30 January 2017
During a routine inspection
This announced inspection took place on 30 and 31 January and 1, 3 and 7 February 2017. The inspection was announced so we could be sure that staff would be available in the office, as it is a domiciliary care service, and to allow that people who used the service to be informed that an inspection was underway. We planned this inspection to follow up on the breach at the last inspection. We subsequently decided to complete a full comprehensive inspection of this service because there had been a number of concerns raised regarding the providers other service and we wanted to confirm that the same issues were not replicated at Helping Hands Community Care - Blyth.
Helping Hands Community Care - Blyth provides personal care and support to people within their own homes or the community across the whole of Northumberland. At the time of our inspection over 900 people were active on the service's register with 415 staff members employed to provide various forms of care and support.
A range of people used the service including older people, young adults, children, those people with complex care needs, those with a mental health condition and those with learning disabilities. Staff supported people with a variety of care packages, ranging from shopping and sitting services to 24 hour support which included personal care, meal preparation and administration of medicines. The service also offered an enablement service. This means staff support people to do tasks they would not normally be able to do without support. For example, going out to the shop or visiting friends or family members.
The service had a manager in post who had started the process to apply to become a registered manager. 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 2008 and associated Regulations about how the service is run. The provider had recently appointed a new managing director and a new nominated individual. A nominated individual has responsibility for supervising the way that the regulated activity is managed. They should be an employed director, manager or secretary of the organisation.
The provider had failed to fully meet the requirement notice relating to the previous breach of Regulation 17, good governance.
Medicines management needed to be improved. For example, staff had not always fully recorded administration of people’s medicines and this made it unclear if people had received their medicines on time and as prescribed. The provider had started to make some improvements in this area.
People’s records were not always up to date or relevant, including care plans and risk assessments and capacity assessments. Reviews of people's care records had taken place. There were no robust quality monitoring checks in place for care records, medicines procedure or full health and safety within the service. We also found policy and procedures were not always in date or in place.
People were encouraged to make their own decisions and had choice in what they wanted to do. A record of a person’s capacity was made available from the local authority if the person was contracted through them. However, the service had not routinely assessed people’s capacity or what that meant for care staff, particularly those privately funded.
The service had not routinely asked for details of lasting powers of attorney or if a person was under the Court of Protection. This meant details may have been missing which were needed to make a best interests decision and ensure the correct people were involved.
People and their relatives told us they felt safe with the service offered. Staff were able to describe correctly what actions they would take if they suspected any abuse occurring.
There was enough staff to provide cover to all of the people who received care and support from the service. However, we have recommended that the provider review scheduling rotas and staff travel arrangements to ensure enough time was allocated for care delivery and to maintain staff welfare.
The provider was rolling out a new training programme to ensure staff were up to date with best practice.
Staff told us they felt supported. Supervision and appraisal systems were in place, although there was not a consistent approach and records were not always in place. Staff meetings took place. We have made a recommendation that all meetings are recorded.
People who received support with meals and drinks told us staff supported them well and helped them to maintain their nutrition and hydration levels, including offering them choice in the support they received. People who were supported with activities as part of their care package confirmed staff helped them to remain socially connected.
People who required additional support from other healthcare professionals, for example GP’s, were supported by staff to arrange this.
People and their families were complimentary about the kind and caring nature of the staff who supported them. They confirmed that dignity was maintained and staff respected them as individuals.
People knew how to complain and we found staff had dealt with any complaint received appropriately and within suitable timescales.
We found two breaches of Regulations with regard to Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The provider had not sent notifications to the Commission which are a legal requirement of their registration regarding, for example, notifications of change to the registered manager. That meant they were in breach of Regulation 15 of the Care Quality Commission (Registration) Regulations 2009.
You can see what action we told the provider to take at the back of the full version of the report.