Background to this inspection
Updated
21 November 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission who is also the nominated individual and provider. A nominated individual is responsible for supervising the management of the service on behalf of the provider. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider/registered manager would be in the office to support the inspection.
Inspection activity started on 9 September 2020 and ended on 14 September 2020. We visited the office location on 9 September 2020 and on 14 September 2020 we made telephone calls to staff and people using the service.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
During the inspection
We spoke with four people who used the service and two relatives about their experience of the care provided. We spoke with seven members of staff including the registered manager, care coordinator, four care workers and a director.
We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures and the providers action plan were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at staff supervisions and staff schedules, policies and quality assurance records.
Updated
21 November 2020
About the service
Harmony Homecare Limited is a domiciliary care agency providing personal care and support to 26 people in their own houses and flats.
People’s experience of using this service and what we found
Medicines were not always managed safely. Individualised risks to people were not consistently assessed and mitigated.
The provider had not always maintained effective oversight of the safety and quality of the service. Where action plans were put in place improvements were not consistently embedded and sustained.
Improvements were required to ensure staff had access to the latest government guidance and information on protecting people and themselves from Covid-19. Staff did have access to a good supply of appropriate personal protective equipment (PPE) and described how to use it appropriately.
Staff were recruited safely and there was enough staff to meet people’s needs under usual circumstances. However, the providers contingency plan required improvements to ensure the service could remain operational under winter pressures and high levels of staff sickness.
People were not consistently supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support consistently support this practice. The provider had in some cases made generic decisions in people’s best interest without consulting them on their preference.
People were invited to give feedback on their care, and we saw positive feedback. Staff enjoyed working for the provider and retention rate of staff was good.
People were safe from the risk of abuse by kind and caring staff who understood how to recognise signs of abuse and how to report it.
The provider worked in partnership with other professionals when needed and liaised with family members to provide updates on change or concerns.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 22 August 2019) and there were multiple breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
We carried out an announced comprehensive inspection of this service on 4, 6, 9 July 2019. Breaches of legal requirements were found in safe care and treatment, good governance and staffing. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harmony Homecare Limited on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.