Hales Group Limited - Ipswich

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people were at the centre of their care and treatment choices and they decided, in partnership with people. However, care plans were in the process of being improved to ensure they reflected people’s needs and changes were documented.

A person told us, “I’m very happy and impressed with this agency, they're excellent. Everyone is so caring… All of the carers are genuinely excellent; it would be unfair to name a few because they're all excellent.”

Records demonstrated people were consulted about the care they were provided with, and this was kept under review. Care plans were in the process of being reviewed and updated, we noted the care plans we saw varied in quality. We identified where some parts had been updated to reflect any changing needs, this was not done throughout, which could lead to confusion. For example, a person’s care plan referred to the bed they used, which was contradictory throughout. We were assured this was being addressed, from discussion with the registered manager and the service’s improvement plan. A staff member showed us the information provided in care workers hand-held devices which showed the tasks required at each care visit, which reduced the risks of people receiving inappropriate care.

The registered manager told us how care workers had received record keeping workshops from the local authority which, along with the monitoring by the registered manager, had improved notes recorded for each site visit. The notes were detailed and evidenced people were being supported in line with their needs and preferences. Daily notes identified when people had advised care workers could leave early.

We received varied feedback from people and relatives about if the care workers remained for the duration of their scheduled care visits. In addition, we noted records of visits demonstrated short visits. However, whilst people did not feel rushed, we received feedback from a care worker who told us when they worked with other colleagues, they sometimes felt rushed. A person said, “They always stay the whole time.” Daily notes identified when people had told the care workers they could leave earlier than their scheduled time. We noted, where people required support of two care workers, the visit records did not always show they were logged into people’s visits at the same time. A member of the office team told us that ‘double up’ care workers worked together including travelling together to visits, they assured us this would be looked into.

A person’s relative told us they care workers attended the visits when they should, however, they did not always stay for the full scheduled time, “As my [family member] is usually happy for them to leave early.I am not worried if they leave early but I do expect the care plan to be followed.” Another relative said, “They're not too bad with timekeeping... They manage to get everything done and will always ask if anything else needs doing.”

A relative told us, “There is a couple [care workers] who are absolutely brilliant they will not go until they are absolutely certain they've got everything done and they asked open-ended questions. I find that really good, they are kind and don’t need prompting… whereas some of them they don't go looking for extra things to do, it's the little things isn't it but it's always the little things that make the biggest difference.” A person who used the service told us the care workers stayed for the scheduled time and laughed when they explained the care workers could leave when they had supported the person with what they needed, “They are very strict with time keeping sometimes I have to even kick them out.”

Recent guidance was sent to care workers relating to communication and how to support and encourage people to accept care when they appeared reluctant to do so. We saw daily notes which demonstrated this was being acted on, for example a person had refused a shower, the care worker had identified it was cold, so they put the heater on and encouraged the person, who then agreed to accept the care.

Care workers told us they were provided with travel time in between their scheduled visits to people. However, we did receive feedback that this was not always enough, which meant they were running late for visits. We asked a care worker what they did when they were running late due to insufficient travel time, and they told us they made sure they did not cut the visit times but worked over their break or finished their work late. A staff member showed us how travel time was calculated on the system for scheduling visits, which was reviewed if they were aware of any road closures. They advised care workers worked in the same area which reduced the need for long journeys between visits. Some people lived less than a mile apart which reduced travel time.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People’s care plans included information about their diverse needs. Care workers had received training in people’s diverse needs including equality and diversity, dementia, learning disability, mental health and autism. We saw useful contact details were in the office, which could be accessed for guidance of required, including LGTB+ helplines.

The registered manager told us they attempted to ensure continuity of care by providing regular care workers. A member of staff told us how the visits to people were scheduled and care workers worked in the same areas, which meant people received care and support from a regular group of care workers. Where people had requested changes in their care workers, this was listened to and acted on, such as if a person did not wish to receive care from a specific care worker.

We received mixed views from people and relatives about if people received care and support from regular care workers who were known to them. One person said, “It goes through phases or having regular staff. There might be one person that I have five times in a week and then it will change last minute.” Another person said, “I mainly get one person.” Another person told us, “There are lots of different carers, I wouldn’t mind the same one.” A person’s relative told us, “There have been quite a few carers. It used to be a handful but there have been a lot of changes. At least 10 different carers. We don’t mind as we’ve got to know them all.” A person’s representative told us, “They keep continuity of care, same group of carers, [care worker] comes Monday to Friday they have such a good rapport… and if [care worker] is off they always let us know who is coming."

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s care records included information about their communication needs. Where required, important information including the complaints procedure, could be provided in accessible formats, including easy read, larger print and in languages other than English.

A person’s representative told us they received a rota of the times of the scheduled visits, and which care worker was due to visit, and this was usually what happened. However, another relative said, “They don’t send us a timetable. The old carer used to send us one, now the timings can vary. I think they’ve taken on lots of new clients.” The registered manager told us a schedule could be provided, in addition, where individuals have access to the care system, the schedule could be viewed there. A person’s representative told us how they had access to the person’s care plan and care notes, and how the office staff had supported them over the telephone to set this up.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

There was a complaints procedure in place and concerns and complaints were being acted on and used to improve the service.

People and relatives told us they knew how to raise a concern or formal complaint, and they were confident they would be listened to. A person told us, “There haven’t been any complaints recently. Perhaps one or two in the past. The boss came around to discuss and it was all resolved.” A person’s relative said, “I find that they listen to me as well as my [family member] and they don't just brush things under the carpet.” A person’s representative told us how the management were, “Very good and easy to contact… Any problems it is sorted out straight away.” Relatives and people had the office telephone number if needed and they could also call an out of hours number if required.

A person’s relative told us how they had contacted the service about how the staff responded to the person’s communication needs and, “This does not happen so much now as I believe I have a good relationship with the staff, and they understand my [family member’s] requirements much better.” The relative also said, “I cannot recall actually being asked for feedback but when I email, they are very responsive and definitely act and respond to my concerns.”

We saw records where people were asked for their feedback and ‘you said, we did’ documents were provided to show what actions had been taken as a result of comments. Additional feedback via telephone calls to people to check if the service was caring, were identified as needing improvement in the provider’s improvement plan, this was in the process of being addressed.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The registered manager told us late and early visits were continuously monitored, which was confirmed in records. We also saw messages sent to care workers to ensure they adhered to their work schedule and guidance provided of actions to take if they were running late for visits. A staff member told us how the visits were monitored remotely and if it was identified a care worker had not attended visits, they were called to gain and estimated time of arrival and, if required, a different care worker could be asked to visit the person. The registered manager and a staff member told us how visits were scheduled in line with the requirements from commissioners. However, scheduling was done to give a time of expected visits, and people were advised scheduled times may be 30 minutes early or late.

We received mixed views about if people and relatives felt visits were late or early. One person said, “Their timekeeping is fine.” A person’s relative told us, “The timekeeping is not very good, and it does really stress my [family member] out.” Another relative said, “They're not too bad with timekeeping. It’s just a half hour slot… The call in the morning is supposed to be between 7.30 – 8am, but that seems to have drifted.” Another relative said, “They arrive when they arrive depending on when they finished the last person. That's the reality of the situation I can't really request the time it's when they will get to you. They have a list, and they work their way through it."

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Where people spoke a language other than English, the registered manager told us the provider used a translation line which could be accessed, in addition they shared an example with us how care workers had used technology to support effective verbal communication with a person.

The registered manager told us how they supported people to access services in the community, where they were not able to do this themselves, or did not have a representative who could support them. This included contacting health professionals on their behalf to reduce the risks of them not receiving the care and support they required. The registered manager told us they had good relationships with other professionals involved in people’s care.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s care records included information about if they had made end of life decisions, including if they wished to be resuscitated. The person’s ‘bio’ provided on hand-held devices advised care workers of the people’s decisions and where these documents could be found in their home. Information was included in care plans relating to people’s decisions of if they wished to remain at home if they became unwell, and important contact details of their representatives, where this had been identified as a point of contact.