Archived: Heritage Healthcare - Darlington

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The provider had policies and procedures in place to keep people safe. Risks to people were assessed and control measures in place to reduce risks. Staff had an understanding of safeguarding and what may constitute abuse. Any concerns were reported to the registered manager who acted appropriately. Staff were confident in reporting concerns. Medicines were managed safely. Weekly schedules were developed to ensure people received their calls at the correct time. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

Care and support was provided using best practice, such as following health and safety guidance. Training plans were in place, along with spot checks, supervision and appraisal planners. Staff felt supported in their roles. People felt staff were well trained and knew how to support them well. People were supported with their nutritional needs where necessary. Staff contacted health care professionals when appropriate. Staff understood the Mental Capacity Act and gained consent prior to any care being delivered. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People and relatives felt the staff were kind and caring. People told us they had good relationships with staff and enjoyed their company. People felt staff showed respect and promoted dignity when supporting with care. People were encouraged to be independent. Staff spoke with fondness about the people they supported. When changes in support were needed, people and/or their relatives were involved.

Care plans were in place setting out individual needs, likes, dislikes and preferences. People were involved in care planning where ever possible. Care plans were reviewed and updated when necessary. The provider worked in partnership with other health care professionals to support people who required end of life care. The provider had a policy and procedure in place to manage complaints. Concerns were investigated and a response made to the complainant. Several compliments had been received from people and relatives with positive comments about the service.

The provider had a quality assurance process in place to monitor the service and drive improvements which included audits of care file, staff files and spot checks. A new electronic system was being introduced to enhance the care management process. The registered manager held regular meetings with staff. People and relatives felt the registered manager was open and approachable. Staff told us the registered manager was supportive and always ready to help. The service worked in partnership with other health care professionals and the local authority. The registered provider ensured staff had access to best practice and guidance from health care professionals.

Further information is in the detailed findings below.

This inspection visit took place on 1 September 2016. This was an unannounced inspection, which meant that the staff and provider did not know that we would be visiting. This was a follow up focussed inspection to look at issues we found on our visit to Heritage Healthcare on 23 and 24 March 2016.

When we visited the service on the 23 and 24 March 2016 we found that medicines were not administered in a consistently safe manner. There was a risk that people were not receiving their medicines as prescribed due to poor record keeping and auditing of errors.

We issued a requirement notice to the registered manager to send us a report (action plan), within 28 days, to explain how they intended to mitigate the risks of poor medicines management and address the breach of regulations. The registered manager sent this report to us promptly and we were satisfied with how they intended to address the issues we found.

Heritage Healthcare is a domiciliary care agency that provides personal care to people living at home within the Darlington area.

There is 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.

On this visit we spoke with the registered manager. They explained the checks they carried out to ensure medicines were administered correctly. We saw improvements the service had made around recording, administering medicines and the auditing system that was now in place.

Heritage Healthcare is a domiciliary care service that provides personal care and support to older people and people with disabilities who live in their own home. The service covers Darlington and the surrounding area and at the time of our inspection the service supported 203 people.

The service had a registered manager. 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 spoke with the members of the staff team including; training manger, care co-ordinators and care staff who told us that the registered manager was always available and approachable. We spoke with people who use the service over the telephone and the relatives of others who were unable to speak with us.

We looked at the medicines administration process and found that the audit process was not completed in time and errors were not addressed quickly. We saw that peoples topical medicines were not always recorded when administered. We looked at how records were kept and spoke with the registered manager and training manager about how staff were trained to administer medicines and we found that the medicines administering, recording and auditing process was at times not safe.

From looking at people’s care plans we saw they were written in plain English and in a person centred way and made good use of, personal history and described individuals care, treatment, wellbeing and support needs. These were regularly reviewed and updated by the care co-ordinators and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP, mental health team and care manager.

Our conversations with people who use the service and checking rotas during the inspection showed us that people who use the service were supported in their own homes by sufficient numbers of staff to meet their individual needs and wishes.

We looked at the recruitment process and found that relevant checks on staff took place and this process was safe.

We looked at the staff training records we could see staff members were supported and able to maintain and develop their skills through training and development opportunities. Staff we spoke with confirmed they attended a range of learning opportunities. They told us they had regular supervisions with the registered manager, where they had the opportunity to discuss their care practice and identify further training needs. During the inspection we were also able to speak with the training manager.

People were encouraged to plan and participate in activities that were personalised and meaningful to them. People were supported regularly to play an active role in their local community, which supported and empowered their independence.

We saw compliments and complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to advocacy services and safeguarding contact details if they needed it.

We found the service had been regularly reviewed through a range of internal and external audits. We saw action had been taken to improve the service or put right any issues found. We found people who used the service and their representatives were regularly asked for their views via phone calls and spot checks by the registered manager and care coordinators.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. Any applications must be made to the Court of Protection. At the time of this inspection no applications had been made to the Court of Protection.

We found breaches 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.