HG Care Services Limited

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.

We last inspected the service on 7 October 2016 when we rated the service as Good overall and we did not identify any breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found the provider was not meeting the legal requirements. We identified breaches of 2 of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were in relation to, safe management of medicines and the effectiveness of governance systems in place. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 Notifications of other incidents.

We made a recommendation that the service further considers their staff supervision and appraisal policy to ensure that standards of work are communicated and maintained to people working a high number of hours.

You can see what action we have told the provider to take at the back of this report. We are currently considering our options in relation to enforcement in relation to some breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

H G Care Services Limited provides twenty four hour domiciliary care and support to approximately 170 adults and children in their own home and who live in Greater Manchester and Stockport. The service’s office is located in Levenshulme in Manchester. The provider was given 24 hours-notice of our inspection.

A registered manager was in place but was not present during the first two days of inspection due to being on leave. The registered manager was present on the third day of 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.

Prior to this inspection the Care Quality Commission (CQC) received some information of concern which was sent to us from the provider and we raised a safeguarding alert about this with the local authority adult safeguarding team. At that time we asked the provider for additional information in relation this. However this was not sent to us. The provider advised us that a similar incident involving the same service user had occurred previously which the provider had not notified us about at the time. During the inspection we gathered more information about the incident which would help our investigation.

Systems in place to ensure the quality of services provided were not always robust and effective.

From the seven care workers files we looked at we saw that these care workers received supervision, training and work monitoring checks during the course of their employment. However these systems were not robust and effective enough to make sure that two care workers who worked a high number of hours received sufficient supervision to ensure they were carrying out their role safely.

During the first two days of inspection we reviewed the care records of six people. We found that accurate and complete records in respect of risk assessments and the care provided to two people who were identified as being at risk of choking, did not clearly identify the factors which might increase the likelihood of the risk occurring. On the third day of inspection day we found that these records had been reviewed and updated to highlight risks, how to mitigate the risk and where the specific needs of both people were being met.

People's care records showed that their needs assessments had been completed prior to the service commencing. Once agreed a person centred plan was implemented providing good information about people’s wishes and preferences and clearly guided staff in the support people wanted and needed.

Appropriate staff training and development was provided enabling staff to develop their knowledge and skills to help ensure people were supported safely and effectively so their individual needs were met.

Arrangements were in place to help protect people from the risk of abuse. The service had an up- to-date safeguarding policy and procedure in place and care workers spoken with were able to describe how they would recognise and report abuse.

Recruitment and induction procedures were in place to ensure only those applicants suitable to work with vulnerable people were appointed. Sufficient numbers of staff were available to support the individual needs of people. Care workers we spoke with told us following their employee induction, training appropriate to the work they carried out was available to them and this was on going.

Where necessary people were supported in meeting their nutritional and hydration needs. Advice and support was sought from the speech and language therapists (SALT) or dieticians where potential risks had been identified.

Care workers spoke caringly about people who used the service. They told us they had developed a good rapport and understanding of the people who used the service and treated people with respect.

Care workers had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

Systems were in place for the reporting and responding to any complaints brought to the attention of the service. Most of the people we spoke with said they had no issues or concerns and felt they could discuss anything with the management team or care workers if they needed to. People were confident they were listened to.

HG Care Services Limited provides 24 hour domiciliary care and support to adults and children in their own home. The service’s office is located in Stockport near Manchester. The service provides care and support to people in Stockport, Rochdale and Manchester areas.

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 people we spoke with told us they felt safe. The staff we spoke with had a good understanding about safeguarding and whistleblowing procedures and told us they wouldn’t hesitate to report concerns.

We found medication was handled safely and people received their medicines at the times they needed it. We looked at how medication was handled at two of the houses we visited. Staff told us they had received relevant training and management conducted regular checks, to ensure staff gave people their medication safely.

The service used a call monitoring system. This enabled management and staff in the office to check care was being provided to people at the correct time of day and in line with people’s care package requirements. Staff spoken with didn’t raise any concerns about staffing numbers, and felt there were enough to care for people safely.

We saw staff were recruited safely, with appropriate checks undertaken before staff began working with vulnerable adults.

The service had a training matrix to monitor the training requirements of staff. This showed us staff were trained in core subjects such as; safeguarding, moving and handling, medication and health and safety. Staff told us they received sufficient training to undertake their roles and said they felt supported.

People told us staff helped them to maintain good nutrition and hydration. People said staff always left them with something to eat and drink before leaving their house.

We saw staff received regular supervision as part of their on-going development. This provided an opportunity to discuss their workload, concerns and training opportunities. We saw records were maintained to show these took place.

The people we spoke with told us they were happy with the care provided by the service. People told us staff treated them with dignity and respect and promoted their independence where possible.

Each person who used the service had a care plan with a copy held at the office and in their own home. This provided staff with guidance about how to deliver care to people. The care plans we looked at were person centred and provided information about people’s likes, dislikes and life histories.

The service sent satisfaction surveys to people who used the service and their relatives. This provided the opportunity for people to provide feedback about the service and recommend how the service could be improved.

There was a complaints procedure in place. We saw complaints were responded to appropriately. People were given a service user guide which detailed the process people could follow if they were unhappy with the service. We saw the service had also received many compliments from people regarding the services they received.

People who used the service and staff told us they felt the service was well managed. Staff told us they felt well supported and would feel comfortable raising and discussing concerns.

We saw there were systems in place to monitor the quality of the service provided. This was done in the form of regular spot checks and observations of staff undertaking their work. We saw medication competency assessments were also carried out. This provided management the opportunity to see how staff worked and make adjustments/suggestions to improve the service people received.

Is the service well led?

Below is a summary of what we found. The summary is based on our inspection of care worker personnel records and speaking with a care coordinator about the way in which care workers were supported and managed. If you want to see the evidence supporting our summary please read the full report.

Is the service well led?

The provider had restructured the staff supervision and appraisal form to help make sure that staff were properly supported to provide care and support to people who used the service.

We looked at staff records that showed staff received a thorough induction when they started their job. This helped to make sure staff knew what was expected of them.

Staff training records were completed to show that staff had received up to date training and qualifications that were relevant to the work they were undertaking.

We saw policies and procedures that were in place to ensure that people who used the service would be safe.

We looked at staff records and saw evidence that the provider had not followed the services own recruitment and selection procedure for some employees.

We noted that not all staff had received regular supervision and appraisal to carry out their role safely and keep their skills up to date.

We saw that the service's medicines policy was effective to ensure medicines were administered safely.

We saw there was a system in place to monitor and evaluate the service.

We spoke with three members of staff who told us that they liked working for the service and that they felt supported in their roles. Staff told us that they received a lot of appropriate training for their roles and we found that training was recorded at the office. The staff we spoke with did not express any concerns about the agency.

We found that the provider had systems in place to ensure that the risk of spreading infection were minimised. There was also an effective system in place to record, monitor and respond to any complaints.