let them know we might be calling them, a few days before we did so.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. This information helps support our inspections.
What we did during the inspection
We spoke with four people who used the service and six people's relatives about their experience of the care provided. We spoke with eleven members of staff including seven care staff, the care manager, the regional director, the director of care and head of compliance.
We reviewed a range of records. This included four people’s care records and medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including training, supervision, as well as care safety and quality monitoring were reviewed.
Updated
24 August 2019
About the service
Human Support Group - Liverpool is a domiciliary care agency providing personal care to 53 people with different health and care needs in their own homes at the time of inspection.
People’s experience of using this service and what we found
People’s experience of using the service varied. Although we heard compliments and praise, particularly for staff that regularly visited people, there were also inconsistencies. Staff and managers were honest about the fact that the last six months had been unsettled and difficult. There had been several changes in managers, which meant issues, including with staffing, concerns, person-centred planning and quality of care, had not always been addressed. We found breaches of regulation with regards to nutritional and hydrational needs, as well as record keeping and quality monitoring. Staffing had much improved, but the planning and deployment of staff needed further review to meet people’s needs consistently. We made a recommendation regarding this.
However, we heard consistent agreement that a new care manager had already made significant, positive changes in the few weeks they had been in post. Staff felt the service was now improving and was the most settled it had been in a long time. The new manager was honest and clear about the fact there was much work to do and they had recognised the improvement needs we identified. They explained to us how they would work to achieve safer, better person-centred care and ensure people, relatives and staff were reengaged and listened to. The care manager brought a unique passion and dedication to their role, which we considered would help them to achieve this.
Although feedback varied about how well staff met people’s needs and listened to them, we also heard much praise. People commented that staff on balance were kind and very helpful. We heard concerns from relatives but also at times very positive comments about their delight with care. The service worked effectively with other professionals and we received some compliments about this.
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 this service was good (published 11 July 2017).
Why we inspected
This was a planned inspection based on the previous rating. The inspection was prompted in part due to concerns received from different sources, including the provider’s notifications, about people’s safety, staffing, person-centred care and planning, as well as service management. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to meeting people’s nutritional and hydration needs, as well as record-keeping and other aspects of service 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 for 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.