Hadley Care

Hadley Care is registered with the Care Quality Commission (CQC) as a domiciliary care service where care and support is provided to older people who live in 12 lodges. At the time of the inspection 80 of the 82 people being supported by Hadley Care received a personal care service. 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 understood they had the right to choose to receive care from an external agency if they wished.

The 12 lodges where Hadley Care provided a service were in various locations in the North Devon area and managed by Fremington Homes Limited. Five to ten people lived together in each lodge. Each person had their own en-suite bedroom, and there were communal areas where people could come together and socialise. The same provider owned both Hadley Care and Fremington Homes Limited, but they were run as separate organisations. People had separate tenancy agreements and all repairs and maintenance to the property were met by Fremington Homes Limited.

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

People and relatives were confident people were safe and well protected from the potential risks of abuse and avoidable harm. Staff received training to safeguard people from harm and were knowledgeable about the risks and potential signs of abuse. Safe and effective recruitment practices helped ensure staff were of good character and sufficiently experienced, skilled and qualified to meet people's needs.

People were supported to take their medicines as prescribed and other risks to their health and wellbeing were managed safely. The provider had good systems to manage safeguarding concerns, accidents and incidents and infection control.

Newly recruited staff completed a comprehensive induction programme. Staff received training in a range of subjects relevant to their roles and were well supported through supervision, appraisal and regular observations of practice. A focus on improving staff wellbeing helped them to carry out their roles confidently and effectively.

People’s relatives complimented the staff team for the care and support they provided. Staff were caring, kind and passionate about their role. They knew people well and had developed positive and meaningful relationships with them. People were respected, and their privacy and independence promoted. The registered manager was proactive in ensuring that an equality, diversity and human rights approach was firmly embedded at the service.

People received personalised care and support. Their needs and preferences were assessed, and the care provided was based on this assessment. Detailed information and guidance helped staff provide consistent care and support in a person-centred way. Care plans were reviewed regularly with people to ensure they still met their needs.

People and their relatives knew how to make a complaint, and complaints were managed in line with the providers complaints policy. There was an ethos of reflecting and learning from complaints and significant events, to identify any action needed to minimise the risk of recurrence.

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.

The management team undertook checks and audits in a wide range of key areas to help ensure a safe service was maintained. The provider routinely distributed feedback forms to people, staff members, relatives of people who used the service and health professionals to gain their opinions on the service provided.

The management team were clear about the provider's values and were proactive in ensuring these were understood and put into practice by the staff team.

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 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hadley Care 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.

The 12 lodges where Hadley Care provided a service were in various locations in the North Devon area and managed by Fremington Homes Limited. Six to nine people lived together in each lodge. Each person had their own en-suite bedroom but the lodges had communal areas where people could come together and chat. The same provider owned both Hadley Care and Fremington Homes Limited, but they were run as separate organisations. People had separate tenancy agreements and all repairs and maintenance to the property were met by Fremington Homes Limited.

At the last inspection on 1 and 2 August 2016 we rated the service as ‘Good’ overall. However, we rated the service as ‘Requires Improvement’ under the key question ‘Safe’, because the information staff needed to minimise risks to people was not always recorded in their care plans. In addition, although people’s care needs were being met, staff were working extra hours to cover the shortfall in the numbers of staff available to support people . Following the inspection we received a complaint regarding the numbers of staff , nutritional support and the involvement of relatives in the planning of people’s care. We looked in detail at the issues raised in the previous inspection and in the complaint. We found no areas of concern relating to these matters during this inspection.

At this inspection we found significant improvements in the assessment and recording of risk in people’s care plans, which meant staff had the information staff needed to keep people safe. The risk assessments were reviewed regularly to ensure they remained current. Where improvements were needed, for example related to the monitoring of fluids, the registered manager acted immediately to ensure this risk was managed more effectively. Risk assessments also supported people to take positive risks, enabling staff to promote their independence and do what they wanted to do in a safe way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

There were sufficient numbers of staff to keep people safe and meet their needs. A successful recruitment campaign meant that the number of staff to support people had increased significantly. This was confirmed by staff and people we spoke to, however two people felt the service could be improved if there were more staff to support them in the evenings or if someone was unwell. The registered manager advised there were systems in place to ensure there were sufficient staff if additional support should be needed. In addition the service had recognised when people needed more support than could be provided by a supported living service, and some people had moved to a more appropriate setting for their needs. The service now carried out a more rigorous pre-admission assessment, and was much clearer with people and their relatives that they could not always support people with very complex needs.

Staff had a good understanding of people’s nutritional needs. Risk assessments were in place, for example if people were at risk of choking. People had been referred for specialist support if required, and guidance followed.

Families were very much involved in life at the lodges. People’s relatives said they were always made very welcome and visited whenever they wished. Where appropriate they were kept informed about the welfare of their family member and contributed to the planning and review of their family members care. The registered manager told us, “It depends on their individual situation. If they have capacity we will ask them if they want a family member involved.”

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.

The registered manager had a clear vision for the service. There was an open and transparent culture of admitting when things had gone wrong, learning from mistakes and using this to drive improvement. They told us the feedback from the last inspection had ,“acted as a trigger for us to actually see how we can do this better”. This had resulted in a review of policies, processes, paperwork and staff roles and responsibilities. They told us their ethos was, “providing the best quality care in a person centred and dignified way and incorporating that culture into the lodges”. These values were promoted and shared throughout the organisation. This was reflected in the recruitment processes, staff training, supervision, and our observations and discussions with staff and the people using the service.

People were supported by a caring staff team who knew them well. The atmosphere in the lodges was happy, relaxed and welcoming, and there was a wide range of activities available if people chose. People commented “We’ve got a lovely lot of carers you know” and, “When its your birthday they give you a party, with music!”. They told us they felt safe, and regarded the staff as their friends. A relative told us,“[Family member] is definitely safe there. It gives me peace of mind. It’s lovely, a really relaxed atmosphere. They’re in the best place”.

People were protected from the risk of abuse through the provision of policies, procedures, robust recruitment and staff training. The registered manager and provider had worked closely with the local authority, acting promptly and decisively to address concerns and minimise risk.

Staff received appropriate training to support people’s mental and physical health needs. People received their medicines safely and were supported by a range of external health and social care professionals.

The service’s quality monitoring systems enabled the service to maintain high standards of care and to promote continuing service improvements.

At our last inspection in May 2014, the provider was fully compliant in the areas we looked at.

Hadley Care Limited is registered with the Care Quality Commission (CQC) as a domiciliary care service where care and support is provided to older people who live in 12 lodges. Six to nine people lived together in each lodge. Each person has their own en-suite bedroom but the lodges have communal areas where people can come together and chat. These lodges are in various locations in North Devon area and are managed by Fremington Homes Limited. The same provider owns both services but they are run as separate organisations. People have separate tenancy agreements. On the day of inspection, with the exception of two people who looked after themselves, all the people living at Fremington Homes received care and support from Hadley Care. People understood they had the right to choose to receive care from an external agency if they wished.

All repairs and maintenance to the property were met by Fremington Homes Limited.

The service had 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.’

People felt safe with the staff who supported them. They told us, “Staff look after us so well and make us feel safe” and “I didn’t realise how safe I was until I came to live here and it is as good as it is.” People were relaxed and comfortable with the staff who cared for them.

People received care suitable for their needs. Staff knew people well, understood them and cared for them. Each person had risk assessments and a care plan in place to support their needs. However, some of those records seen required more information to enable staff to give care in a consistent way. People received their allocated care hours. The majority of people received their core care hours during the day but staff were also on duty during the night. There was an on-call service where a manager could be contacted for guidance outside of normal hours..

People said staff were kind, caring and friendly who helped them to maintain their independence. People were very complimentary of the staff and comments included, “Staff are very attentive … nothing is too much trouble … they are dedicated … they are good all the way down the ladder with no exceptions” and “The attitude of staff here is very sympathetic and caring … they are happy to help and it shows”.

Staff were recruited safely, were well trained and received supervision in their work. They felt appreciated, listened to and part of a team. People’s needs were being met but this was from staff working excessive hours. The registered manager was actively recruiting to increase numbers. Staff were able to demonstrate an understanding of what abuse was and how to recongise and report it should they have any concerns.

People received the medicines prescribed for them. They chose to either manage their medicines by themselves or have staff support them. People had access to community healthcare services, such as community nurses, GP’s, opticians and dentists. Accidents and incidents were monitored, recorded and followed up if any action was required.

People were complimentary of the food served and helped to choose the meals served each week.

There was a complaints policy and procedure in place with information about how to raise concerns or complaints. Complaints received were fully investigated. No complaints were raised during the inspection but one was raised after the inspection. The registered manager was in the process of addressing the concerns.

The culture of the service was open and welcoming. People were able to choose to see their relatives at any time they wished. People and their relatives were involved in making decisions about how the service was run.

There was a range of quality monitoring systems in place to improve the service. Despite these not always being recorded, the registered manager was aware of any shortfalls in pactice and was addressing them.

Hadley care clear values about the service which the registered manager and care staff promoted.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found the service was safe because people who received support from the service told us the staff looked after them and treated them well. One person said "The carers are all very kind to me". Another person said "All the girls are lovely". People told us they could speak with the staff or their manager if they had any concerns.

Staff we with spoke with told us that they received training in a range of health and safety areas such as moving and handling, medication awareness, and safeguarding. This meant staff were enabled to deliver care and support safely.

On the day of our inspection we met six people who were supported by the service and they looked happy and relaxed. They told us that the support they received made them feel safe and reassured. A relative we spoke with said that the support their relative received gave them peace of mind, and allowed them to go away without having to worry.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw comprehensive assessments of need were done before a person received support. A care and support plan then identified in detail for staff what support a person needed, when, for how long, and their preferences. We saw the manager did regular checks on medication, and spot checks were carried out to make sure care and support were being delivered safely by the staff.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards, however this does not apply to domiciliary care agencies.

Is the service effective?

This service was found to be effective because people told us that the service supported them to live their lives in a way that suited their personal needs and maintained their quality of life. Some told us that they would prefer more opportunities to go out into the community, but on the whole were very happy with the care and support provided. A relative told us 'They can really spot if things are wrong and get it sorted.' Another told us 'They have been fantastic from beginning to end, the staff have always been very efficient, and everything is done with such care, compassion, and love.'

Staff told us the provider arranged a range of relevant training and support to help them meet the needs of the people they supported. Training records confirmed what staff had said, and showed that specialist training such as for Parkinson's disease and diabetes had been delivered. People told us they felt the support helped them to maintain some independence. We saw in the policies and procedures that staff were instructed to always ask a person how much of a task they would like to do themselves.

Relatives we spoke to told us that they 'couldn't praise the support offered highly enough' and another relative told us 'I don't know what would have happened to my relative if they had not received the support they do'. People and their relatives told us that if they were unhappy with something then they felt confident they could talk to staff or the manager and it would be sorted out quickly. This showed people's views were listened to and the service was effective at dealing with any concerns or issues.

Is the service caring?

We found the service was caring. For example, we observed staff treated each person as an individual with dignity and respect. They spoke to people in a calm, re-assuring and friendly manner. People told us that all of the support staff were very kind and 'couldn't do any more to make them feel comfortable'. A relative told us that everyone in the service knew them by name and this familiarity made them feel their relative was very well cared for. Another relative told us that they 'couldn't be happier' about the care their relative received.

We saw the service had done a significant amount of work to try and support individuals with more complex care needs in order that they could remain in their own accommodation. For example, we saw records that showed support staff had undertaken some care and support tasks over and above the normal level expected, and received specialist training and support from other health professionals to achieve this.

Is the service responsive?

We found the service was responsive because people's needs were thoroughly assessed by the service before they received support, and other information, such as any health or social care assessments were also used. The manager told us most people would trial the service for two weeks and during this time a fuller assessment and care planning would take place. This meant that people had the opportunity to see if they were satisfied with the service and their needs and preferences were fully understood.

We saw that people's care was planned and delivered in line with their individual preferences. Each person's care plan was reviewed every four months, and changes made to the support needed if necessary. The manager told us people were also re-assessed if they had been in hospital for a while in case their support needs had changed.

We saw that the team manager had regular discussions with people about their support, and that relatives and carers were also invited to these. Notes of these reviews were recorded in people's care plans and were used as part of their annual care plan review. This helped ensure care and support remained appropriate to each person's individual needs.

People told us they were able to make choices regarding what time they received their support. The staff we spoke with, demonstrated a good understanding of each person's support needs and preferences and how they should be met. This meant that people were able to retain control over their daily activities.

Is the service well led?

We found the service was well led. The manager has been in post for a number of years and is currently registered with CQC.

There was a clear staffing structure in place with clear lines of reporting and accountability. Staff said they were well supported by colleagues and the provider's management. They said they could report any issues or concerns to the manager in the first instance. The manager said they were able to contact the director of the company and external health and social care professionals for advice or support whenever needed. This showed that appropriate support was available for all staff.

The quality of the service was monitored through regular personal contact with people and their representatives, audits, staff supervision, observations of staff practice, peer reviews, and annual staff and service user surveys.

We saw the provider had a comprehensive range of policies and procedures for staff to follow. The provider also provided a staff handbook containing key procedures and guidelines for staff to follow.

We reviewed a number of management documents and saw examples of clear monitoring of staff training and supervision, to ensure this was received on a regular basis.

We asked the service to provide an action plan to show how they intended to be compliant with medications and with outcome seven, safeguarding, as we found that not all staff were fully aware of the process and procedures.

We visited the registered office on 13 June 2013 and then visited people in two of the lodges on 18 June 2013. We found that systems had improved to ensure medications procedures were more robust, and all staff had clear guidance and reminders about safeguarding processes.

People we spoke with were happy with the service they received. Comments included ''Staff are always very kind and helpful'' and ''We could not ask for better.'' One relative we spoke with said they felt reassured by the staff teams ''skills and caring nature.''

We found recruitment processes were robust and people were able to have their say about how the service was being run. Systems were in place to monitor the quality of carer and support provided.

We spent time at the registered office looking at records relating to staff training, support and induction. We also asked for information about how well the agency monitors and reviews the quality of care and support it provides.

We spent time talking with six people who receive a service from Hadley care. We spoke with six staff two who were newer to the service and others who were more experienced carers. During our visits to the lodges where people have tenancies, we also looked at the care plans and medication records of three people.

We found that improvements were needed in relation to the handling of people's medication and in ensuring that the safeguarding policy and training was robust to fully protect people.