Archived: Hales Group Limited - Bourne

We completed an inspection of the service on 09 April 2014. We found that the provider needed to make improvements to ensure that the service had sufficient staff resources to enable visits to be completed at the right times. In addition, we found that more robust systems needed to be used both to consult with people who used the service and to ensure that they received a good quality service. After our inspection the provider told us that it had made all of the changes needed to address our concerns.

We completed our present inspection on 01 September 2014 to check that the provider had made the necessary improvements. When doing this we also considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be genuinely committed to helping them.

Is the service responsive?

We found that the service was responsive. People said that they usually received care from staff who knew them well. They considered that this made it easier for staff to provide them with flexible care that responded to their changing needs and wishes.

Is the service safe?

We did not specifically examine this question during our present inspection visit. However, our inspection dated 09 April 2014 found that the service was safe. This was because staff had received training and understood their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse.

Is the service effective?

We found that the service was effective. This was because the provider had made a number of improvements. The changes had helped to ensure that most visits were completed on time. This meant that people usually received an effective service that met their needs for care at home.

However, a minority of visits were still not being completed at the right time and some people found the situation to be stressful and concerning.

We have told the provider that it may find it useful to note that occasions when visits were not completed at the right time reduced its ability to reassure people they would receive all of the care they needed.

Is the service well led?

We found that the service was well led. This was because the provider had made a number of improvements. These included consulting with people about their experience of using the service so that they could suggest any changes that needed to be made. In addition, documents and records showed that the provider's quality checks had been strengthened. These quality checks enabled the provider to evaluate how well people were being supported at home.

However, we noted that there had been a small number of occasions when a planned visit to a person's home had not been completed at all. We saw that the provider had established the circumstances behind each of these missed visits. In addition, action had been taken to help prevent the problem from happening again.

We have told the provider that it may find it useful to note that the recurrence of missed visits reduced its ability to reliably care for people at home.

Is the service caring?

People said that staff were respectful, kind and attentive.

Is the service responsive?

We saw that people's individual needs for care were assessed and met. This also included people's individual choices and preferences about how they wanted to be cared for at home.

Is the service safe?

Staff had understood their roles and responsibilities to ensure that people were protected from the risk of abuse. People were reliably assisted to use medicines. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements.

Is the service effective?

We found that staff knew people's individual personal and healthcare needs. However, people were concerned about visits not always being completed at the right times. Records confirmed that the system used to allocate staff to complete visits was not wholly reliable or effective. This limited the provider's ability to reassure people that they would reliably receive the help they needed at home.

Is the service well led?

The quality assurance system was not robust. People had not been fully consulted about their experience of using the service. Some quality checks had not been completed in a rigorous way to establish how well the service was meeting people's needs and expectations. These oversights reduced the provider's ability to reliably care for people at home.

When we visited on 16 July 2013 to check progress against the compliance actions we set, there was a new manager in post. We spoke with the manager, two members of the care staff and four people who used the service. We also looked at their latest report from the local authority.

One person we spoke with told us, 'I trust the girls to do the job, they are very good I can't complain.' Another person told us, 'The carers are all lovely.'

Staff had received training in how to schedule visits. Records showed schedules now included travel time. Where people needed two carers their visit times were co-ordinated to ensure both care workers were present at the same time. Records showed the manager was monitoring how staff completed the schedules on a weekly basis.

The manager, care workers and people who used the services told us some care plans had been reviewed. The manager has systems in place to ensure all people using the service had their care plans reviewed. One person said, 'XXXX came out two weeks ago and did a review.'

However people said care workers did not always turn up at the required time. One relative told us, 'They are not perfect at turning up on time.' People told us when care workers were late for their visits this impacted on their care.

People were supported to obtain and take their medication. One person told us, 'They took that [medication] over; they put it out for me. They do the lot, they collect it. They are very very good.'

Schedules were not planned to enable people to receive care at their preferred time.

The provider had appropriate recruitment processes in place.Care workers received adequate training but supervision and appraisals did not always happen on a regular basis.

People were asked for their views on the quality of the service they received. There was no robust audits and investigation of incidents to monitor the quality of service provided.

The provider took account of written complaints and responded appropriately. However people told us they never got a response when they raised a verbal complaint. One person told us, 'If I have any complaints I phone them, but I don't know if anything happens.'

Records showed people were involved with their care and had the opportunity to change their care to meet their needs. Care plans showed people had an initial assessment and routine reviews. Care was also reviewed if people's needs changed.

People told us staff were good at their jobs. One person said, 'They are gentle with you.' Records showed staff received appropriate training and were supported through supervision and appraisals.