Background to this inspection
Updated
2 September 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave a short notice of the inspection because we wanted to contact people to gather their views and needed their consent to do that, and also to ensure the registered manager would be in the office when we attended.
Inspection activity started on 12 July and ended on 15 July 2021. We visited the office location on 13 and 15 July 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from three local authority areas involved, care professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with seven people who used the service and three relatives about their experience of the care provided. We spoke with the provider and registered manager and contacted all staff working for the organisation for their views. We contacted four social workers and used their responses to support the inspection process.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four staff files in relation to recruitment, training and staff support. A variety of records relating to the management of the service, including policies and procedures, were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
2 September 2021
About the service
HMS Care is a domiciliary care service providing personal care to people living in their own homes. At the time of this inspection, 93 people were using the service.
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
Risks to people and staff had been identified assessed and reviewed. However, some updates were still required and detail could be more robust. We have made a recommendation around reviewing and highlighting risks to staff.
Staffing levels had been affected recently due to the pandemic and a number of staff leaving at the same time. This had impacted on the system to allocate staff to people’s care calls. Some people did not feel the care they received always met their needs and preferences, due to the lateness of calls, staff not staying for the allocated time or the inconsistency of staffing. Staff had been recruited safely, however, some records required improvement. We have made a recommendation around reviewing staffing levels and recruitment practices.
Medicines were safely administered to people. Some improvements to records were made during the inspection to better support staff. Any medicines concerns had been reported correctly and investigated by the provider.
Staff followed infection control procedures and were complimented by people. However, two staff were reported to have pulled down masks to speak to people. The registered manager was dealing with this.
Staff received induction and training, and had ongoing support from management. Spot checks and staff competencies were completed. Any staffing issues raised had been investigated and reported correctly. Additional training had been booked to take place.
People told us they were treated with dignity and respect and encouraged to be as independent as possible. Person centred care plans were in place. A small number were in the process of being updated.
People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. This was going to be updated after our feedback to further improve the process from suggestions made.
The registered manager had a good working relationship with people and other healthcare professionals. However, some comments were made that communication with office staff, particularly, could be improved.
The provider and registered manager were committed to continuous improvement of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 25 September 2020) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations, but further improvements were required, and additional time needed to sustain this.
Why we inspected
We carried out an announced focused inspection of this service on 20 August 2020. We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This inspection also followed up on two further breaches of legal requirements regarding safe care and treatment and staffing to make sure they had been addressed. The provider completed an action plan after the last inspection to show what they would do and by when to improve these breaches. Breaches were met, but the overall rating for the service has not changed following this focused inspection and remains requires improvement, as further time is required to embed practice and further improve in some areas.
This report only covers our findings in relation to the Key Questions, safe, effective, responsive and well-led which contain those requirements or had been previously rated as requires improvement.
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 as requires improvement. 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 HMS Care 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.