During an inspection looking at part of the service
Not everyone using Herts at Home receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
People’s experience of using this service and what we found
External agency staff deployed to cover for staff shortages did not always provide consistent care appropriate to meet people’s needs.
People had not experienced any missed care visits however, people said they were not informed when care workers were running late.
Care workers ‘slept in’ at the housing schemes however, there was no ‘out of hours’ support available during the night in the event of an emergency.
Care worker’s training matrix did not include fire safety training and care workers confirmed they had not received this training. This meant care workers may not understand about fire prevention and people may not be protected in the event of a fire.
Care workers reported good support from their local managers and were comfortable to approach them and felt well supported. However, feedback indicated the management culture was not always open and transparent, senior management were not always approachable and did not always support the team to do their roles.
People said they received good care and support however, people and relatives across all areas this service operated told us some care workers were not happy, demoralised and demotivated.
The provider had undertaken an organisational re-structure which left some care workers feeling undervalued. A divide had been created within the staff team as a result of the re-structure, this had contributed to the dip in morale and wellbeing.
People, their relatives, care workers and external professionals were encouraged to complete quality assurance questionnaires forms. However, feedback indicated the staff team were not assured their anonymity or confidentiality would be protected either through quality assurance surveys or the provider’s whistleblowing processes.
Safe and effective recruitment practices were followed to help ensure recruits were of good character and sufficiently experienced, skilled and qualified. Care workers were trained and had their competencies to safely administer medicines checked by senior staff. Care workers had received infection control training, their performance in this area was assessed at local management spot checks.
People were supported and encouraged to be as independent as possible with a risk assessment process. Care workers were knowledgeable about potential risks to people’s health, well-being or safety. These needs were assessed and reviewed to take account of people’s changing needs and circumstances.
People said they felt safe. People’s relatives were confident people were safe and protected from abuse and avoidable harm. People were supported by care workers who had been trained how to safeguard people from harm. Care workers understood the risks and potential signs of abuse and knew how to raise concerns.
Incidents and accidents were recorded, investigated by local managers and reviewed by the senior management team to help ensure appropriate steps were taken to improve people’s safety and wellbeing.
People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
The two registered managers had regular contact with managers for each extra care housing scheme and the community team. Regular checks and audits were undertaken across a wide range of areas including the management of medicines, health and safety, complaints, safeguarding, accidents and incidents, care workers’ performance and people’s support plans.
Health and social care professionals told us the management team were always responsive to any comments and suggestions and demonstrated commitment to working collaboratively with people, their families, specialists and professionals as needed.
The management team and care workers were clear about the provider’s values and the purpose of the services provided. The management notified us of certain events that occurred. This meant we could ensure appropriate and effective actions had been taken.
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 18 December 2019).
Why we inspected
This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found the provider needs to make improvements. Please see the safe and well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Herts at Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.