Harbex Nursing & Care

Harbex Nursing and Care is a domiciliary care agency. At the time of our inspection the service was providing care and support to 53 people living in their own homes. The service did not provide any nursing care.

People’s experience of using this service:

Staff were aware of risks to people’s security and took steps to ensure their safety. They demonstrated a good understanding of safeguarding policy and procedures and were vigilant to any signs of abuse. Where risk to people’s health, safety and wellbeing had been identified care plans were put in place to manage these risks. Care plans were person-centred and generally provided staff with the information they needed to provide care and support in a way that met people’s needs and preferences. However, we found one care plan did not indicate the person’s current needs.

There were enough care staff to meet the needs of people and deliver a consistent service. When taking on new staff the service ensured appropriate checks were carried out to check candidates’ suitability to work with vulnerable people. Ongoing training provided staff with up to date knowledge and understanding of their care and support responsibilities.

Medicines were appropriately managed for people who needed assistance with medicines. Clear records of any creams applied, and medicines administered were monitored and kept up to date.

People said the staff were well trained, understood them and knew how to meet their needs in a person-centred way. One person told us, “[The staff] all know what to do and how to do it.” All staff had access to supervision and their performance was regularly monitored.

People told us that they were supported by staff who knew them well. Visits were allocated in zones which reduced the travel time for staff and meant people were supported by small and consistent staff teams.

When we asked them, people supported by Harbex Nursing and Care said that the care staff were kind, caring and cheerful. They confirmed staff sought their consent before undertaking any care task or entering their home and that they would always offer choices around how their care was provided. They told us that the care staff had enough time to perform tasks and would spend time listening to what they had to say. Privacy and choice were respected, and confidential information was kept securely.

The people we spoke with were aware of how to complain and told us that when they had made complaints these resulted in improvements in their support. We saw complaints were taken seriously with full consideration and appropriate investigation.

There were processes in place to monitor the safety and quality of the service. The manager and provider undertook quality assurance monitoring of the service and any actions arising from this had been addressed.

People were given opportunities to provide feedback on the quality of their support and given the opportunity to comment on the service they received. Surveys and questionnaires showed a high level of satisfaction. Analysis of trends showed an increase in satisfaction levels since the previous year.

Services like Harbex Nursing and Care are required to have a manager who is registered with the Care Quality Commission (CQC). A new manager had been appointed to the service at the end of February 2019, but had not yet completed the registration process. The manager in post was supported in the day to day management of the service by the provider, compliance and quality manager and recently appointed key workers. The management team were open and supportive to staff and understood their responsibilities to operate the service safely and effectively.

Rating at last inspection:

At our last inspection, the service was rated “Requires Improvement’”. Our last report was published on 23 May 2018 and recorded multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection. Our announced inspection started on 14 May 2019 and ended on 15 May 2019.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

The previous inspection took place in July 2013. At that inspection, we found that the service had met all regulatory requirements.

The service had a registered manager who had been in post since October 2010. A registered manager is a person who has registered with the Care Quality Commission (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.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the end of the full report.

People told us they felt safe with the care and support they received from Harbex Nursing and Care. Staff we spoke with could tell us about the types of abuse and what action they would take if they suspected that abuse was taking place. We found that the service could not demonstrate that all staff members were up to date with safeguarding training. This meant people using the service may be at risk of harm due to lack of staff knowledge and awareness in this subject. Risk assessments were vague and lacked person-centred information to help staff minimise or control identified or potential risks. We noted that risk assessments needed to be reviewed and updated more consistently. This meant that people were still at risk because staff were either unaware of their current circumstances or did not have sufficient information to manage risk safely.

There were recruitment processes in place; these needed to be more robust to help ensure that people were supported by care staff that were suitable to work with vulnerable people. This meant that people were potentially at risk of harm because the provider had not ensured suitable staff were employed. The service did not have many missed visits. The manager credited this to the use of an electronic monitoring system. People told us however that many times their care staff were late. This meant that people were not receiving care and support at times that suited them. People were generally satisfied with the consistency of care and told us they had regular care staff supporting them.

There were systems in place to help support people to take their medication safely. Medication errors were thoroughly investigated and staff members had to undergo refresher medication training and be assessed as competent before they could administer medicines. This should help to ensure that people received their medication safely. People told us care staff had good hygiene practices and wore personal protective equipment when carrying out their duties. This should help to ensure that people were protected from the risk of infection. Accidents and incidents were recorded and the service took appropriate action to help ensure people were kept safe.

People felt that care staff had the right skills and knowledge needed to undertake their caring role. The service had systems in place to deliver the Care Certificate induction standards to new recruits. We saw that people’s consent to care and support was sought correctly. People’s consent to receive care was sought appropriately. However, staff had not yet done training in the Mental Capacity Act 2005. The registered manager told us these were scheduled for later in 2016. Staff received supervisions and appraisals to help ensure they received the necessary support to carry out their roles. Records did not support that all staff had received supervision or an appraisal. The service had good relationships with two training providers. This should help to ensure staff attained ongoing learning to perform more effectively in their jobs. The service facilitated people’s access to health care professionals if required. This meant people were supported to receive the right health care when they needed. People were supported and encouraged to make healthy eating and drinking choices. This should help people to maintain a balanced diet and support their wellbeing.

People told us care staff were kind and considerate to them. They gave us examples of how staff were proactive and went the extra mile. This meant people felt cared for and supported effectively by their care staff. People were treated with dignity and respect and encouraged to maintain their independence depending on their abilities. This helped to promote their continued wellbeing.

Care plans were task specific and did not always reflect people’s preferences and choices. Care plans were reviewed but we did not always see records to indicate that these were taking place when they should. This meant that people may not be receiving the appropriate care and support for their current needs. There was a system of managing complaints and people told us they were aware of the complaints procedure. The service sent out an annual client questionnaire and the last one sent out was in May 2015. The results of these had not been collated as the service was making changes to its feedback mechanism. This meant that while the service had sought people’s opinions on their care and support it did not demonstrate what action was taken as a result of their feedback.

People were happy with the service they received from Harbex Nursing and Care. Staff were positive about the agency and were supported by their managers. We found that quality assurance processes in place 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. We saw that the provider had a suite of policies and procedures in place; this should help to ensure staff had appropriate guidance to carry out their roles. The service did not always meet the legal requirements of notifying the CQC of safeguarding incidents.

We did not see evidence that regular staff meetings were held. We noted a meeting had been held in February 2016 but that only senior care staff and managers were in attendance. Staff meetings should help all staff to feel supported in their roles and give them the opportunity to discuss concerns they may have about their work. The registered manager told us that communication amongst staff and management was good. Care workers confirmed this, saying that there was an open door policy at the service.

The service had developed good partnerships with local authorities and other providers in the sector. This should help Harbex to keep up to date with good practice and discuss challenges within the care sector.

We spoke with 12 service users. All told us they felt safe. One person told us 'I feel safe; the staff speak to me very respectfully I am treated very well by them'. Another said 'I feel safe and well cared for '. A relative of one service user we spoke with confirmed staff spoke with their X respectfully'.

All service users we spoke with who received assistance with their medication from care staff confirmed they always received their medications on time and staff discussed medicines with them. One person we spoke with told us, 'The staff talk to me about my medication and they ask permission, I have the leaflets about my medicines and I read them'.

We looked at four staff files and saw evidence of training recorded and we were shown a training matrix and saw relevant and recent training had been undertaken.

The staff we spoke with were complimentary about the manager. Some comments received were 'The manager is lovely she is always here, she is a really good manager and supportive she is always on hand for you' and 'The manager is very nice and supportive I can go to her with any problems'.