The inspection took place on 18, 19 and 23 January 2018 and the first day was unannounced. At the previous inspection in September 2016 we found breaches of legal requirements in relation to notifications of incidents, staff recruitment, risk assessments and governance systems. At this inspection, we noted some improvements had been made with regards to meeting some of these requirements. However further improvements were required.
We asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Response and Well Led to at least good. We found the provider had implemented some actions, we found insufficient improvement had been made in some areas. Further information about these is identified within this summary and the full report. This is the second time the service has been rated ‘Requires Improvement’ overall.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to younger and older adults, some of whom are living with dementia, with a variety of needs. Support provided includes assistance with personal care, domestic tasks and outings into the community. At the time of this inspection the service supported 62 people.
There was a manager in post who had been registered with CQC since October 2010. A registered manager is a person who has registered with CQC 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.
Not everyone using Harbex Nursing & Care 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.
We found six breaches of the Health and Social Care Act regulations in relation to recruitment processes, staffing training, risk assessments, need for consent, person-centred care, managing complaints and quality assurance. This is the second consecutive rating of ‘Requires Improvement’ for this service. You can see what action we told the provider to take at the back of the full version of the report.
We made one recommendation that the provider ensures all staff were trained in topic areas relevant to the population served.
We found the service was not always safe in some respects though people told us they felt safe with the staff who supported them. Generally, people were supported by a consistent staff team and the provider had suitable systems in place to take action to protect people from abuse including accidents and incidents.
Recruitment processes were not robust. This was a continued breach of the relevant regulation and meant people were not protected from risk of unsuitable staff being employed.
Risk assessments were not always up to date and risks to some people had not been assessed and recorded. This meant staff did not have sufficient information to ensure people were supported people safely.
A few people told us they had experienced missed visits. Most people we spoke with said staff were often late for their visits and the reason for this was not always explained. This meant people did not consistently receive care and support as agreed and in line with their needs.
Where assessed, people were supported by competent staff to take their medicines safely.
The registered manager and staff demonstrated some awareness of the Mental Capacity Act and we saw there was a policy in place to guide practice. However, we found the service did not work consistently within the principles of the MCA principles and this was a continued breach of the regulation.
Staff received an induction, training that the provider considered mandatory and shadowed experienced colleagues prior to working unsupervised. Staff had supervisions and appraisals. We found not all staff had had training in topic areas relevant to the population served.
The service acted proactively to ensure people received relevant health and medical attention as required and that they maintained a balanced diet. These actions contributed to people’s quality of life and wellbeing.
Staff’s approach was caring and empathetic. People and their relatives gave us many examples of how staff supported with kindness and compassion. People said staff carried out their duties in a respectful manner and that they were supported by staff who knew them well.
People told us staff encouraged them to be independent according to their abilities. Staff we spoke with confirmed this. This helped to promote people’s general good health and wellbeing.
The agency operated within a diverse and multicultural community and had systems in place to ensure people’s equality and diversity needs were recognised. People and relatives told us the agency and staff responded flexibly to their needs.
There was a process in place for managing complaints and concerns raised. However, we found not all concerns were recorded within the provider’s complaints process which meant the provider had limited oversight of all issues raised and we found no evidence to show some people’s complaints had been resolved.
Everyone we spoke with said staff knew them well. People and relatives were happy with the agency and said their approach was open and honest.
Quality assurance processes were not robust and did not give the registered manager and provider effective oversight of the quality and safety of service. This meant that people’s care and support was not adequately monitored to ensure their safety and wellbeing.
There were relevant policies and procedures in place; this helped to ensure staff had appropriate guidance to carry out their roles.
Following our last inspection, we wrote to the registered manager regarding their legal obligation to notify CQC incidents. Our records showed the service had made significant improvements in this regard. We also found the provider was displaying the service’s most recent inspection rating at their office and on their website.