Hertsmere Valley Care Services Limited

Hertsmere Valley Care Limited is a domiciliary care service which provides personal care and support to people in their own homes. The service was supporting 28 people at the time of our inspection.

People’s experience of using this service

People told us people they were happy with the care and support they received because they felt safe and all their needs were met by kind and caring staff.

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take medicines safely.

Risks to people were assessed and regularly reviewed. Staff understood the actions needed to minimise the risk of avoidable harm including the prevention of avoidable infection. Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor

practice.

People praised the managers of the service and agreed that they were approachable, knowledgeable, fair and did their job well. The staff team worked well together and supported the registered manager.

The staff team was committed to providing a high-quality service. They had undertaken training so that they were skilled and knowledgeable to effectively meet people’s needs. Staff understood their responsibilities to report any concerns.

Staff encouraged people to be as independent as possible and respected people’s privacy and dignity. Staff knew people well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well. Care plans contained information about each person’s individual support needs and preferences in relation to their care.

Recruitment practices were safe and relevant checks had been completed before staff worked at the service.

People told us that staff were able to meet their needs and were respectful of their individual preferences.

People confirmed the service did not miss any care calls and that staff were usually on time.

People received care and support from a small group of staff, which provided consistency.

The managers of the service actively sought the views of people and their relatives about the running of the service and they dealt promptly with any concerns that people raised.

The provider had systems in place to monitor and improve the quality and safety of the service provided.

Rating at last inspection

At the last inspection we rated this service Good. The report was published on 25 September 2017.

Why we inspected

We carried out a focused inspection of this service on 21 April 2021. This report only covers our findings in relation to the Key Questions Safe, Effective and Well led as we were mindful of the impact and added pressures of Covid-19 pandemic on the service. This report only covers our findings in relation to the Key Questions safe, effective and well led.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a registered manager in place who was also the provider. 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 and associated Regulations about how the service is run.

When we last inspected the service on 02 and 03 May 2017 we found that although the service had made some improvements further improvements were required. The overall rating for the service was Requires Improvement at that inspection. Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements.

At this inspection we found that the provider had made the necessary improvements and was meeting the regulations of the Health and Social Care Act. People told us they received care and support that met their individual needs and preferences. People were involved in the development, planning and review of their care. Care plans were personalised and contained detailed information about people’s support needs and risk assessments were detailed and specific providing staff with all relevant information to help ensure risks were both identified and mitigated where possible

Staff knew people well, supported them to retain their independence and treated them with dignity and respect. Staff were able to demonstrate a good knowledge of safeguarding procedures and knew how to recognise and respond to any allegations of abuse. Medicines were managed safely, staff had received training in the safe administration of medicines and had their competencies checked.

People were supported by sufficient numbers of staff and these were recruited through a robust process which helped to ensure staff were suited for the roles they employed. Staff had received an induction and received on-going training and support. Staff had opportunities to attend team meetings and had individual meetings with their line manager to discuss any concerns.

People were supported to make their own decisions, and to retain where possible everyday living skills and abilities and their choices were respected. Their views were obtained through various systems in place to obtain feedback. People’s views were taken into account and acted upon appropriately.

There were systems and processes in place to monitor and improve the service to achieve a consistently good standard of care and support for everyone who used the service. There was a call monitoring system in place and spot checks were completed to help monitor the visit times.

There was a registered manager in place who was also the provider. 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 and associated Regulations about how the service is run.

When we last inspected the service on 19 January 2017 we found breaches of regulations 11, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People’s consent was not routinely or consistently obtained. Although there was a complaints process in place, we found that the complaints log did not have any complaints recorded. The provider’s quality monitoring and governance was inadequate, as there were no systems in place to monitor the safety and quality of the service. The provider was unable to demonstrate that people received their visits at the agreed times. There was no call monitoring system in place at the time of our inspection. Staff did not always have a DBS check completed before they started working with people using the service. Staff did not always have training and support to assist them in their roles. References were not validated in accordance with the providers own recruitment policy.

We took action using our regulatory powers and urgently imposed a restriction to ensure Hertsmere Valley Care Limited did not start providing a service to new people and sought urgent assurances to ensure existing people were kept safe. The overall rating for the service was ‘inadequate’. The service was put in special measures which meant that the service was kept under regular review. We also shared our findings with the local authorities safeguarding and commissioning teams.

Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made some improvements. Further improvements were required to achieve full compliance with the regulations, and the restriction on taking on new people will remain in place until we are satisfied that the improvements are sustained.

People told us they received care and support that met their individual needs. People were involved in the development, planning and review of their care.

People and their relatives were more positive about the service they received than they had been previously. They told us things had improved in recent months. However staff still did not always arrive at the planned time. The people we spoke with had not experienced any missed visits. People told us staff supported them and completed the tasks they were required to do.

Since our last inspection the provider had put a call monitoring systems in place to monitor staff arrival or departure times. Staff had received some training on how to use the system effectively, and this was being further developed to ensure the system provided timely information to senior staff to enable them to take action to manage the service effectively.

People told us the staff who supported them were respectful and maintained their dignity and privacy. We saw that people’s care plans and risk assessments had been reviewed since our last inspection and did contain sufficient detail to inform staff how to care for people safely. These required further development and in particular around personalisation. There was some evidence that people had been involved in discussions about their care and support and this was being implemented as a routine process. People’s likes and dislikes and personal information had been included in their care records.

Staff were able to demonstrate that they knew how to identify and protect people from possible harm or abuse by reporting and elevating any concerns. Staff had received some training and further safeguarding and refresher training was being arranged for all staff.

People were asked to provide consent before staff supported them and this had been recorded in their care plans. Staff had some understanding of the Mental Capacity Act (2005) (MCA) requirements and the provider told us that MCA/DOLs training was being arranged for all staff.

People were being supported and prompted to take their medicines and staff had received basic training in how to administer medicines. However, records relating to the ‘prompting of medicines were not properly or consistently completed and this was an area that required improvement. The provider had put a system in place to audit people’s medicines and medicine records to make sure any concerns were quickly identified and the risk of a reoccurrence minimised. As this had only recently been introduced it was too early to assess how effective the process was.

The recruitment process had been reviewed and a more robust system put in place. However we found that further development was required to make this more effective and ensure pre-employment checks were consistent.

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Staff received some training. The provider told us further training was being planned for all staff to complete. The system for planning and reviewing staff training needs required further development so that the system could help identify when staff required refresher training. The provider had introduced competency checks for staff. However this had only recently been introduced and needed to be embedded to demonstrate that this was a consistent process.

The provider told us staff had received supervision and we saw records which confirmed this. A system of regular supervision was being planned and the provider told us that staff would receive on-going support and supervision at regular intervals.

The provider had introduced some systems and processes to help monitor the overall quality of the service provided. We saw that some audits were in place to ensure the service was operating effectively and safely. The complaints process had been reviewed and a more consistent approach to the recording and investigation of complaints was required.

There was a registered manager in place who was also the provider. 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 and associated Regulations about how the service is run.

People and their relatives were not always positive about the service they received. Staff did not arrive on time and people told us they had experienced missed visits. People told us staff did not always stay the prescribed time and sometimes provided very little support to people. There were no systems in place to monitor staff arrival or departure. People told us they had concerns about some of the staff and visits were often provided later or earlier than the expected time. Three of the five people we spoke with gave positive feedback in relation to one member of staff who had recently stated to provide their care.

People told us the staff were not always very kind or caring. The provider was not able to give us any evidence that people were involved in the development or review of their care plans and times of visits. People’s likes and dislikes and personal information were not included in care records.

Staff did not always understand their responsibility to protect people from harm and abuse. Although the provider told us they had received training in how to safeguard people from harm they were not able to demonstrate they understood what constituted abuse or how potential referral should be managed. There was a policy in place in relation to safeguarding people but staff were not aware of its existence.

People had a pre service assessment in place completed by commissioners but there was no provider assessment undertaken. We saw that risk assessments were basic and lacked the level of details to inform staff how to manage risks effectively. The provider told us care plans were on the system however did not show us these when requested as part of the inspection. Consent was not obtained or recorded on people’s care records and staff did not understand when we asked them about the arrangements for obtaining consent and also did not understand how this related to MCA legislation.

We could not be assured that there was a process in place to monitor the process to check that people received their medicines appropriately and safely. Audits had not been completed in respect of people’s medicines.

People were supported by a small team of staff. However we found that the recruitment process was inadequate and checks were not completed before staff started working. We could not be assured that the staff were suited to work with people in their own homes.

Staff received some training. However, the provider was only able to give us a certificate covering up to 12 topics on one day. Staff were unable to demonstrate that they understood the learning and the provider was not able to provide evidence of any competency checks. There were no systems were in place to monitor and check the training and skills of staff. Staff’s abilities and care practices were observed by new staff who had not had their own competency checked. We found that staff had not received training in some subjects such as end of life care and mental capacity. The provider told us staff received some supervision although they were unable to provide any evidence of this at the inspection and staff were not aware that they had supervision.

We could not assess if people were supported to eat and drink sufficient amounts due to the provider not making any care plans available during the inspection. We also could not check if people were supported to maintain their health as this information was not made available to inspectors. People were not supported with social interaction and engagement and staff did not understand when asked about 'engagement' with people.

The provider was not able to show us any completed audits in place to ensure the service was operating effectively and safely. We could not be assured that complaints were acted upon or that when feedback was received that it was acted upon. We found the provider had a limited understanding of how they should be meeting the regulations and also in relation to our regulatory role.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.