Archived: Harmony Care - Staffordshire (DCA)

Harmony Care is a domiciliary care agency that provides personal care within people’s own homes for younger and older adults with a variety of needs, including people living with dementia, learning disabilities or autistic spectrum disorder, mental health conditions or a physical disability. At the time of our inspection the agency was supporting 70 people.

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:

Quality monitoring systems included audits, spot checks on staff practice and regular checks on people’s satisfaction with the service they received, by surveys, phone calls or visits from the service’s management. The provider had recognised the service needed to improve following our previous inspection and people and staff told us there was improvement. These improvements needed to be embedded into usual practice as there were still some areas where people said there could be some improvement, for example for some people felt less staff visiting and consistent provision of rotas (so they knew which staff were coming) was needed.

People and relatives told us they felt safe with care staff and staff were able to demonstrate a good awareness of each person's safety and how to minimise identified risks. People and care staff told us they were able to attend people’s care calls within a timely way and stop for the duration of their planned care call.

People were supported by care staff that were caring. People received care and support based on their individual needs and preferences. Staff were knowledgeable about people, their needs and preferences and used this to develop a good relationship with the people they visited.

People were supported by care staff who had the skills and knowledge to meet their needs. Staff understood, felt confident and well supported in their role. People's health was supported as staff worked with other health care providers when needed to support people’s healthcare needs.

People were supported to have maximum choice and control of their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans reflected people’s needs and preferences and the staff were able to explain recent changes to people’s care. People told us they were involved in assessments of their care needs and reviews were carried out by visiting senior staff.

People knew how to complain and that any concerns would be listened and responded to by the provider. The manager saw complaints as useful feedback from which to develop and improve the service.

People, relatives, staff and professionals gave us an overall positive picture as to the quality of care people received, and said they were able to share their views with staff.

People and relatives told us the manager and staff were approachable, organised, listened and responded to them and acted on feedback when they shared this with them.

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 04 December 2018) and there were three breaches of regulation. We had issued the provider with a warning notice in respect of poor governance. The provider completed an action plan after the last inspection to show what they would do and by when they would improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Harmony Care - Staffordshire (DCA) 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.

Harmony Care is registered to provide personal care and support to people living in their own homes. There were 77 people using the service at the time of our inspection.

A requirement of the provider’s registration is that they have a registered manager. A registered manager is a person who had registered with the Care Quality Commission to manager the service. Like registered provider’s 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. At the time of our inspection visit there was not a registered manager in post, they had stepped down from their role on the 22 October 2018. An acting manager had been appointed by the provider, who had commenced their employment on 22 October 2018. The newly appointed acting manager was supported by a director of operations during their probation and induction.

The provider had not ensured that effective quality assurance procedures were in place to assess and monitor the quality and safety of the service people received. Following the first day of our inspection visit we asked the provider what actions they planned to take to improve their service. When we visited on the second day of our inspection visit, we saw the provider had taken action to immediately mitigate the risks to people, from receiving unsafe care.

We initially found risk assessments were not always in place to manage the risks associated with people’s safety, health and well-being. Medicines were not administered to people safely, as we could not always determine whether people received their prescribed medicine as they should. In addition, staffing levels were not sufficient to ensure people always received their care and support at agreed times.

Following the first day of our inspection visit the provider had taken action to update procedures and care records, to improve risk management and medicine administration procedures, and ensure there were sufficient staff available to meet people’s agreed care packages.

Accidents and incidents, and safeguarding concerns had not been consistently recorded, investigated, and analysed to ensure lessons were learnt from such events, and risks to people were mitigated to prevent future occurrences. The provider had not always ensured CQC were notified of incidents as they were required to. By the second day of our inspection visit procedures were in place to ensure future events were recorded, investigated, and notified to CQC.

Staff completed training to meet people’s needs, however staff training was not up to date, and we identified not all of the training was effective. Mental capacity assessments had not always been completed for people who needed them. This meant decisions that were made in people’s ‘best interests’ were not always accurately recorded. The provider had plans in place to review staff training, and all care records for people who used the service.

We received mixed feedback from people about how the service was run. People told us they felt individual staff who supported them were kind.

Prior to using the service people were assessed so that the service could meet their needs and people told us they usually felt involved in decision-making about their care and support. However, information about how people could be supported with their communication needs could have been more detailed.

Staff enjoyed working at Harmony Care, however, they did not always feel supported by the management team. There was an ‘out of hours’ call system in place to provide support and advice to staff whilst they were working in people’s homes.

There were systems in place to gather people’s feedback. People knew how to make a complaint if they needed to, however, people’s feedback and complaints were not always recorded, and were not always analysed to ensure the provider learned from these.

People told us staff respected their right to privacy and explained to us how staff supported them to remain independent. People who required support with eating and drinking were provided with foods they enjoyed.

We found there were three 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.