The inspection was announced and took place on 26 February 2018.Harp Care is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides personal care to people with a variety of needs including older people, younger adults, people with a learning disability and physical disability. At the time of the inspection, 13 people were using the service.
Not everyone using Harp Care receives a 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. Twelve people were being provided with ‘personal care’.
At the last announced comprehensive inspection in December 2016, we judged that improvements were required in delivering a safe and well-led service. During that inspection we found the provider to be in breach of the regulation related to fit and proper person’s employed. This was because the registered manager had not completed all the appropriate and standard safety recruitment checks to ensure staff were safe to provide care to people. We also found the provider to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe’ and 'is the service well-led' to at least good.
At this inspection we found that improvements had been made to promote the safety and quality of the service. We found that the provider was now compliant with both regulations, however further required improvements were needed and we found one new breach of regulation.
We were told one of the three partners of Harp Care, was also a care worker. We found the partner had not ensured they were appropriately trained to deliver the regulated activity they were providing. We could not asses if people being cared for had been impacted by this and have covered this in the key question, ‘is the service well-led’. This resulted in one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. A service cannot have an overall rating of ‘Good’ with a breach of one or more regulations in any one key question.
Regular audits and quality assurance checks required further development in order for the service to improve.
The registered manager was unable to explain her responsibilities under the duty of candour. We recommended the registered manager seek guidance on the duty of candour from the Commission’s published guidance for providers.
Staff told us they felt supported and people felt able to contact the office in the knowledge they would be listened to. People who used the service, relatives and care workers all spoke positively of the registered manager and their commitment to the service and people who used it.
There was a registered manager in post. 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.
People were protected from abuse. Staff followed the provider’s safeguarding procedures to identify and report concerns to people’s well-being and safety.
Appropriate risk management systems were in place. Staff followed the guidance in place to support people's safely in line with the risks identified to each person’s health and well-being.
People were supported by a sufficient number of staff who underwent appropriate recruitment checks.
People received the support they required to take their medicines. Staff knew how to minimise the risk of infection.
Appropriate systems were in place to enable staff to report and learn from incidents that may happen at the service. Staff had access to out of hours’ guidance for additional support when responding to an emergency or difficult situation.
Staff received support, supervision and attended training to enable them to undertake their roles effectively. People were involved in the planning and review of their care. Staff delivered people’s care in line with their changing needs, preferences and best practice guidance.
People were encouraged to maintain a healthy diet and to have sufficient food to eat and drink. Staff supported people to access healthcare services when required.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff sought people’s consent before providing care and treatment.
People received care in a manner that treated them with respect and promoted their privacy and dignity. Staff developed positive relationships with the people they supported and offered emotional support when needed.
People and staff commended the registered manager and their care provision. People received person-centred care and benefitted from an open and transparent culture.
People were confident about making a complaint and had received information about how to make their concerns known. The registered manager sought people’s views about the service and acted on their feedback.
The registered manager made improvements when necessary to develop the service. There was collaboration between the registered manager and other agencies to enhance the quality of care provided to people.