Archived: Havilah Office

There was a registered manager at the service at the time of our inspection. 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 last inspection took place in May 2017 when we rated the service as requires improvement, identified breaches of three regulations and served a warning notice in relation to safe care and treatment. This inspection was planned to follow up on whether the service had taken appropriate action to address our previous concerns. At this inspection we found that the service had not taken adequate action to become compliant with these regulations.

People were not protected from risks to their health and wellbeing because risks had not always been identified and existing assessments were not detailed enough to guide staff about how to manage specific risks. Staff did not know how to mitigate certain risks people faced. A relative told us that they had been required to explain to staff how to keep their family members safe while care was provided.

Care documentation was disorganised and was not reviewed on a regular basis. The information contained did not provide enough detail to enable newly allocated staff to provide person-centred care. People were at risk of not being supported to eat and drink enough because there was inadequate guidance about Percutaneous endoscopic gastrostomy feeding (PEG feeding) and there was no formal system to monitor people’s weight where required.

Medicines were not managed safely. Accurate records about which medicines were given were not maintained. The management team did not know all the medicines that were being provided to people and protocols were not in place when medicines were provided on an as required basis.

Staff were not adequately trained to meet people’s needs. Staff were not fully supported in their role by an adequate induction period, supervisions or appraisals. The provider could not be assured that people were suitable for working in the caring profession because they had not recorded the outcome from criminal record checks.

People were usually supported by their family to access healthcare professionals when they became unwell. However, people were at risk of not maintaining their optimum health because staff did not know what to do in all emergency situations and did not know how to monitor people for signs of infection or deteriorating health.

The service was not organised in a way that promoted safe and quality care through effective monitoring systems. The service was not well led and there was not a clear management structure in place.

There were sufficient numbers of staff deployed to meet people’s needs. People were treated with dignity and respect and a relative told us that the care staff worked well with their family members after a period of settling in. Some attempt was made at offering people choices about care tasks however this was not reflected in the care records. A relative told us they knew how to raise concerns if necessary though no formal complaints had been made since the last inspection.

The provider followed the latest guidance and legal developments about obtaining people’s consent to care. People’s relatives had signed care plans to indicate their involvement in care planning as appropriate.

We found five breaches of the regulations around training, safe care and treatment, person-centred care, good governance and meeting nutritional and hydration needs. Full information about CQC’s regulatory response to any concerns found during inspections is added to the back of the full version of the reports after any representations and appeals have been concluded.

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.

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.

The service provides personal care and support for people living in their own homes. At the time of the inspection there were two people using the service.

There was a registered manager in post who was present during the day of our inspection. 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.

Risks to people’s health and wellbeing were assessed and there was guidance to show how risks were managed, but risk assessments did not include details of who staff should contact in the event any emergencies. Staff had received training to safeguard people from harm; however the provider did not notify us of an allegation of abuse as they are required to do.

Medicines were not managed safely. Staff had received training and people’s relatives expressed no concerns about how medicines were administered, however medicines were not managed safely as accurate records were not maintained.

Enough staff were deployed by the provider to meet the needs of people who used the service and they had been suitably vetted before they began work. Training was completed by staff to update their practice and skills and staff received good support from the management team.

Quality assurance systems were not robust enough and had not identified the concerns we found. In addition, feedback was not sought by the provider to obtain people’s views and seek staff opinions. The last inspection report and rating was not displayed on the provider’s website so people could make an informed decision about using the service.

Care plans were in place to guide staff about how best to support people, but were not personalised to take in account people’s overall assessment of needs. People had access to healthcare services when they needed this and were supported with sufficient food and drinks.

Staff spoke positively about the care they provided and a relative observed the staff to be caring and said that staff provided care in a dignified and respectful manner.

Best interests meetings had been held in collaboration with professionals involved in people’s care and the provider followed the legal requirements in accordance with the Mental Capacity Act (MCA) 2005. People had access to healthcare services when they needed this and were supported with sufficient food and drinks.

We found three breaches of regulations in relation to safe care and treatment, person centred care and good governance. You can see what action we asked the provider to take at the back of the full version of this report.

Our last inspection was completed on 16 February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to quality monitoring, person centred care, consent, medicines management, safeguarding adults from abuse, staff recruitment checks, staffing, complaints, good governance and statutory notifications. We checked whether the provider had followed their plan during this inspection to confirm that they now meet legal requirements.

Havilah Office provides personal care to adults and young people in their own homes in East London. At the time of the inspection there were three people using the service.

There was a registered manager in post. 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.

People were not always protected from risks to their health and wellbeing because risk assessments to guide staff were not always clear.

Medicines that were administered on an as required basis were not managed safely because corresponding care plans or protocols were not in place to guide staff.

There were enough staff to meet people’s assessed needs. People felt safe and were protected from the risk of potential abuse by staff who were suitable to work in the caring profession.

Staff were trained to carry out their roles and were supported by management who used a robust supervision system.

The provider followed the latest guidance and legal developments about the Mental Capacity Act 2005. Staff used a range of communication methods to support people to express their views about their care.

People were supported to get enough to eat and drink and people had access to healthcare professionals.

Staff had developed long-standing, caring relationships with people using the service and respected people’s diversity and privacy. This consistent care team provided care tailored to individuals.

The provider gave opportunities for people to feedback about the service and staff and relatives felt that the culture at the service was open and approachable. The service had made improvements in monitoring the quality of the care provided but further work was required in this area.

We have made one recommendation in relation to monitoring the service.

We found one breach of regulation to medicine management. You can see what action we told the provider to take at the back of the full version of the report.

The people who used the service were happy with the care given to their relative. One person said, 'I have no problems with Havilah Office, the carer is very good.'

We were told the agency had provided the families with information about the service. They were also asked how they wanted the care and support to be delivered. The agency also took into account people's cultural preferences.

We saw that people's care needs were assessed and recorded in their care plans. Risk assessments had been carried out. People told us they felt their relative was safe.

We were told by the people we spoke with that they had been asked to consent to the care given to their relative and knew they could withdraw the consent at any time they wanted to.

We contacted two care workers and spoke with them about the training and support provided by Havilah Office. All of the staff told us they received regular training and supervision, which they found useful.

There were quality monitoring processes in place. This meant that people received their care and support from an agency which regularly checked upon the effectiveness its own practices and procedures.