Pathways of Hope

Pathways of Hope provides personal care to people living in their own homes. At the time of our inspection there were 39 people using the service. Not 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

Improvements had been made since the last inspection. When staff were recruited, checks were completed to ensure they were safe and suitable to support people in their own homes. The registered manager had sought advice and guidance from other providers and healthcare organisations to improve the service. Information within people’s care plans had been reviewed, and risks assessed. Work was in progress to ensure information about people was current and person-centred.

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. Staff were trained to understand the importance of gaining people’s consent when delivering personal care. Staff completed a range of training to support people as needed. Staff had contact with a range of health and social care professionals when people required their services.

Feedback from people and their relatives about their experience of the service had been obtained. Comments were positive.

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 16 January 2023).

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 improvements had been made and the provider was no longer in breach of regulations. At our last inspection we recommended the registered manager sought advice and guidance on how consent from people was sought and documented within care records. At this inspection, the registered manager had acted on our recommendation, improvements had been made and consent was gained lawfully.

This service has been in Special Measures since 16 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 19 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We undertook a focused inspection to review the key questions of safe, effective and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pathways of Hope 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.

Pathways of Hope provides personal care to people living in their own homes. At the time of our inspection there were 39 people using the service. Not 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

Pre-employment checks for staff were not always completed robustly for people to be assured they received care from staff who were of good character and safe to provide support. Governance of the service failed to identify areas for improvement and actions taken by the registered manager at the last 2 inspections were not sufficient to ensure people received safe care and support.

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 did not always support this practice.

Some people said care staff did not always spend the allotted time with them or were informed when staff would be late. One person said, “I would recommend the carers but not the management”. Another person was complimentary about the service and told us, “I have only been using them for a few weeks, but staff seem polite and eager to help”.

People were supported by trained staff. One person commented, “The care is very good. All the carers are from ethnic minorities, and they are incredibly polite and well-trained. All the basic skills are clearly embedded in their training. There has been a marked improvement from other agencies. I am well surprised”. People requiring help with their prescribed medicines were supported by staff who had medication training. Staff had contact with a range of health and social care professionals when people needed them.

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 requires improvement (published 28 October 2021). 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 remained in breach of regulations. The service has been rated requires improvement at the last 2 consecutive inspections.

Why we inspected

This inspection was prompted in part by information of concern which we received concerning the conduct of care staff which was discussed with the registered manager at inspection. As a result we undertook a focused inspection to review the key questions of safe, effective and well-led only. The inspection was also undertaken to see whether improvements had been made after the last inspection, and whether the Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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, Effective and Well-led which contain those requirements.

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 requires improvement to inadequate. 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 Pathways of Hope on our website at www.cqc.org.uk.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the 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 monitor the service and will take further action if needed.

We have identified breaches in relation to the pre-employment checks for the recruitment of staff, the display of rating on the provider’s website, and the governance of the service at this inspection.

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

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 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.

Pathways of Hope is a service that provides care to people living in their own homes. It is based in Chichester, West Sussex. It is the only service owned by the provider, who is also the registered manager. Not everyone who used the service received the regulated activity of personal care. CQC only inspect 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. At the time of the inspection there were 53 people receiving personal care. Care was provided to children and people with a range of health care conditions which included those living with Dementia, Diabetes, Parkinson’s Disease and Multiple Sclerosis. Some people received multiple visits throughout the day. Four people required live-in carers.

People’s experience of using this service and what we found

Staff recruitment was not always safe or robust. Although improvements had been made since the last inspection, we continued to find concerns in relation to the oversight of some staff’s recruitment.

We continued to find concerns in relation to some staff’s training. Consideration of staff’s skills and levels of experience had not always been made before they were deployed to support people with specific needs. For example, not all staff allocated to support people with their medicines had undertaken training or had their competence assessed.

Not enough improvement had been made since the last inspection and we continued to have concerns about the leadership and management of the service. Some quality assurance processes had been introduced to help improve the oversight of people’s care, yet most planned improvements had not been implemented to ensure concerns found at the last inspection, had sufficiently improved.

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. Staff’s understanding of the actions they should take if people lacked capacity was not always sufficient. We recommended the registered manager sought advice and guidance to improve staff’s understanding.

People were provided with care that met their needs. Improvements had been made since the last inspection in relation to managing risks relating to people’s health conditions. People told us they felt safe and were reassured by the support staff provided. There were enough staff to meet people’s needs and the registered manager had been creative in finding ways to ensure there were enough staff to cover wide geographical areas. For example, they had employed staff to work as drivers to support care staff who did not drive, to attend care calls.

People were protected from the transmission and spread of infection and told us that staff always wore appropriate personal protective equipment that made people feel safe.

People’s needs were assessed, and they were involved in discussions about their care. There were further plans to improve the assessment processes and guidance provided to staff to ensure effective delivery of care continued and was consistent. People were supported and able to receive support from external professionals to help maintain their health. People told us they received the correct support from staff and that staff were kind and caring. One person told us, “Staff have helped me to get better. They are only too pleased to be helpful and are very obliging. They’ve helped me to get my independence back.”

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 Requires Improvement (published 17 June 2021). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of three regulations.

Why we inspected

We previously carried out an announced comprehensive inspection of this service on 27, 28 and 29 April 2021. 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 in relation to safe care and treatment, staffing, recruitment, and the governance of the service.

We undertook this focused inspection as we have had concerns raised to us since the last inspection in relation to unsafe staff recruitment. We also wanted to check the provider 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, Effective 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 remained Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective 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 Pathways of Hope on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the 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 monitor the service and 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. We have identified continued breaches at this inspection in relation to staffing, recruitment and the leadership and management of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the registered manager 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 alongside the registered manager and 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.

Pathways of Hope is a service that provides care to people living in their own homes and is based in Chichester, West Sussex. Not everyone who used the service received the regulated activity of 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. At the time of the inspection there were 47 people receiving personal care. Care was provided to children, young and older people with a range of health care conditions which included those living with dementia, diabetes and physical disabilities.

People’s experience of using this service and what we found

There was a lack of oversight to assure the registered manager people were receiving appropriate care to meet their needs. Shortfalls found as part of the inspection had not been identified by the registered manager. Quality assurance processes were not robust or effective in identifying areas that required improvement. The registered manager had not always ensured they were suitably registered to provide care to all groups of people they were supporting. Following the inspection, we made a safeguarding referral to the local authority for them to consider as part of their safeguarding duties.

Staff had not always received a thorough or robust recruitment. There was a lack of oversight of staff training and this meant some staff did not have safe pre-recruitment checks or training before being deployed to work alone and support people who were living in their own homes. Most staff had not had their skills or competence assessed to assure the registered manager they were able to effectively meet people’s needs.

Risks to people had not always been identified or mitigated. One person had not been always been supported to have their medicines according to the prescriber’s instructions.

We have recommended the registered manager seeks support and guidance from reputable sources. This was required to improve the assessment, planning and review of people’s needs. To improve the information provided to staff to help support the consistent delivery of care. To improve information that is provided to people to meet their communication needs and understanding. To ensure staff have a sound awareness of what to do if a person is unable to give their consent to care.

Although our inspection found concerns about some people’s care, feedback from people and their relatives was positive. They told us staff were kind, caring and responsive to their needs. One person told us, “The care I get is excellent and I can’t fault it in any way. They know what I need and will always do that little bit extra."

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.

People were involved in their care and the registered manager and staff worked in partnership with external health and social care professionals to ensure people received coordinated care. Feedback about people’s care and experiences was welcomed and people told us they felt comfortable raising issues with staff and the registered manager. People were supported to plan for care at the end of their lives.

There were enough staff to meet people’s needs and ensure care visits were covered. People were protected from the spread of infection. When people required assistance to prepare food and drinks they were provided with choice and visits were scheduled to ensure people received support at mealtimes.

People were supported to retain their skills and their independence was promoted. People and relatives told us staff were kind and caring. Privacy and dignity was maintained, and people were treated with respect.

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 3 February 2020 and this is the first inspection.

Why we inspected

This was a planned inspection as the service had not been inspected. It was also prompted in part due to concerns we received about staff’s practice, skills and competence. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the 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. We have identified breaches in relation to safe care and treatment, staff recruitment and training and the leadership and management of the service. Please see the action we have told the registered manager to take at the end of this report.

Follow-up

We will request an action plan from the registered manager to understand what they will do to improve the standards of quality and safety. We will work alongside them and the local authority to monitor progress. 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.