Archived: Haven Social Care Limited

Haven Social Care Limited provides personal care to adults living in their own homes. At the time of our inspection they were supporting 24 people.

The service had 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.

The service was last inspected in January and February 2016 when we found breaches of two regulations and made one recommendation. These issues had not been addressed.

Staff were not recruited in a safe way as interviews and skills audits were not assessed by the provider. People told us there were not enough staff and this meant they had to wait for care, particularly at weekends. The provider did not maintain sufficient records to ensure that staff identities were known. Staff did not receive sufficient training or support to perform their roles.

People told us, and records confirmed, care plans were reviewed and updated every six months. Care plans were task focussed and did not contain information about people’s preferences for care, food or staffing. There was limited information about people’s pasts, cultures and identity. We have made recommendations about recording people’s dietary preferences, cultural and identity needs.

People receiving care lived with a range of long term health conditions. The support they required to maintain their health and the impact their health conditions had on their support was not recorded. We have made a recommendation about recording people’s health needs.

Risk assessments were in place for some identified risks. However, the measures in place to mitigate risk were not robust and did not contain enough information for staff to use to keep people safe. Some risks had not been properly identified and there were no measures in place to mitigate them.

People were supported to take their medicines. There was insufficient information in care plans to ensure this was managed in a safe way. Records of medicines were unclear and did not show they were administered as prescribed. The service did not check medicines records to ensure medicines were managed safely.

People told us they were offered choices and care workers asked their permission before providing care. Records of consent were not in line with legislation and guidance as friends and relatives without appropriate legal authority had signed consent forms of people’s behalf.

The provider had a complaints policy in place and had not received any formal complaints since our last inspection. Records showed that feedback had not always been responded to. We have made a recommendation about responding to feedback.

Feedback about the management and leadership of the service was mixed. People and some staff told us the registered manager was kind and supportive. Other staff told us the service was disorganised and the registered manager did not respond when they requested support.

There were no effective systems in place to monitor the quality and safety of the service. Records were not routinely checked and some could not be located during the inspection.

People told us staff had a caring attitude and treated them with dignity and respect. Care workers spoke about the people they supported with kindness and affection.

We found breaches of six regulations. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

against the risks associated with unsafe or unsuitable care because records about people were not kept up to date to reflect current health and care needs. The service had taken action to address these issues and now met the legal requirement for Regulation 9. In January 2015 the service was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 as the registered person had not notified the Care Quality Commission of allegations of abuse in relation to people who use the service. The service had taken action to address this issue and met the legal requirement for Regulation 18.

Haven Social Care Limited is a domiciliary care agency providing support to people in their own homes. At the time of our inspection they were providing support to 20 people.

The service had 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.

The service did not have enough staff to ensure that people's needs were met. Although the service was taking action to address this, there had been periods where the staffing levels had been so low that people received care late and some care visits were missed. This was a breach of Regulation 18 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.

Staff recruitment policies were robust, but had not always been followed. This meant that staff who may not have been suitable to work in care had been employed by the service. This was a breach of Regulation 19 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.

The service was not consistently well led. The contingency plans for staffing had not been effective which had led to poor care being delivered. Although action was being taken to address this, issues had not been identified or acted upon in a timely manner. We have made a recommendation about quality assurance and audit.

Staff received group supervision and support. Staff told us they found the group supervision useful, however, the group setting meant that individual performance monitoring and development was not completed. We have made a recommendation about staff supervision.

People told us they felt safe when receiving a service and described how staff took action to keep them safe. Staff demonstrated they understood safeguarding adults policies and the registered manager took appropriate action to deal with any allegations of abuse.

People's care plans were detailed, personalised and contained robust risk assessments that ensured that risks to people were managed and their freedoms supported. People's care was reviewed regularly and where necessary changes were made to people's care packages.

Where the service was responsible for supporting people with their medicines this was managed safely and people were supported in a safe way. Likewise, where the service was responsible for supporting people with their food and hydration and other health needs this was managed well.

People told us their staff were caring and good at their jobs. People felt their care workers listened to them and provided them with high quality care.

Staff received the training they needed and people felt confident that staff had the training they needed to perform their roles.

The service had a complaints policy and people knew how to make complaints. People told us that when they had made complaints these had been resolved in an appropriate and timely manner.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe and their relatives said the same. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Personal Protective Equipment was available for staff to use to minimise risk of infection and to carry out their role. Other equipment was available including hoists and staff had been trained how to use them to avoid people being put at unnecessary risk.

Managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations as the service followed up on these matters so that they did not happen again.

Is the service effective?

People's health and care needs were assessed with them. Relatives were also spoken to to ensure they had a care plan that met people's needs. The service contacted and involved specialists where mobility and equipment needs had been identified for people.

Is the service caring?

People and their relatives said the care staff were kind and supportive. One relative said "the care worker is like one of the family now." Another relative said "[the care worker] helps me with the cleaning, they are very good".

People's preferences were taken into consideration and the service tried to accommodate where people wanted a particular carer.

Is the service responsive?

People and staff knew how to make a complaint if they were unhappy. We saw where staff had raised concerns and the registered manager had responded to these quickly which demonstrated they listened to staff. We saw that matters requiring investigation were undertaken and the results fed back to staff and people who used the service as necessary.

We looked at people's personal records and found that they did not always reflect the current needs of a person where changes had been identified in behaviour. The service had not completed an up to date risk assessment to protect the person or staff entering their home. We also found that records relating to medication were not always accurate or clear to explain what the current procedure to follow was.

Whilst staff knew to report safeguarding matters to management, the local authority or the Care Quality Commission we did not receive earlier safeguarding notifications from the provider in a timely manner.

We have asked the provider to tell us what improvements that will make in relation to their records and notifications to the Care Quality Commission.

Is the service well-led?

People using the service, their relatives and friends at the service completed a survey to comment on how the service and staff performed. Staff were also asked for feedback to find out how their role was to help the provider make improvements.

The service worked well with other agencies and services to make sure people received their care in a joined up way in relation to obtaining further assessments from other health professionals.

The service has a quality assurance system, to improve the quality of care people received. Staff had regular team meetings and supervision. We saw records to show people were contacted to ensure they were happy and received quality monitoring visits. The registered manager showed us a record of a service recovery plan which was to enable them to learn from past mistakes and try to continuingly improve. We were shown how the service was improving their staff records by auditing them and contacting staff for missing information. The service was also introducing call monitoring for quality control purposes.

We looked at five support plans and saw that they were person centred and tailored to each individual. Information was recorded about people's past history, their likes and dislikes and how they wanted to be independent.

Staff showed a good understanding in relation to safeguarding adults and knew how to escalate concerns. However we did note that there was a lack of training in the area of restraint and the Mental Capacity Act 2005.

Staff were supported in their role and received appropriate supervision and one to ones. Staff we spoke to told us that they were encouraged to complete additional training to improve and some told us they were seeking further qualifications to develop in the role.

The service sought the views of people using the service via a survey.