This inspection took place on 17 March and 1 April 2015 and was an announced inspection. This meant the provider was given short notice that we were coming. We carried out a comprehensive inspection and followed up on the previous breaches that had been identified during our last inspection. During this inspection we found evidence of breaches of regulations; 12, 13, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
As we have found evidence of ongoing breaches we will report on this when it is complete.
We previously visited the service on 18 October 2013 and found evidence of a breach of regulation 11 safeguarding people who use services from abuse and regulation 20 records. The provider sent us an action plan to tell us how they would ensure the breach was met. We reviewed the actions the provider had taken on 12 September 2014 to check if the provider had made the required improvements.
We also carried out an announced inspection on 12 September 2014 and found evidence of breaches of regulation 21 requirements relating to workers and regulation 10 assessing and monitoring the quality of service provision. The provider sent us an action plan to tell us how they would make improvements. At this inspection we also found evidence of an ongoing breach of regulation 20 records. We took enforcement action and asked the provider to tell us how they would meet the breach. We reviewed these regulations as part of this inspection. Prior to our inspection we reviewed information we held about the provider including notifications and safeguarding information.
Helping Hands Domiciliary Care Service is registered to provide personal care for older people in their own homes. The service had a nominated individual who took responsibility for the service. It was not a requirement to have a registered manager in place for this service.
Staff we spoke with were able to discuss the signs of abuse and what actions they would take if they suspected abuse had taken place. Training records indicated not all staff had received training in the protection of vulnerable adults.
We received mixed feedback from people who used the service about whether they felt safe. One person told us, “The girls are okay. I do not want male carers and they still send them round. They don’t even alert me. When it started (the service) they met me. I have told them the preferences for women carers since this.”
We received mixed feedback about the staffing numbers for the service. We were told, “The rotas never stay the same. (Name of provider) doesn’t like staff having the weekend off. They are struggling for staff. Staff don’t turn in.” Some people who used the service provided positive feedback about the staffing arrangements for the service. We were told, “I am very pleased, and I’ve had the same carers all the time. I have a good rapport with them, they are kind and helpful”.
We looked at the Medication Administration Charts (MAR) charts and identified some concerns in relation to these, for example; medication was recorded on individual lines however there were no details relating to dosage or time of administration for staff to follow. One MAR chart had details of staff signatures relating to one person’s administration that had been crossed out for six days; we could not see evidence of the reasons for this. The provider told us they were seeking advice from a pharmacist to ensure recording for medications was appropriate and accurate.
We looked at the training records relating to medications. The staff files we looked at identified training in medication administration had taken place. Two staff members we spoke with confirmed they had completed medication training. We looked at records relating to on line training for medication. We saw 19 of the 34 staff required to complete the on line medication training had no records relating to this.
Staff told us there was a robust process in place for recruitment. This included relevant checks as well as an induction programme and the shadowing of more experienced staff. We saw evidence of application forms in the staff files which included interview records detailing brief notes. However two application forms we saw had details that would require follow up by the provider. We saw no evidence that these had been followed up to ensure people were recruited in a safe and appropriate manner.
We spoke with staff about the training provided for them. Three staff members we spoke with told us the provider had supported them to complete a nationally recognised qualification. We saw evidence of nationally recognised qualification in one of the staff files we looked at, this had been dated several years prior to inspection. A more detailed training matrix we looked at identified training for staff such as first aid, moving and handling, dementia and infection control. Records for moving and handling indicated all staff were up to date, however we recognised gaps in training for staff.
We were shown a supervision matrix which detailed when all staff had last completed supervision. Records indicated dates had been documented where signatures were required, but it was not clear who had completed the supervision. We noted three staff had no records relating to supervision taking place, one record noted one person had not received supervision for 14 months and a further two records indicated the date for supervision was overdue.
We asked people who used the service about whether they had an assessment prior to their care commencing with the provider. One person said, “When it was set up it was explained and there were set times all done and set.” Other people who used the service were able to recall some form of initial assessment. Evidence of initial assessments were seen in peoples records.
People using services and relatives we spoke with said that their care was provided well and specific benefits were discussed such as keeping people well, avoiding residential care and providing a good start to the day despite a chronic condition. We received positive feedback about the staff members from people who used the service. We asked people who used the service and their relatives about their involvements in the development of their care records and care delivery. We were told, “When it was set up we were and still are very involved and they had a person to write it all down. It looks like a good care plan and they fill in the charts so we know what is being done”.
We spoke with staff about the care records for people who used the service. We received mixed feedback. Comments received were, “Care plans are normally a list of things to do”, “I use the care plans but some of them need updating with the clients (people who used the service) needs”, “We are never consulted when the care plan is reviewed. We are not informed of any changes”
We looked at the care files for seven people who used the service. Records comprised of a series of tick boxes which identified concerns such as mobility, hearing, sight, speech, bladder, diet, breathing and confusion. Records indicated call times required for each person. However feedback about consistency of visits did not corresponded with the times noted in people’s records. All but one of the care plans were very brief in their detail and consisted of a list of tasks for staff to undertake at their visit. We could not see evidence of people’s individualised care needs in records we looked at.
People confirmed they were appropriately referred to relevant health professionals, such as the GP, by staff if concerns were raised. One person told us, “If the staff think anything needs attention, they prompt us to get the doctor. The staff are excellent.”
We looked at the complaints and compliments folder. There was evidence of positive feedback from people who used the service and their family.
We asked the provider about how they dealt with complaints. We were shown a service user guide which detailed the complaints procedure that people who used the service had access to; however we noted that the details for contacting the Care Quality Commission were incorrect.
We spoke with people who used the service and relatives about any complaints they may have about the service. One person told us, “I took up an issue about Saturday’s and they are now turning up on time. I had to complain and they have been better since this time” and, “I also have a social services review and the agency came. They were very much up to speed. There was one problem with a particular carer but it was sorted out quickly last year once they (The provider) were aware.” We could not see evidence of this complaint in the complaints file.
We spoke with people who used the service and their relatives about the service. We received mixed feedback. Examples were, “I would not recommend the company but would do so for the carers who are very good”, “I think it’s the management that get some things badly wrong”, “The communication in the office is not good”,
The provider showed us evidence of audits that had been commenced. These covered topics such as staff files and information in service users care files. Records consisted of a check list of documents in the files. Details were basic and there was little evidence to support actions if they were required.
We looked at records of ‘team meetings’ and saw the date for these were seven months prior to our inspection. Records did not indicate evidence of an agenda or attendees for structured meetings.
There was evidence of certificates in place such as fire and health and safety advice. We also saw the providers Care Quality Commission certificate, certificate of accreditation, management qualification for the provider, and employer’s liability insurance were on display in the office.