Background to this inspection
Updated
14 April 2023
The inspection
We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.
Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.
Inspection team
The inspection was carried out by 1 inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be available to support the inspection.
Inspection activity started on 6 January 2023 and ended on 1 February 2023.
What we did before the inspection
We reviewed information we had received about the service since their registration. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 3 people who used the service and 3 relatives about their experience of the care provided. We spoke with 8 members of staff including the registered manager, field supervisor and care workers.
We reviewed a range of records. This included 3 people’s care records and multiple medication records. We looked at records in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
This performance review and assessment was carried out without a visit to the location’s office. We used technology such as phone calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation. Inspection activity started on 6 January 2023 and ended on 1 February 2023.
Updated
14 April 2023
About the service
Harmony Projects is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and children with various needs including, physical disabilities and people living with dementia or a learning disability. At the time of this inspection 43 people were using the service.
Not 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
Systems were not robust enough to demonstrate medicines were effectively managed. People's medicines records did not always contain enough detail. People’s allergies were not recorded. Although a medicines audit tool was in place and being completed regularly it did not pick up on the discrepancies we found during the inspection.
There was mixed feedback from staff about the provider and wider management team, some staff felt supported in their roles whilst others didn't. The provider had poor management systems in place to support oversees staff with their employment at the service. Staff told us about various issues with their employment and contracts. We escalated these concerns to the local authority.
Care plans did not consider people's end of life wishes. We fed this back to the provider, who told us they would take action to ensure people’s end of life wishes would be discussed and included in people's care plans.
Staff had received training in safeguarding people. People were protected from the risks of abuse and staff were trusted to keep them safe. People's care needs were risk assessed and people’s ongoing risk assessments were reviewed on a regular basis and when needs changed.
Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults. Staff had received an induction when they first started working at the service and training relevant to their roles had been provided.
People told us staff were on time for their visits, however, when staff were delayed, people were not always informed. The provider was already aware of this feedback and had spoken to staff to resolve the issue.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
At the time of the inspection, the location did not provide personal care for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
Staff knew people's histories and preferences and used this knowledge to support them in the way they wanted. People’s views and decisions about care were incorporated when their care packages. People were involved in making decisions about their day to day care. People were treated with dignity, privacy and respect. People’s independency was encouraged where possible and this was reflected in people’s care plans.
People’s communication needs were met. The service was aware of the Accessible Information Standard (AIS) and each person’s specific communication needs were detailed in their care records. Complaints had been responded to in line with the providers complaints policies and procedures.
Person-centred care was promoted. The provider and staff demonstrated a commitment to people, and they displayed person-centred values.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection
This service was registered with us on 13 November 2019 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Enforcement and Recommendations
We have identified a breach in relation to the effective management of medicines at this inspection. We have made a recommendation in relation to people’s end of life wishes
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.