We carried out an announced inspection of HG Care Services Limited on 22, 23 and 25 October 2018. HG Care Services Limited is a domiciliary care service and provides twenty-four-hour domiciliary care and support to adults and children in their own home. The service’s office is located on Stockport Road, Levenshulme, Manchester. At the time of our inspection, the service offered support to 326 people and employed 145 members of care staff.
At our last inspection of this service in October and November 2017 we found two breaches of regulations; these were Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-Led to at least good, which we received. At this inspection although the process of governance and oversight of the service had improved we have made a recommendation for improving the process of auditing.
Not everyone using HG Care Service Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
Medicines were not consistently administered in a safe way. At this this inspection, we found the management of people’s medicines had improved, however we saw some gaps in staff signatures in one person’s medication administration records (MAR’s) who we visited at home. We determined medicines had been given as prescribed but these were not consistently recorded in the MAR charts we saw.
For another person who we visited we found their lunchtime medicines, which were due two days after our visit, had been popped out of the medicines pack and then placed back into it with cotton wool; we could not determine if the person had done this themselves but there was no clear record that this had been communicated back to the office. We also found additional sachets of a laxative medicine for this person on the floor of their house, but there were no clear records in the MAR’s or communication sheets to confirm why this was the case.
Although medicines were audited and staff were subject to observations of practice and spot checks these interventions had failed to identify the issues we found during the inspection regarding the safe management of medicines.We have made a recommendation about the management of people’s medicines and the frequency of associated auditing systems.
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 we spoke with felt they were safe when receiving support from HG Care Services and knew what to do if they were not happy about care and services. Staff could describe to us how they endeavoured to keep people safe.
Suitable safeguarding procedures were in place, which were designed to protect vulnerable people from abuse and the risk of abuse.
People had risk assessments in place which included areas such as the environment, medication and moving and handling. These provided guidance to staff as to what action to take and were regularly reviewed by the service.
People's needs were assessed in sufficient detail to inform the delivery of care by staff who supported them.
An external company was used to undertake checks and maintain the fire extinguishers, fire alarm system, emergency lighting and smoke detectors to ensure the safety of the office based staff.
Recruitment processes were in place and ensured that staff were of suitable character to work with vulnerable people. Newly recruited staff were required to undertake a probationary period before being offered a permanent position, which included observed practical assessments before confirmation in their role. Staff we spoke with confirmed they received regular one to one supervision. However, two staff records indicated only one reference had been obtained. We have made a recommendation that the service reviews the latest best practice relating to the safe recruitment of staff to ensure that employees are safe to work with vulnerable people.
There was an appropriate, up to date accident and incident policy and procedure in place. Incidents were logged and tracked including the date of the incident the name of the person concerned and the action taken to reduce the potential for repeated events.
People told us they considered staff to be knowledgeable and skilled in meeting their needs and confirmed the care workers and other staff they met were competent. Staff told us they had enough time when visiting people to effectively meet people’s needs and people told us staff stayed the full length of the visit but could sometimes be late.
The service gave people the appropriate support to meet their healthcare needs. Staff liaised with healthcare professionals to monitor people's conditions and ensure people health needs were being met.
Staff told us that if they had any concerns about the capacity of a person using the service, they would contact the office. We saw where people lacked capacity this was clearly recorded within their care plan. The requirements of the Mental Capacity Act 2005 were being met. Appropriate arrangements were in place to assess whether people could consent to their care and treatment. We saw people had signed consent to their care and treatment.
People who used the service and their relatives told us care staff were kind, caring and helpful and treated them with respect.
We found the service aimed to embed equality and human rights though good person-centred care planning. People's confidentiality was protected. Records containing personal information were being stored securely.
People we spoke with who used the service and their relatives confirmed they had been involved in planning their care and each person who used the service had a care plan in place that was personal to them. People could receive information in formats they could understand such as in different languages.
The provider had a complaints policy and processes were in place to record any complaints received. People we spoke with told us that they knew how to complain and had details of how to make a complaint.
End of life care not had been discussed with people who used the service. Staff had not received training in end of life care provision because the service was not involved in supporting any person who were at the end stages of life at the time of the inspection.
The staff we spoke with spoke positively about how the service was run. Staff told us the registered manager was supportive and considered their welfare.
We saw that staff meetings were held regularly and staff had the opportunity to raise any issues.
We saw spot checks and direct observations were carried out with staff to ensure that standards of care were maintained.
We found the service had policies and procedures in place, which covered all aspects of service delivery
Results of the most recent questionnaires and surveys received where mostly complimentary about the service.
There was an up to date provider and manager registration certificate on display in the office premises along with an appropriate certificate of insurance. The last report was displayed on the provider website as required.