Archived: Huggies Cares Ltd

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults with a variety of needs. Support provided includes assistance with personal care, domestic tasks and outings into the community. At the time of this inspection the service supported 34 people.

The service did not have a registered manager since December 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. We checked our records at the time of this inspection and found the manager’s application was hindered by an address error on their registration certificate. This meant they were unable to proceed with their registration until this error had been resolved. We will make further checks to ensure their registration is completed.

We found five breaches of the Health and Social Care Act regulations in relation to recruitment processes, staffing training, care records, the management of complaints, acting on feedback and quality assurance processes. You can see what action we told the provider to take at the back of the full version of the report.

We made two recommendations that the provider implements effective systems for monitoring accidents and incidents and for safeguarding people’s rights in line with the Mental Capacity Act.

We found the service was not safe in some respects though people told us they felt safe. People were supported by a regular staff team and the provider had suitable systems in place to take action to protect people from abuse.

Where needed, people were supported to take their medicines in a safe way. We identified concerns regarding medication administration training and competency checks. This meant people were potentially at risk because staff did not have the right skills and experience.

Missed visits were rare but staff were often late for their visits. This meant people did not consistently receive care and support as agreed and in line with their needs.

Recruitment processes were not sufficiently robust. This was a continued breach of the relevant regulation and meant people were not protected from risk of unsuitable staff being employed.

People were protected from risk, including risk of infection, because appropriate assessments and prevention measures were in place to help ensure people were supported safely.

The service was not always effective because staff did not receive a robust induction, training relevant to their role or appropriate professional support. This meant people were at risk because staff had not received the necessary skills to do their job effectively.

Improvements had been made in ensuring the service met the requirements of the Mental Capacity Act 2005. However, we found inconsistencies in how the provider followed the MCA and recommended a more effective system be put in place to protect people’s rights.

People and relatives said staff’s approach was caring and empathetic, and that they were treated with dignity and respect. Staff carried out their duties in a responsible and professional manner and demonstrated they knew the people they supported well.

People gave us examples of how staff encouraged them to be independent according to their abilities. Staff we spoke with confirmed this. This helped to promote people’s general good health and wellbeing.

The service operated within a diverse and multicultural community and had systems in place to ensure people’s equality and diversity needs were recognised.

The service was not consistently responsive. While improvements had been made in reviewing support plans so they were fit for purpose, we noted some care records were not in place or did not contain complete information about people’s needs or conditions.

While the service had procedures in place to manage complaints and concerns raised, the manager was unable to provide us with documentary evidence on how they had managed two recent complaints relating to the timing of visits and gender preference of staff attending visits.

Support plans in place contained detailed person-centred information providing staff with adequate information to help staff support people responsively.

We found the service was not consistently well led. The service was without a registered manager since December 2016. Quality monitoring processes were insufficiently robust and had not identified concerns we found during our inspection. This was a continued breach of the regulation and meant people were potentially at risk because the quality of care provided was not effectively monitored.

Some improvements had been made in relation to seeking feedback from people and their relatives. We also saw the manager had asked staff to appraise the performance of the management team. The manager had not yet developed a plan of action to make the improvements suggested by people, relatives and staff.

Staff told us the management team was approachable and supportive, and that regular staff meetings were held. This helped to ensure staff had the opportunity to raise any concerns they may have about their work and appropriate guidance to follow.

Huggies is a domiciliary care agency located in the Trafford area of Manchester. The agency provides care and support for adults with a variety of needs such as mental health needs, sensory difficulties and dementia. The provider’s statement of purpose states that support provided includes assistance with personal care, domestic tasks and outings in the community. At the time of our inspection 47 people were receiving services.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the end of the full report.

People told us they felt safe with their care staff. Staff we spoke with were aware of the types of abuse and knew how to report any suspected abuse. Recruitment and selection processes in place were not sufficiently robust to help ensure that staff recruited were suitable to work with vulnerable adults. The service did not have an effective system in place to record safeguarding referrals and investigations. This meant that the provider was unable to effectively identify any patterns or trends that may help to keep people safe from harm.

Risk assessments were carried out but these did not always provide sufficient guidance to staff to help them manage people’s risks and support them safely. People’s medicines were managed safely and people told us care staff were careful when administering their medicines. Training records showed that all staff were up to date and competent in administering medication. This meant that people were supported in a safe way to take their medication. Infection control practice was good

People felt that care staff had the right skills and knowledge needed to undertake their caring role. We saw that mandatory training in key areas such as safeguarding and moving and handling were done and refreshed each year. This should help to ensure that care staff supported people safely and effectively. There were no records to demonstrate that care staff received regular supervision and annual appraisals. This meant that we could not be certain that care staff were receiving necessary professional support to carry out in their role effectively.

Records we viewed did not evidence that people had consented to the care and support they received. The service facilitated people’s access to medical attention and healthcare professionals when required. This meant people were supported to receive the right health care when they needed. Some people were supported to make healthy nutrition and hydration choices. This should help people to maintain a balanced diet and support their wellbeing.

People told us care staff supported them in a caring manner. They gave us examples of how staff were proactive and went the extra mile. This meant people felt cared for and supported effectively by their care staff. People were treated with dignity and respect and encouraged to maintain their independence depending on their abilities. This helped to promote their continued wellbeing.

People told us the service was flexible and responded to their needs. We found that care plans we looked at in the office were not consistent with those we viewed in people’s homes. Not all care plans contained person centred information about what people expected from the care and support they received. However, there was sufficient information within plans to guide staff to provide safe and effective support. People told us they knew how to raise a complaint or a concern. The agency did not keep a systematic record of how it managed any complaints received. This meant we could not tell if the service how the service had dealt with complaints and if how it had learnt from these. We found no record that the service had asked for people’s opinions on the support they received. This meant we had no evidence that people were helping to influence and improve the care and support provided by the service.

We observed an open and approachable culture at the agency. People and relatives, in the main, expressed satisfaction with the agency and the support they received. However, there were some relatives who told us that management practice and communication could be strengthened. The provider and the registered manager did not have appropriate systems in place to effectively manage the operation of the service. There was a lack of effective and robust quality assurance systems to provide effective monitoring of the quality and safety of service. The service did not always meet the legal requirements of notifying the CQC of safeguarding incidents. This meant that people’s care and support was not adequately assessed monitored to ensure their continued safety and wellbeing. We saw that the provider had a suite of policies and procedures in place; this should help to ensure staff had appropriate guidance to carry out their roles. Staff meetings were resumed in September 2016 and were scheduled to happen on a monthly basis. This forum would give care staff the opportunity to discuss their work with managers and colleagues.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The agency took people's care needs into account when making decisions about the numbers, qualifications, skills and experience required to cover the rotas with the correct level and calibre of staff.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure unsafe practice was identified and people were protected.

Is the service effective?

People's care needs were assessed by senior managers and they, along with their family members, were involved in developing their own plans of care. People told us their care plans reflected their current needs and we saw they were up to date.

Family members we spoke with told us the agency had promoted the independence and built up the trust of their relative and they were confident their relative would be supported well.

Is the service caring?

We received feedback from people using the service and their families. We asked them for their opinions about the staff supporting them. All the feedback was positive and included comments like " the staff are always on time', 'they are like one of the family" We have a good relationship which we have built up over time.' and " I feel listened to".

When speaking with staff and managers it was clear they genuinely cared for the people they supported. We were shown pictures of a Christmas meal the agency had arranged because they did not want people without family nearby to feel isolated and alone over Christmas time.

The service was person centred and took into account the diverse range of people needing support. The agency tried to match people with staff who they felt could best meet their needs. We found the agency respected people's preferences, interests and wishes and cared about the people using the service, their families and the staff team.

Is the service responsive?

People we spoke with knew how to make a complaint if they were unhappy. The service worked well with other agencies and services to make sure people received care they needed. We saw the agency had challenged another service provider where they felt there had been a shortfall in care received.

When we discussed areas which could be improved, and pointed out shortfalls, the manager acted promptly to address the issues raised. People we spoke with told us things they had raised with the manager had been addressed appropriately, with sensitivity and with a good outcome.

Is the service well-led?

Speaking with the senior management team we could see there was strong leadership. They told us their emphasis was on developing staff and supporting them within their role. Along side this they were keen to share their skills and knowledge which was done via a comprehensive in-house training schedule.

The senior management team were "hands on". This meant they visited people regularly and maintained good relationships with people using the service, their families and the staff team. Staff had a good understanding of the ethos of the agency and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People we spoke with confirmed this and told us they trusted the agency. Staff confirmed they felt it was a good place to work and were supported well.