Archived: HMS Care

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.

HMS Care is a domiciliary care service providing personal care to adults in their own homes. Not everyone who uses the service received personal care. CQC only inspects where people receive personal care. At the time of the inspection 45 people were using the service.

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

Following the previous inspection in October 2019 the provider sent us an action plan. This included information about the actions they had taken to make improvements within the service.

At the last inspection medicines were not managed safely. At this inspection? whilst paperwork had been put in place to support medicines administration, records continued to be incomplete. Whilst audits had identified the gaps in administration records, actions had not been taken to address these errors and ensure people had received their medicines or medical advice sought.

At the last inspection staff had not always received supervision, competency checks and spots checks. At this inspection some improvements had been made with spot checks and competencies being undertaken. Supervisions were in the process of being completed. Actions had been taken to improve core training to ensure staff received the correct information to develop their skills and knowledge. Not all training was up to date due to Covid-19.

Whilst there were processes in place to support staff with using personal protective equipment (PPE), it was fedback by people using the service and their relatives during inspection that not all staff were wearing appropriate PPE. This has also been substantiated by some of the staff who have fedback. The registered manager did address this via an email to staff during the inspection.

At the last inspection governance and performance management systems were not effective. During this inspection improvements to governance systems had not been made. The provider and registered manager had no oversight of the audits being completed and therefore had not been able to identify any actions required. The provider’s action plan stated there would be a “new audit schedule” introduced to ensure monitoring. There was no evidence of this being in place. There was no evidence that the provider had an oversight of the service as they had not completed any management audits.

People said they felt safe with the service they received. They said they would raise concerns but that concerns were not always responded to. People spoken with felt communication could be improved. People fedback that the allocated times of visits were not always adhered to and they did not always have regular carers. People found the carers to be “caring, polite and good company.”

Care plans were currently being updated in to a new person-centred format. Records we reviewed contained information on people’s care routines and preferences for how they wished to receive their care. Changes to risk assessment paperwork was being implemented. However, risk assessments were not completely up-to- date and had not been embedded sufficiently to evidence they were suitable.

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.

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 requires improvement (published 12 November 2019). There were multiple 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 enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 01 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what actions they had completed in respect of the improvements they needed to do.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

HMS Care is a domiciliary care service providing personal care to adults with a range of health issues in their own homes. 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. At the time of the inspection 67 people were supported in this way.

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

The quality of information in people's care plans varied and some records we looked at did not include information about individual risks or had not been reviewed in a timely manner. Care plans were currently being updated to ensure they were clearly person centred.

Medicines management needed to be improved, including staff checks on their competence to administer medicines to people safely.

People felt safe with the care staff who visited them and were happy with the caring nature of the staff team, describing staff as kind and thoughtful. People confirmed they received enough suitable food and drink.

There were enough staff to provide the care and support people required. However, some people did not receive their visits at the times expected and people reported not receiving staff rotas when requested.

Staff felt better supported with the current manager, however, supervision, yearly appraisals, spot checks and competency checks were not all in place.

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. However, some documentation regarding this was not always in place.

Governance and performance management systems were not always effective. Although some improvements had been made since our last inspection, we found further action was needed in various areas of the service. The management team were responsive to feedback and wanted to improve the service for the benefit of the people receiving it.

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 requires improvement (published 3 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was the first time we inspected the service, which was registered with CQC in July 2017. We have rated the service as ‘Requires Improvement’.

HMS Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, including some people with dementia, and to younger adults with physical disabilities.

Not everyone using HMS Care receives 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. At the time of this inspection the service provided personal care to 45 people.

A registered manager was not in place at the time of the inspection. 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. The previous registered manager had de-registered approximately seven months before our inspection. The provider had employed a new manager who was in the process of applying to CQC to become registered manager.

Safe recruitment processes had not been followed. Staff had delivered care before the provider had taken all reasonable steps to ensure they were of good character. Some staff had started work before the provider had received satisfactory Disclosure and Barring Service (DBS) checks or two references. The provider told us these recruitment decisions had been made by a previous manager, and that going forward the recruitment policy would be adhered to.

People told us they felt safe and staff had a good understanding on safeguarding policies. However, processes in place to protect people from financial abuse had not been followed.

There was limited evidence that the provider learned from mistakes. Accidents and incidents were reviewed, however, the number of missed visits, where staff did not attend a scheduled visit, were not monitored. Despite having to use their emergency contingency plan four months before our visit, this was still not detailed enough to minimise risks to people if the provider was unable to deliver the service.

Medicines were well managed and infection control policies were followed.

A staff training program was in place, so all staff received training key to their role before they started delivering care. Staff told us they received regular meetings with their supervisor and that the staff in the agency office were very supportive. Some of the agency office staff had limited experience within adult social care, but were about to begin diplomas in Health and Social care.

We have made a recommendation that the manager is also supported to access personal development relevant to their role.

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. However, legal documentation relating to Lasting Power of Attorney (LPA) had not been viewed by staff. We were told records which noted people had LPAs in place would be reviewed to ensure legal processes had been followed.

People’s health was monitored. Where needed staff had made referrals to healthcare professionals, and sought emergency help where people were unwell.

People and relatives told us staff were caring. They gave us examples of when they had been touched by the way staff had gone out of their way for people. We saw that staff knew people well and had good relationships. People’s privacy and dignity were respected, and they were encouraged to be independent.

People were given information about the service in a format which was meaningful to them. People told us they wanted to be informed in advance which staff members were scheduled to visit them. When we shared this feedback with the provider they arranged for weekly rotas to be sent to people detailing their upcoming visits.

People and relatives were involved in the planning of their care. Care plans were very specific on the tasks which staff needed to carry out to meet people’s needs. However, at times they were task-focussed and varied in how person-centred they were.

Where people were supported with activities, these were tailored to people’s interests and hobbies.

The provider had not recorded any complaints, however people told us they had raised informal complaints and share feedback with care staff and those from the agency office. We discussed this with the provider and they told us they would start to record this type of feedback so it could be better monitored and used to drive improvements.

The provider had not operated a robust quality assurance system. Audits carried out had not identified the shortfalls which we found during this inspection. Where audits had highlighted improvement areas action had not always been taken to address them.

People and staff spoke highly of the new management team. They told us the service was improving, and that the new management team had been proactive in making positive changes to the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to good governance and staff recruitment. You can see what action we told the provider to take at the back of the full version of the report.