Archived: Home Is Where the Help Is Ltd

The service is a domiciliary care agency which provides personal care to people living in their own homes throughout Northumberland. At the time of this inspection there were 28 people using the service.

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 felt very safe with the staff who visited them. People’s care needs were risk assessed and measures were in place to reduce risks. Accidents and incidents were investigated, recorded and acted upon to prevent a repeat occurrence.

Staff were fully aware of safeguarding processes. Solid systems were in place to protect people from the risk of harm or abuse. Medicines were well managed and there were good infection control measures in place.

Staff recruitment was safe and there were enough staff to safely deliver a consistent service. We have made a recommendation about the job application process to ensure best practice guidelines are followed.

The registered manager promoted a person-centred culture. There were good working relationships between staff, relatives and external professionals to ensure people got any additional support they needed.

Significant improvements had been made to the service and the whole staff team continued to learn and develop. The registered manager carefully monitored the quality and safety of the service. All regulatory requirements were met.

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 requires improvement (published 9 August 2019) where we identified one breach of the regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and 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. The overall rating for the service has changed from requires improvement to good. 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 Home Is Where the Help Is Ltd 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.

Home Is Where The Help Is Ltd is a domiciliary care agency. It provides personal care and support to people living in their own homes. It provides a service to a range of people including those living with a dementia and physical disabilities. 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 inspection there were 12 people using the service and 11 people were receiving the regulated activity of personal care.

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

At our previous inspection we found a breach of regulation 7, 9, 11, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to the accuracy of care records, medicines not being safely managed, risks to people were not identified, people’s needs not being fully assessed or reviewed, the suitability and training of all staff, the provider not delivering personalised care, safeguarding incidents not being shared with the local authority, and there were no systems in place to allow for the monitoring of the care provided to people. At this inspection we found improvements had been made to all areas apart from the quality and assurance systems in place. This was a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The quality and assurance systems in place were not fully effective in monitoring the safety and care provided to people. Risks had not always been fully identified and mitigated. Some people’s records did not fully detail the support they were being provided with or contained documented reviews.

Medicines were not always safely managed. Some records were not fully accurate and people’s care plans did not include all support provided with medicines. We have made a recommendation about this.

People were positive about the care they received from staff. Staff knew people well and delivered personalised care which met their needs. Staff worked in partnership with other health and social care agencies to provide responsive and continuous care to people.

Staff received training appropriate to their roles. All staff had their suitability checked and were safely recruited before delivering care to people. A full induction was provided before staff began supporting people.

People told us that staff were respectful of their privacy and dignity. Staff spoke caringly about people and knew their personal preferences.

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 (and update)

The last rating for this service was inadequate (report published 05 March 2019).

At our previous inspection, we identified multiple breaches regulations. At this inspection we found a continued breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements had been made to all other areas.

This service has been in Special Measures since our inspection in March 2019. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the governance of the service. Details of action we have asked the provider to take can be found at the end of this report.

Follow up

We will continue to monitor the service through information we receive from the service, provider, the public and partnership agencies. As part of our process we will be requesting an action plan to be completed to address the issues identified. We will re-visit the service in line with our inspection programme. If we receive any concerning information we may inspect sooner.

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.”

At this inspection we identified a number of concerns and shortfalls resulting in a breach of regulation 7 (requirements relating to registered managers), regulation 9 (person-centred care), regulation 11 (need for consent), regulation 12 (safe care and treatment), regulation 13 (safeguarding service users from abuse and improper treatment), regulation 17 (good governance), regulation 18 (staffing) and regulation 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of regulation 18 (notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009.

These breaches were because the registered manager did not effectively manage the regulated activity, the provider did not have oversight of service, staff were not safely recruited, safeguarding incidents were not escalated to the local Safeguarding Adults team, staff did not receive appropriate training or induction, the provider had not appropriately assessed the risks to the health and safety of people using the service, medicines were not safely managed, consent was not sought before supporting people, there was no governance framework in place and the Commission was not notified of a safeguarding incident which effected a service user.

Home Is Where The Help Is Ltd is a domiciliary care agency. It provides personal care and support to people living in their own homes. It provides a service to a range of people including those living with a dementia and physical disabilities. At the time of inspection there were 27 people using the service and the service was unable to inform us how many people were receiving the regulated activity of personal care.

There was a registered manager in post who has been registered with the Care Quality Commission (CQC) to provide regulated activities since August 2018. A registered manager is a person who has registered with the 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 registered manager and provider were not meeting all of the requirements or regulations and had not submitted notifications to the Commission.

During the inspection we found that there was no governance framework in place to assess, monitor and improve the quality and safety of the service. Accidents and incidents were not recorded. There was an infection control policy in place but staff had not received training around this. Staffing levels reflected the needs of people using the service and visits were appropriately scheduled to meet people's needs. This meant the service did not have enough suitable staff available to support people, as the service did not safely recruit staff or provide training. Records did not show that people had consented to the delivery of care. People did not have comprehensive care plans or initial assessments in place in their care records.

Risks people faced had not been identified, assessed or mitigated. The service was not using suitable staff to support people with care in their homes. Staff had not received training around safeguarding vulnerable adults as part of their induction or on-going training. Staff were not safely recruited and had not been provided with induction training required for them to safely support people. There were policies in place designed to help keep people safe from abuse, these included the provider's safeguarding vulnerable adults' policy and information for people and relatives about reporting abuse. People told us they felt safe with the care provided by staff from the service.

Medicines were not safely managed; best practice guidance was not being followed by staff and staff had not received training around medicines. People did not have medicine care plans in place with all of the necessary information needed to fully support people. Care plans for 'as required' medicines were not completed and not recorded on people’s medicine administration records. Records regarding other professionals involved in people's care were missing from people’s care records.

There were no records to show the service was actively requesting feedback from people to help assess and improve the quality of care delivery. People told us that staff treated them with kindness, dignity and respect whilst delivering personal care. People were supported to maintain social relationships through enabling sessions with staff. There was an equalities and diversity policy in place at the service but staff had not received training around this.

There was no complaints procedure in place but people and their relatives were provided with information on how to raise a complaint when joining the service. The were no complaints received or records available to demonstrate this. People and their relatives told us that they felt confident in raising a complaint and who they would contact. No one was accessing an advocacy service and people we spoke to were unaware of this type of support available if they needed it.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Assessments had not been made for people for safety reasons in line with the Mental Capacity Act 2005. Staff did not receive training around the MCA.

You can see the action we have asked the provider to take at the back of the full version of this report.