Archived: Stocksfield and Haltwhistle

Since our last inspection in November 2016 the provider had sent us weekly action plans of how they were going to address the concerns and meet the regulations. This inspection was to ensure concerns had been addressed and that the provider was now meeting the regulations.

At the last inspection in November 2016 the overall rating for the service was required improvement with an inadequate rating in well led.

The overall rating for this service is now inadequate and the service has been placed 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.

The provider was given short notice because the location provides a domiciliary care service into people’s homes. We needed to make sure that some notice could be given to people who used the service and also to ensure that key staff would be present at the provider’s offices.

Stocksfield and Haltwhistle provide personal care and support to people within their own homes in the communities of Hexham, Haltwhistle and the surrounding areas. The service is managed from an office on the outskirts of Stocksfield.

168 staff currently provide support to 268 people. The service is available for a wide range of people, including those who are older, those with mental health needs and those with more complex 24 hour healthcare requirements. The organisation on average completed 4452 calls per week, which provided people with 3272 hours of care, although this can vary due to the nature of the service. Many of these calls, for example, were to deliver personal care or administer people’s medicines but other calls may have been to complete housework or do shopping for an individual. The service also offered an enablement service, which provided people with support to remain as independent as possible, avoiding social isolation. This included help to visit shops or other venues important to them.

There was not a registered manager in post at the service. 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 of the Health and Social Care Act and associated regulations about how the service is run.

There had not been a registered manager since the previous one retired. However, a new manager had been appointed a few weeks prior to our inspection and confirmed they were about to start the CQC application process. A new managing director had been appointed in November 2016 and since our last inspection a new nominated individual had taken over. We recognised that the new management team were dealing with issues that were historic in nature and had been embedded into the providers culture.

We had raised concerns in connection with the management of people’s medicines at the last two inspections we undertook at the service. There had been an improvement to the format in which medicines were now recorded. However, we continued to find discrepancies in the way in which medicines were managed. Out of the 14 people we visited, we found errors of some description in the way staff had managed people medicines in 11 of these people. We also found that the medicines policy had not been updated in line with National Institute for Clinical Excellence (NICE) guidance published in March 2017.

Accidents and incidents were recorded on the providers IT system, but we found that actions had not always been recorded and no analysis had been completed to learn from these or spot any trends forming. We asked for a copy of the provider's business continuity plan a number of times and were eventually sent it over a week after the initial request.

Staff had not always followed the requirements of the Mental Capacity Act 2005 (MCA) as records were not always in place to confirm any best interest decision’s had been made or to record if a person lacked capacity. Although we overheard people being asked for their consent before staff embarked on any personal care, we also found some people’s records did not specify as to why particular actions were followed by staff.

People had an assessment carried out when they started using the service. Care records had been updated and reviewed but not in all cases and therefore did not always give clear guidance. Care staff relied on relatives, people and other care staff who verbally shared information with them regarding people's personal care needs.

Surveys had not been completed to gain the views of people, their relatives or staff at the service.

Service audits to monitor and continually improve the service were not effective or were not in place. The shortfalls we found had not always been identified, particularly with regard to medicines.

People knew who to contact if they had a problem or complaint. Verbal complaints reported were logged on the provider's IT system. People told us that the provider looked into any complaints they had raised, but because sections were not always completed, we were not always able to see the outcome or the lessons learnt from each complaint or if indeed the complainant was satisfied.

Staff were recruited safely with a suitable induction completed. Staff had received a range of training, however, we were provided with a training matrix which was not accurate and therefore we could not be sure that staff had received the training reported.

At their supervisions and appraisals staff had the opportunity to discuss concerns and any further training needs. However, not all staff received regular supervision or an annual appraisal. Staff did not feel as supported in their work as they had previously been. However, we recognised that the provider had been subject to a number of staff changes, including within the management team, which was likely to have caused a feeling of unrest within the teams. This was now being addressed

People and their relatives felt safe, cared for and supported by care staff in their own homes. They told us they were treated with kindness and respect and were complimentary about the staff who supported them.

However some people were not happy as they did not have consistent care staff. Where there were missed visits the provider took action to try and prevent the risk of this happening again, although the systems used were not robust. The provider did not always inform people of changes to their rotas or planned care visits.

People were supported to eat and drink by care staff who knew what their food preferences were. The management team consulted health and social care professionals when needed.

The provider had sent the Commission notifications in line with their legal responsibilities.

We found four breaches in relation to Regulation 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to, the need for consent, safe care and treatment, staffing and good governance.

We made one recommendation in connection with the provider's rota system.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 1, 2, 3 and 4 November 2016 and was announced. This was so we could be sure that staff would be available in the office, as it is a domiciliary care service. The inspection included a follow up to the previous regulations which were not met.

Stocksfield and Haltwhistle provides personal care and support to people within their own homes or the community in Hexham, Haltwhistle and the surrounding areas. At the time of our inspection 247 people were active on the services register with over 155 staff members employed. There was a range of people using the service including older people and those with learning disabilities. Staff supported people with a variety of care packages, from shopping to 24 hour support which included personal care 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 the hairdresser.

The service had 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. The registered manager was also the 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 practice around medicines had not improved since the last time we inspected and we found further concerns in the way that staff recorded people’s medicines and the practices that were followed. Accidents and incidents were not always fully recorded and it was not clear whether they had been dealt with effectively by the provider.

People’s records were not always up to date or relevant, including care plans and risk assessments. Reviews had taken place, but not always with the person or their relatives fully involved. There were no monitoring checks in place for care records, medicines or accidents for example. We also found policy and procedure documentation continued to be out of date.

People were encouraged to make their own decisions and where they could not, best interest decisions were made. Where it was considered that people did not have capacity to make decisions, records did not show how capacity was assessed, or detail how 'best interests' decisions had been made. The service did not routinely asked for details of lasting powers of attorney or if a person was under the court of protection. This meant that details may have been missing which were needed to make a best interest decisions and ensure the correct people were involved.

People knew how to complain. However, the provider continued to not have suitable systems in place to evidence that complaints would be dealt with in a timely and effective manner.

People told us they felt safe with care staff. There were safeguarding policies and procedures in place. Staff could tell us what correct action they would take should they have any areas of concern around people’s safety.

There was enough suitably recruited staff to provide quality care to people in their own homes. The provider had ensured the staff were trained to provide the care people needed. This included face to face and eLearning training. Supervision and appraisal systems were in place and staff meetings took place.

People were supported with their nutritional needs, including having enough food and drink and maintaining their choices around these.

People who required additional support from other healthcare professionals, for example GPs, were supported by staff to arrange this. People told us that the staff who supported them were friendly and caring and respected them and maintained their dignity.

Although the some changes had not been initially made, the provider has now made some improvements, although not enough to meet the breaches we found. We have asked the provider to send us weekly action plans and are closely monitoring this information to ensure that actions are taking place to address our concerns.

The provider had not sent us notifications which are a legal requirement of their registration regarding, for example, changes to their registration and had failed to display their latest rating on their website.

The provider was in breach of four regulations; you can see what action we told the provider to take at the back of the full version of the report.

Stocksfield and Haltwhistle provides personal care and support to people within their own homes in Hexham, Haltwhistle and the surrounding areas. At the time of our inspection 318 people were active on the services register with over 140 staff members employed. There were a range of people using the service including older people, people with brain acquired injuries, people with learning disabilities and children. Staff supported individuals with a range of services from shopping only to full 24 hour care or enablement. Enablement is supporting people to do tasks they would not normally be able to do without support; for example, going out to the shops.

The service had 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.

The practice around medicines needed to be improved. We found information not always in place and staff were not always following safe management of medicines procedures.

Accidents and incidents were not always recorded and it was not clear whether they had been dealt with effectively by the provider. Where issues (including complaints) had occurred, actions had been taken but it was not always clear if lessons had been learnt.

We found people’s records were not always up to date, including care plans, reviews and risk assessments. The provider did not have suitable procedures or practices in place to store records securely at their offices and archiving procedures were not effective.

People’s care records were not always reviewed and elements of information was not always fully completed which meant that the provider could not be assured that people’s care needs were fully addressed and tailored to the individual.

People told us that they knew how to complain and would if they needed to. People we spoke with said that complaints had been dealt with to their satisfaction, if they had made one. However, we found that the provider did not have suitable systems in place to allow us to confirm that complaints were dealt with in a timely and effective manner.

People and staff told us the service was well managed. However, we found no recorded monitoring checks in place for care records, medicines, accidents or personal files. We also found policy and procedure documentation was out of date.

People told us they felt safe in the company of the care staff and that their belongings were secure. There were safeguarding policies and procedures in place. Staff knew what actions they would take if abuse was suspected. The provider had dealt with previous safeguarding concerns appropriately.

The provider had dealt with emergency situations, for example, adverse weather conditions and provided an out of hour’s on-call system, manned by senior staff.

There was enough suitably recruited and vetted staff to provide quality care to people in their own homes. The provider had ensured the staff were trained to provide the care people needed. This included basic training, as well as more specialised training using healthcare professionals, when required. Supervision and appraisal systems were in place and staff meetings took place. Care staff told us that management were at hand to support them if they asked.

The registered manager understood the requirements of the Mental Capacity Act 2005. People were encouraged to make their own decisions and where they could not, best interest decisions were made. Although a record of a person’s capacity was normally made available from care managers at the local authority, the service had not routinely detailed what that meant for care staff and how care staff would need to support the people with decision making. The service did not routinely (as part of the assessment process) ask for details of lasting powers of attorney, or if a person was under the court of protection. This meant that relevant details may have been missing in order that best interest decisions were made with the appropriate people involved. We made a recommendation to the provider regarding this.

People received suitable support with their nutritional needs, including adequate food and drink between visits. We saw evidence to suggest that where people required additional support from other healthcare professionals, like GPs, that the staff helped them to arrange this.

People told us the care provided by the staff was good. They remarked on how friendly, approachable and caring the staff were. The registered manager spoke about people with a caring manner and showed he was passionate about providing a good service to people.

Staff provided people with information that enabled them to understand the service they were receiving. People told us their independence was supported by staff at the service and they respected their dignity and privacy.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to regulation 12 safe care and treatment, regulation 16 receiving and acting on complaints and regulation 17 good governance.

The provider had not sent us notifications which are a legal requirement of their registration regarding, for example safeguarding incidents. After requesting further information we have judged these latest findings demonstrate an on going breach of regulations.

We used our enforcement powers with the provider for breaching regulations 12 and 17; and for regulation 16, you can see what action we told the provider to take at the back of the full version of this report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we have found.

Is the service safe?

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw people were safe and protected from abuse. Staff demonstrated to us an understanding of the types of abuse and how they should be reported. All staff had received training in the safeguarding of vulnerable adults and whistleblowing.

Is the service effective?

People who used the service were asked if they understood their rights. People we spoke with were aware of their rights and what to do if there were any problems.

Staff received the appropriate training and professional development to assist them in their role.

Is the service caring?

People were treated with respect and dignity.

People had care plans in place to provide staff with the correct guidance on how to meet people's needs.

People's preferences, interests and needs were recorded in people's care records.

Is the service responsive?

There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.

Is the service well led?

There was a manager in post at the service who was registered with the Commission in line with legal requirements.

The service had a quality assurance system in place that to monitor the performance of the service.

People and their relatives told us staff treated them with respect and helped them to remain as independent as possible. One person said, 'The care staff I have are first class. The girls are marvellous and I couldn't do without them.'

People told us they were happy with the service they received. One person told us, 'It's not just the care staff who are good. The office staff are extremely good and helpful.' A relative said, 'I couldn't fault the carers we get. They're competent and well trained and they know exactly what to do and they just get on with it.' However, we found that care and treatment was not always planned in a way that was intended to ensure people's safety and welfare.

We found staff recruitment procedures were in place and records showed that these were followed when new staff were appointed. We saw appropriate checks were undertaken before staff began work.

We saw the service had an up to date complaints policy and procedure and advice on how to make a complaint was documented in people's service user guides, within their care records.

Peoples care records and staff personal records were maintained and updated regularly. Records were kept securely and could be located promptly when needed.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People and their relatives were generally satisfied with the standard of care provided. One relative with whom we spoke told us that care was, 'respectful' and that communication from Helping Hands was regular and timely. We concluded that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people were protected from the risk of infection because appropriate guidance had been followed.

People told us that they thought staff knew what they were doing. We concluded that staff received the appropriate training for their professional development.

However, the service had received two complaints from people. These complaints were not handled effectively by the provider.