Archived: Health Care Recruiters Limited

We last inspected this service in July 2016; at this inspection visit, we rated the service as ‘Requires Improvement. We identified concerns around the statement of purpose, need for consent, good governance and staffing.

This inspection took place across two dates, 30 March 2017 and 12 April 2017. This inspection was announced 24 hours’ prior to the inspection. We did this as the service was small and we needed to be sure someone would be available to provide us with the information we required. At the time of our inspection, Health care recruiters provided services to four children.

There is currently no registered manager at the service. The previous registered manager de-registered in October 2016. There is a interim manager at the service. 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.

At the last inspection we found a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we found the service did not have a robust quality auditing system in place. During this inspection we reviewed the audit records and could not find documented evidence to show audits were being undertaken. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

At the last inspection carried out in July 2016 we found a breach of Regulation 18, Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff had not received formal supervision. During this inspection we found that staff felt supported by the management and were able to make contact if they needed to. We have made a recommendation about this.

At the last inspection we found a breach of Regulation 11, Need for consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care records for adults had no evidence of mental capacity assessments, or best interests decisions where needed.

During this inspection we could not check if there had been an improvement, as the service did not provide any packages of care to adults.

At the last inspection we found a breach of Regulation 12 Registration Regulations 2009 (Schedule 3) Statement of purpose. This was because the statement of purpose did not reflect the registered services they provided. During this inspection we found statement of purpose had been re-written to reflect the current services provided.

We reviewed the staff rotas and spoke with staff during this inspection. Relatives told us that the service has a lack of contingency staff to cover the care packages, and that they do not have many staff to cover the package. We reviewed the staffing and there were no missed visits.

Care records detailed when people needed care and support. This had been agreed with people, their families and other health and social care professionals. The level of detail in people's care plans was not consistent across the service; some parts had not been updated following changes in peoples care, and support needs. We have made a recommendation about this.

Care records included detailed risk assessments, which provided staff with guidance on how the risks to people were minimised. Staff responsible for the administration of medicines had been trained to administer them safely.

Care plans showed that where appropriate the service had made referrals to health care professionals.

Systems were in place to reduce people being at risk of harm and potential abuse. We found suitable recruitment processes were carried out.

Staff were provided with detailed guidance in people's care plans regarding the support people required with their nutrition.

Relatives were positive and complimentary about the care their family member received. Relatives told us privacy and dignity was promoted and respected by the staff. Staff had a good understanding of protecting and respecting people’s human rights.

People and their families told us they received personalised care which was responsive to their needs.

People were encouraged to raise any concerns or complaints. The service had a complaints procedure.

The manager and staff had a good understanding of the principles underpinning providing care in people's own homes.

Accidents, incidents, complaints and safeguarding alerts were appropriately reported by the service. The manager investigated accidents, incidents and complaints. This meant the service was able to learn from such events.

The policies and procedures we looked at were regularly reviewed. Staff we spoke with knew how to access these policies and procedures. This meant clear advice and guidance was available to staff.

Following the inspection the manager provided us with an initial action plan in order to address the concerns we found and to make improvements to the service.

You can see what action we told the provider to take at the back of the full version of the report.

The registered manager was given 24 hours’ notice prior to the inspection, so that we could be sure they would be available to provide us with the information we required.

We last inspected this service in September 2013. The service was judged to be compliant in all the areas we looked at.

Health Care Recruiters provides staff to support families to care for children and young people and adults with complex or life threatening needs in their own home as well as providing staff to work in hospitals and care homes.

At the time of our inspection Health Care Recruiters provided services to five people.

The registered manager of the service was present throughout our 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.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. People told us the service was reliable.

Staff we spoke with told us they were given enough time with people. People we spoke with told us that staff stayed for the allocated time.

We looked at assessments undertaken for all five people before the agency agreed to provide their domiciliary care package and found that safety checks and risk assessments were undertaken however, the standards were different between the assessments children and adults. We found care plans for children identified risk management in a person centred way however care plans for adults were basic and were not written in a person centred manner.

We looked at how people were protected from bullying, harassment, avoidable harm and abuse. We found that the service followed safeguarding reporting systems, as outlined in its policies and procedures.

We found that the service promoted staff development and staff received training appropriate to their roles and responsibilities. However, this was not consistent as some staff members had not received training. Induction provided for staff who supported children was suitable however we found induction for staff who supported adults was not suitable for people working in community care. This had been designed for workers who worked in hospitals.

Staff told us they felt well supported by management however, there was no evidence to show regular supervisions or meetings had been undertaken. Staff informed us they relied on parents of children they looked after to supervise them and provide guidance rather than management.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act [MCA]. We looked at people's care records and found no consent, mental capacity assessments, or best interests decisions where required. The mental capacity act is not applicable to children instead; the service had sought adequate consent from the parents.

Some care records held details of joint working with health and social care professionals involved with people, who used the service, however others lacked detail.

We received consistent positive feedback about the staff and about the care that people received. Staff had awareness on how to respect people’s privacy, dignity and rights.

The manager advised us that staff were always introduced to service users, prior to any support being provided. Staff had been trained to operate and monitor equipment that people used. Assessment processes were in place, which helped to ensure staff had a good understanding of people's needs before they started to support them however this was not consistent throughout the service.

The service had a complaints procedure which was made available to people they supported. People we spoke with told us they knew how to make a complaint if they had any concerns. We saw evidence of how a compliant was dealt with.

We found concerns regarding leadership and governance. Staff had not been provided with adequate leadership and oversight. At the time of the inspection we found management did not have adequate contact with the staff team and the majority of staff were unaware who their manager was and any developments in the organisation. Staff informed us there were no staff meetings and supervisions had stopped around February 2016.

There were no robust systems to monitor and assess the quality of the service. We found no audits had been undertaken on medication administration and care files. Staff competence had not been undertaken regularly to ensure staff continued to deliver safe care. Competence checks had been left to parents of children supported by staff. We found people were satisfied with the service they received. We found the registered manager receptive to feedback and keen to improve the service. They worked with us in a positive manner providing all the information we requested.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of governance, person centred care, staffing and governance. This also included a breach of Regulation 12 of Care Quality Commission (Registration) Regulations 2009- Statement of purpose. You can see what action we told the provider to take at the back of the full version of this report.

We spoke to three providers who used staff from the agency. They told us they were more than satisfied with the staff that were supplied. They said 'They are very good and can do the job we need. They are trained well.' 'They always follow care instructions and will ask if they are not sure, no complaints.'

We found parents had expressed their views and values and had been involved in making decisions regarding their child's care and support. Children using the service had opportunity and support within the assessment framework to consider the options available to them such as their preferred routine, level of support and what activity they wanted to do.

Care planning was person centred. This meant children's care and support was planned according to their needs, wishes and choices as well as respecting the need for safety. Children were protected from unlawful discrimination and were supported to attend school, access healthcare and take part in community life. Parents felt their home was respected and their children kept safe. "My children and my home are in safe hands."

People were cared for by staff that had been carefully recruited, of good character and well trained and supported.

Quality monitoring systems helped to ensure people received a safe and effective service. People's views were listened to.

We found that staff were allocated sufficient time to support young people they cared for. They had regular carers who were trained to provide a personalised service. Specialist intervention such as keeping airways clear by aspirating and using special methods of feeding was provided by staff trained and deemed competent to do this.

One person told us 'They weren't just sent to us, they were introduced gradually and I have every confidence in their ability. Yes I would definitely say my children are in safe hands. As a mother that's important. I have never had any cause for concern'.

We found some improvements were needed to ensure staff were trained and competent in recognising and dealing with child protection issues.

People were cared for by staff who had the necessary character checks to ensure they were physically and mentally fit, trustworthy, and qualified. Staff were monitored. One parent told us 'We do get surveys to complete on each of the workers. I can only comment they are absolutely fantastic. I couldn't wish for a better service'. We were also told 'They always contact us to see if everything is all right. If I thought there was a problem I definitely would say'.