Hales Group Limited - Norfolk

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulations in relation to safe care and treatment and staffing.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a proactive and positive culture of safety based on openness and honesty. Staff did not listen to concerns about safety and did not always investigate and report safety events. Lessons were not learnt to continually identify and embed good practice.

Daily risk meetings and handover minutes from 1 on call person to another were viewed but did not always show what actions had been taken to manage risk or who should follow things up. Lessons learnt from incidents were not robust as communication across the staff team was poor and management staff were stretched. Provider audits identified actions but did not always show how these actions had been followed up particularly when staff needed support and retraining. We identified that medicine audits were carried out on a small representative sample which did not enable the provider to identify themes or patterns or look at records in line with call scheduling to determine levels of risk such as time critical medicines. For example, medication audits completed in January 2025 covered medications administered in August, September, October and November 2024 . This was not in line with the service’s own policy which outlined medication audits were to be completed monthly. This meant errors were not identified in a timely manner.

Auditing and quality assurances that were in place were ineffective in driving improvement or reducing risk within the service to ensure the safety of people.

Staff reported working without support and sometimes made multiple attempts to escalate concerns or report changes to people’s needs with no clear response from management or improvement noted.

The provider did not work well with people and health system partners to establish and maintain safe systems of care. They did not manage or monitor people’s safety. They did not make sure there was continuity of care, including when people moved between different services.

Concerns had been identified the provider was not fulfilling its commissioning arrangements and was delivering the care in the way that was not agreed. Care plans were not reviewed in a timely way and there were limited mechanisms for people to feed back their experiences. This meant gaps in care provision were not being identified in a timely way or fed back to partner agencies so care and support could be adjusted and shortfalls addressed. Staff told us ongoing referrals to other agencies were slow and staff were not told the outcome.

A number of people using the service had reablement packages which involved short term care until the person was back to fuller independence. This involved some joint working. Feedback from 1 care provider said Hales were always enthusiastic and keen to engage with other health care professionals. However, this was not demonstrated in practice.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Whilst staff confirmed they had received safeguarding training, not all staff were confident that they had the opportunity to raise concerns or that concerns were addressed by leaders. For example, 1 staff member said, “I go home at the end of a shift and have things on my mind that I need to tell them, but I might not be able to do so until 9am on Monday morning but it may be important or a safeguarding issue such as if someone has been admitted to hospital. I need to communicate this so no one else goes into their property as they are not there. But you cannot get through to anyone.” 

Processes were not in place to discuss and escalate risk effectively and share with staff teams. As part of this assessment, we identified a number of safeguarding concerns which were escalated to the local authority safeguarding team. This had not been independently identified by the service, as they did not have robust processes in place to pick up on quality issues and safety.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Appropriate, up to date and clear guidance was not always in place to support staff in delivering safe care. People told us about gaps in their experience of the care they received. Language barriers were raised as a concern, as some people felt they could not make their needs known. Both staff and people raised concerns about using the app to clock into people’s property and record how care needs had been recorded electronically, sometimes this was not completed contemporaneously. Staff told us training was good but there was limited opportunity to embed their learning or share information.

During our assessment we identified concerns with record keeping and the escalation of information so risks could be appropriately managed. Records were generic and were not regularly reviewed in consultation with others to ensure they remained relevant. For example, administration and application of creams were poorly recorded increasing the risk of skin breakdown. Several people had a breakdown of their skin condition and instructions on how to support them was poor and, or contradictory. One person reported that their personal care was not given thoroughly whilst others raised concerns about spacing of calls and how they could be left for a long period of time without personal care and continence care. We identified gaps in records such as allergies not being recorded, placing people at risk of harm We identified gaps in records relating to people’s support to move safely, and for those who required hoisting, information was disjointed and could increase the risk of poor care. We found information was not consistently recorded for example, 1 person’s risk assessment stated there were no risks relating to them leaving their home unaccompanied, whereas their care plan stated there was a risk in this area. This created the risk of inconsistent care provision.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

People generally had the equipment they needed to reduce risks to them in their home environment. However, these risks were not subject to regular review to ensure any changes in people’s needs and, or circumstances could be addressed quickly and in consultation with other services. Individual risk assessments were often generic and lacked personalisation. For example, one risk assessment stated ‘other inhabitants were a risk’ but did not clarify what the actual risk was or any mitigation.  Some information necessary to the risk was not always included. For example, a fire risk assessment we reviewed made no mention of a zero-base cream being used and the risks associated with emollient creams in terms of fire and smoking. This is because some emollient creams are highly flammable, placing people at increased risk in a fire.

Other comments were more positive about people's safety within their environment and a person said, "They make sure the environment is safe before they leave."

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs. Work force planning was poor and staffs’ rotas were subject to change. Staff were expected to work long hours, with little or no travel time. Our evidence identified staff were poorly supported and there was a lack of effective support for staff in terms of regular supervisions, spot checks and opportunities for personal and professional development. Training was not always up to date and new starters had little support after their initial induction. The provider did not have an effective way to monitor care calls and ensure it had enough staff at all times to deliver care based on people’s care needs. This resulted in care calls being missed or delivered at inappropriate times and cut significantly to enable the care worker to cover all their calls. Staff reported office staff being rude and abrupt when dealing with staff. The main way the office communicated with staff was electronically, but we saw important information was often lost as staff had not opened up the information and signed to say they had read it on the app. Improvements had been made with the arrival of the new manager and supervisions and spot checks had been carried out since them starting in the post.

Some staff had not received their yearly training for basic life support and moving and handling. People being supported told us they did not always feel confident with the staff providing their care and felt they lacked basic skills. The provider had systems in place to ensure staff were recruited safely. However, the provider had not applied for a disclosure and barring check (DBS) for the new manager as part of their recruitment process. DBS checks helps employers make safer recruitment decisions by providing criminal record checks, particularly for roles involving vulnerable groups like children and adults.

Ineffective systems were in place to regularly monitor staffs’ practices within the workplace to ensure staff were reducing the risk of cross infection in line with policies and procedures. The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

We received mixed feedback from people about infection control. Most told us that hygiene practices were good and that care workers wore gloves and plastic aprons when supporting with personal care.

However, we were also told where people needed support with their personal care, staff who were late impacted on this, placing people at the risk of acquiring infection. We also received reports of care workers rushing and at times leaving people’s properties untidy. We viewed several complaints about cleanliness and infection control, with 1 care worker stating personal protective equipment PPE was not adequate. There was no effective oversight by the provider to ensure consistent best practice in relation to infection control.

The service did not make sure medicines and treatments were safe and met people’s needs. Systems and processes did not identify and mitigate risks associated with medicines. From our analysis of call scheduling, people did not get regularly spaced visits to ensure medicines could be administered at regular intervals in line with the prescribers’ instructions. Missed or delayed medicines meant people’s conditions could be exacerbated or place people at increased risk of avoidable harm. We identified missed medicines and no clear escalation to ensure people had no ill effects from this. We found no timings were recorded on medication administration records (MARs) and these were inconsistently logged in care notes. Staff recorded medicines as administered ‘AM’, ‘Lunch time’ or ‘PM’ without specifying the time it was given. This could reduce the effectiveness of the medicines prescribed or increase the risk of over prescribing. We found there was not always a medication administration record in situ and at times medicines had run out, been missed or administered at the wrong time which increased the risk to individuals. We identified medicines were not always available as required. For example, 1 person had medicines for reducing blood clots and reducing the risk of stroke and heart attacks. Records showed their medicines had not been available to administer for a couple of days and care staff had not been able to get through to the office to report their concerns. It was not clear what actions had been taken to ensure this person received the care they needed. We identified records were not clear and the recording of medicines (particularly creams and medicines for occasional use such as pain relief) were not always recorded in care plans and, or risk assessments. We found another example where a risk was identified in another person’s care plan of them taking the wrong or too much medication, but the service failed to identify and mitigate this risk and did not identify any risk of potential harm from this person’s medication being stored in a location that was accessible to them. Medicine audits carried out by the provider had been ineffective in identifying issues or ensuring robust actions were taken and lessons were learnt to reduce the risk of avoidable harm. Since our assessment and feedback, the provider has advised that they have reviewed how they will make improvements to medicine safety at the service, including moving to electronic medication administration records.