HICA Homecare - Hull

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were happy with the care being provided and praised their regular carers.

Care and support was tailored to people's need as most staff knew people well. There were some shortfalls within care records to identify peoples assessed needs. We made a recommendation about updating people's assessed needs on the new electronic care planning system.

Robust recruitment processes were followed. People were actively involved in the recruitment process to ensure the right staff were being employed.

The provider had systems in place to safeguard people from abuse and staff demonstrated an awareness of safety and how to minimise risks.

Medicine systems were in place, however there was no ‘as and when required’ medicine guidance to support staff with administration. We made a recommendation to implement PRN protocols to support staff with decision making when ‘as and when required’ medicines were needed.

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 told us the management team were approachable and they felt appreciated by their manager and the wider organisation. Staff recognition rewarded staff throughout the year.

Processes to assess and check the quality and safety of the service were completed. The registered manager and operations manager carried out audits and quality monitoring reports. These identified areas of the service that required improvement and these actions were carried out.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Model of care and setting maximises people’s choice, control and independence

Right care:

Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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

Rating at last inspection

The last rating for this service was Good (published 28 December 2017).

Why we inspected

This was a planned focused inspection. This report only covers our findings in relation to the review of the key questions Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HICA Homecare Hull on our website at www.cqc.org.uk

Follow up

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

At a comprehensive inspection in October 2015 the service was rated as ‘Inadequate’ because the provider was in breach of three regulations assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a requirement notice in respect of safeguarding people from harm (health needs were not identified or monitored). We issued warning notices in respect of safe care and treatment (poor management of medicines and missed calls) and governance (quality assurance systems were ineffective at identifying problems with medicines and staff training).

At a second comprehensive inspection in April 2016 the provider was no longer in breach of these regulations, as they had improved in all of the areas and met the Warning Notices. However, we could only change the rating to ‘Requires Improvement’ because we had not seen sufficient consistency in meeting the regulations for a sustained period of time and we found the provider was in breach of a new regulation in respect of refresher training to ensure staff knowledge and skills were updated and in line with best practice.

At this inspection in 2017 we found the overall rating for this service to be 'Good'. This was because the one breach we found last time was now met. Staff training was up-to-date and refreshed, and sufficient consistency had been achieved by the provider in meeting all other regulations. This meant the provider had sustained improvements over the last 20 months.

The rating is based on an aggregation of the ratings awarded for all 5 key questions.

HICA Homecare - Hull is a not for profit care agency owned and managed by Humberside Independent Care Association (HICA). The agency provides home care services within Hull and East Riding of Yorkshire to younger adults and adults who may have a learning disability or Autistic Spectrum Disorder, mental health needs, a physical disability, alcohol or drug dependency, sensory impairment, an eating disorder or be living with dementia. At the time of the inspection it was providing support to approximately 270 people over the age of 18.

The provider was required to have a registered manager in post. On the day of the inspection the registered manager had been in post for the last four months. However, we were informed that an acting manager would soon be submitting an application to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the risk of harm by the provider’s systems to detect, monitor and report potential and actual safeguarding concerns. Support workers were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing such concerns. Risks were managed so that people avoided injury or harm. People’s homes were risk assessed to ensure they and support workers were protected from harm during the times care and support was delivered. Support worker numbers were sufficient to meet people’s needs. Rosters were accurately maintained. Recruitment policies, procedures and practices were carefully followed to ensure support workers were suitable to deliver the service to vulnerable people. We found that the management of medication was safely carried out.

We found that people were supported by qualified and competent support workers who were themselves regularly supervised and had their personal performance annually appraised. Communication across the service was improving and support workers felt they were well informed. People’s mental capacity was appropriately assessed and their rights were protected when necessary using Court of Protection orders. Support workers demonstrated knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager demonstrated how the service worked with other health and social care professionals and family members to ensure decisions were made in people’s best interests where they lacked capacity. People were supported with nutrition and hydration when required, to maintain their health and wellbeing.

We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with any relevant information about the service and were involved in all aspects of their care. They were asked for their consent before support workers undertook any support tasks and had signed a declaration giving their consent to receive support. People’s wellbeing, privacy, dignity and independence were monitored and respected and staff understood the importance of maintaining and encouraging these wherever possible. This ensured people were respected, felt satisfied and were enabled to maintain control of their lives.

People were supported in accordance with person-centred support plans, which reflected their needs well. These were regularly reviewed. We found that there was a complaint procedure in place and people’s complaints were investigated without bias. However, some people felt the procedure could have been more effective if more action were seen to be taken. People that used the service were encouraged to maintain strong networks with relatives and friends.

We found that the service was well-led and people had the benefit of both a culture and a management style that were professional, enabling, open, positive and approachable. There was an effective system in place for checking the quality of the service using audits, satisfaction surveys, meetings and ‘spot checks’. There was an aspirational philosophy that underpinned the organisation’s commitment to continuous improvement, called SHINE. People were assured that recording systems used in the service upheld the organisations confidentiality codes, as records were well maintained and held securely at the agency premises.