HLC Care Agency Ltd

HLC Care Agency Ltd is a domiciliary care agency providing personal care to five people at the time of the inspection. Most of the people who used the service were older people.

The Care Quality Commission (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

We received positive feedback from people who used the service and relatives. Comments included, “Care staff are caring, good and they do listen to me” and “My carer is absolutely amazing; she is good and I cannot fault her at all.”

The registered manager failed to have a robust record keeping system in place. Records on MAR chart seen in the office were not always accurate.

The service had a system in place to assess, monitor and improve the quality and safety of the services provided in some areas. However, this had not been effective in identifying what we found.

Epilepsy care plan for one person lacked adequate detail. There were no detailed seizure triggers and what to do in an emergency apart from calling the GP. Other care plans contained detailed risk assessments.

Risk to people’s health and wellbeing were addressed and mitigated. Environmental risk assessments were also in place, which identified and reduced any environmental risks to people and staff.

Robust recruitment processes were in place. This prevented unsuitable staff from working with vulnerable adults. People told us staff were reliable and consistent. Staff were skilled in carrying out their role. The registered manager ensured staff were appropriately trained.

People’s needs were assessed prior to receiving a service including their protected characteristics under the Equalities Act 2010. People told us they felt at ease with staff and staff were caring.

Staff told us there was an open culture where they were kept informed about any changes to their role.

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 Inadequate (published 19 December 2019) and 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.

We carried out a targeted inspection on 24, 25 and 26 August 2020 to check whether the Warning Notices we previously served in relation to regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. At that inspection, the service was not rated. We found the provider had improved the service by ensuring that medicines were managed safely. However, the provider required further improvement in risk assessment, care related guidance, effective quality auditing and contemporaneous record keeping.

This service has been in Special Measures since 19 December 2019 During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced inspection of this service on 24, 25 and 26 August 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and notifications of other incidents.

We undertook this focused inspection to check they 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, Responsive 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 changed from Inadequate to 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 HLC Care Agency 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.

HLC Care Agency Ltd is a domiciliary care home service providing personal care to 11 people at the time of the inspection. Most of the people who used the service were older people. Everyone who used the service received personal care. The Care Quality Commission (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

Care plans contained some risk assessments which were appropriately linked to their support needs. However, risks were not consistently assessed and there was still a lack of information for staff about how to support people to remain safe.

Staff were trained with the right skills and knowledge to provide people with the care and assistance they needed. However, the training programme did not contain any provision for Parkinson’s disease, which was relevant to the people supported.

The provider did not have an effective system in place to assess, monitor and improve the quality and safety of the services provided.

Since our last inspection, the provider had ensured that medicines were managed safely or in line with best practice.

Staff felt there was an open culture where they were kept informed about any changes to their role. Staff told us the registered manager was approachable and listened to their ideas and suggestions.

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 rating at the last inspection was Inadequate (published 9 January 2020) and 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 we found the provider had improved the service by ensuring that medicines were managed safely. However, the provider requires further improvement in risk assessment, care related guidance, effective quality auditing and contemporaneous record keeping.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at the entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of the key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

HLC Care Agency Ltd is a domiciliary care home service providing personal care to 15 people at the time of the inspection. Most of the people who used the service were older people. 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

The feedback we received about the service was mixed. Whilst people told us they were happy with the care staff who supported them, they were not positive about the service overall. People told us that they had regular staff who supported them and had a good relationship with those staff. However, people did not feel engaged with the office staff and told us that they did not have regular contact with the office.

Medicines were not well managed. There was a complete lack of oversight of medicine administration. There was a lack of information about some people’s medicines such as what they took and what the medicines were for. Medicine administration records were not always in place and were not complete or accurate. Staff were administering medicines for some people where this was not recorded in the care plan. There were no checks on staff practice to ensure they were administering medicines safely.

Risks to people’s health and wellbeing had not always been assessed. People were at risk of harm because staff did not always have the information they needed to support people safely. There was a lack of information about people’s health conditions and how to identify if they were becoming unwell.

The registered manager was not able to evidence that staff had been recruited safely in that they did not have records of staff full employment history or ensured that they had followed the services recruitment policy on references.

The service was not well led. The provider, who was also the registered manager, did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Auditing had not identified concerns relating to service quality. Records were not always complete and accurate and opportunities to improve the service were not always taken.

The provider had not always treated people with respect as they had failed to maintain the quality of the service. People said the care agency was not involved in reviews they had with social services and they were not involved in updating their care plans.

The registered manager was not able to demonstrate that people were supported to have maximum choice and control of their lives or that staff supported them in the least restrictive way possible and in their best interests. There were no records that decisions made on behalf of people were made in their best interests by people who had the legal authority to do so. We made a recommendation about this.

Care plans did not include detailed information about how people wanted to be supported including at the end of their life. There was a lack of information about people’s preferences, life history and background. There was also a lack of information relating to people’s religious and cultural needs. People had regular care staff who knew them well and had learnt how to support them well. However, there was a risk that any new staff would not know how to meet people’s personalised needs.

Partnership working needed to be improved. Where people needed a referral to another service these were made through social services or the GP. However, staff had not developed working links with other health and social care professionals such as occupational therapists or diabetic nurses.

People told us that staff had the skills they needed to support them and that they felt safe with staff. However, there were areas where training needed to be improved. For example, staff had not completed training in specific areas such as epilepsy or training in equality and diversity.

Staff knew how to communicate with people where they needed this support. However, the registered manager had not made sure that information was provided in an accessible format.

People told us that they knew how to complain if they needed to do so. Where complaints had been made to the service they had been dealt with appropriately.

Staff had access to the equipment they needed to prevent the spread of infection, such as gloves and aprons. People told us that staff used these when providing personal care.

People told us that they were happy with the support they received with eating and drinking.

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 Good (published 9 August 2017. Since this rating was awarded the registered provider of the service has moved premises). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the date the service re-registered with CQC after they moved location.

Enforcement

We have identified breaches in relation to people’s safety, personalised care 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. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.