Background to this inspection
Updated
10 August 2022
The Inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by one inspector and five Experts-by-Experience. An Expert-by-Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It also provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 27 June 2022 and ended on 25 July 2022. We visited the location’s office on 25 July 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We communicated with 64 people who used the service and 46 relatives about their experience of the care provided. Not everyone who used the service communicated verbally or wished to speak on the telephone, therefore they gave us permission to speak with their relative. We spoke with 20 members of staff including the registered manager, one care co-ordinator, two quality assurance offices and 16 care workers.
We reviewed a range of records. This included eight people's care records and multiple medicine records. We looked at six staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures, training data and quality assurance records were reviewed.
Updated
10 August 2022
Hales Group Limited South Tyneside is a domiciliary care service that provides personal care to people living in their own homes. At the time of inspection 261 people were supported by the service and 229 people were receiving the regulated activity personal care.
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
Following the previous inspection in August 2021 the provider sent us an action plan. This included information about the actions they had taken to make improvements within the service.
At our last inspection the provider had failed to robustly manage the risks relating to the health safety and welfare of people, including managing people’s medicines safely. At this inspection improvements had been made and the service was no longer in breach of the regulation safe care and treatment as systems were becoming more robust to minimise the risk of harm to people. Improvements had been made to medicines management. Systems were in place to manage medicines safely where support was required.
There were some improvements since the last inspection to ensure people received safe care. People told us they felt safe and the service took appropriate action to help ensure people were protected.
Although people said they felt safe there was a risk of harm as rotas were not well-managed. People were at risk of harm as there was impact to people’s safety and well-being where calls were very late. People and relatives gave examples of how this impacted on personal care, nutritional needs and medicines.
Improvements were still required in rota management to ensure people received timely and consistent care from staff they knew. The timings of people’s calls and constant change in carers was a major cause of complaint. People were not all informed if a call was going to be late or where there were changes to carers.
All people and relatives were complimentary about the direct care provided by support staff. Relative’s comments included, “The girls are magnificent, they really are, and they are very supportive to me as well”, “There is a bit of joviality, a good manner. They are really lovely, they do care” and “They are all very friendly and easy to get along with.”
Improvements had been made to the quality assurance systems but further improvements were required to ensure people received timely, consistent care and person-centred care with their views being taken into account.
Electronic records provided detailed guidance to assist staff to deliver care and support to meet people’s needs. Risks were assessed and mitigated to keep people safe. Staff recruitment was carried out safely and effectively.
The provider was monitoring the use of PPE for effectiveness and people’s safely.
Improvements had been made to staff training. Staff worked well with other agencies to ensure people received appropriate care and support. Staff were supported by the organisation and were aware of their responsibility to share any concerns about the care provided.
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.
We have found evidence that the provider still needs to make improvements. Please see the safe, effective and well-led sections of this report.
You can see what action we have asked the provider to take at the end of this full report.
For more details, please see the 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 15 December 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 improvements had been made and the provider was no longer in breach of some regulations.
However, we found the provider remained in breach of some regulations.
This service has been in Special Measures since 15 December 2021. During this inspection the provider demonstrated that some 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 carried out an announced inspection of this service on 11 August 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 safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, staffing and good governance.
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. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.