During an assessment under our new approach
Hales Group Limited – Norfolk is a domiciliary care service which provides personal care to people in their own homes. The last inspection of this service was on 9 November 2020. This was a focused inspection looking at the key questions Safe and Well-led and was requires improvement.
A comprehensive assessment was planned due to concerns identified by the local authority and intelligence received by CQC from whistle blowers, notifications, complaints, and safeguarding concerns which suggested a decline in the quality of the service being provided and potential breaches of regulation. The assessment took place from 19 March 2025 to 7 May 2025. We made an onsite visit to the service’s office on 26 March 2025.
At the time of our assessment, it was providing support to 140 people. There was no registered manager, but an acting manager was in post. The assessment was conducted by 2 inspectors and an Expert by Experience who is a person who has personal experience of this type of service. They were able to speak with 19 people using the service and their relatives about their experiences of this service.
We found 5 breaches of regulation relating to person centred care, consent, safe care and treatment, governance and staffing.
Concerns identified included, widespread failings with call scheduling resulting in people experiencing missed, late or rushed calls and care workers failing to spend the allocated time with them. Call scheduling had an impact on people’s care and the safe administration of medicines, support with meals and personal care. Missed medicines were not effectively managed or escalated to ensure people did not suffer any ill effects and we were not assured the provider observed the prescribers’ instructions to ensure people had their medicines on time.
People experienced poor communication with office staff and were not advised who was delivering their care or reasons for lateness. Care staff reported working under stressful conditions without adequate travel time and without the support of their senior team, often working unacceptably long days. Stressed care workers meant their wellbeing was not prioritised by the organisation and this had an impact on the people being supported. People were supported by multiple care staff, and documentation was poor so we could not be assured that people received timely, consistent care around their needs. Risks associated with people’s care needs were not adequately picked up by provider audits making it more likely for errors to occur and for people to suffer from avoidable harm. Care notes were not always completed contemporaneously or changes in need escalated to ensure the care plan remained appropriate.
There was limited evidence of how the provider acted in people’s best interest when they were unable to consent to care and treatment and how changes in people’s cognition and circumstances were escalated to ensure necessary care could be provided.
Mechanisms for staff support were poorly executed with staff not receiving regular supervisions or spot checks to ensure they were delivering care correctly. This left people vulnerable to receiving poor care. We also found evidence of training being out of date so were not assured of the competencies of the staff.
Person centred care was not at the heart of this service provision with poor scheduling, poor work force planning, poor support for staff and poor documentation and review of care plans. People were not routinely asked for their feedback, and they had little influence in how their care was provided, when and by whom.
There was a lack of effective quality monitoring systems and provider audits failed to identify the concerns we did. Poor communication and records failed to identify changes in people’s needs. A lack of oversight made it difficult to ascertain how this service was being effectively delivered.
‘This service is being placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.’
In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.