Hales Group Limited - North East

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.

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

There was little improvement since the last inspection to ensure people received, safe, timely and consistent care that met their needs.

People were at risk of unsafe care 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 missed or were very late. People and relatives gave numerous examples of how this impacted on personal care and medicines.

Management of rotas was identified as the cause for most complaints and safeguarding referrals. However, there had been no sustained improvements since the last inspection to ensure people received safe, timely and consistent care. Feedback received from people, relatives and staff described the anxiety, stress and impact on their emotions as well as physical well-being due to the inadequate rota management and ineffective communication with office staff and management.

People were not involved in decisions about their care with the timings of their calls and constant change in carer a major cause of complaint. People were not treated with respect as a robust system was not in place to inform them if a call was going to be late or where there were changes to carers.

People did not all receive care from staff who knew them well or were aware of their needs. Improvements had been made to care records. However, due to information technology failures with the electronic care management system, information was not always available for staff to ensure they knew the care and support people required. Systems were not in place for all people to receive their medicines in a safe way.

The culture of the organisation did not promote a person-centred approach to delivering care or an openness which empowered staff and people. Most people and staff told us they did not feel listened to or valued. Although questionnaires were sent out by the provider to gather people’s views, feedback from people was they saw no change as a result of their feedback.

Analysis of complaints took place to identify themes and trends, but they kept re-occurring. Most people said they did not experience improvements to their care as a result of complaining.

Rotas were not managed effectively so people who required support with nutrition received regular food and drink. This placed people at risk of dehydration and malnutrition.

The quality assurance systems in place were not effective. The provider failed to ensure the quality and safety of the service was monitored effectively to ensure people’s safety. Effective systems were not in place to ensure improvements to the safety and care people received.

Some improvements had been made to staff training, but further improvements were required as effective systems were not in place to ensure staff were trained and competent to carry out their role to ensure people’s care and safety.

Most people and relatives were complimentary about the direct care provided by support staff. They trusted the workers who supported them. They said staff were kind, caring and supportive of people and their families.

Safe recruitment procedures helped to protect people from unsuitable staff.

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.

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 1 April 2021) and there were multiple breaches of regulation. 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 followed up on the breaches of regulation and enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines management, people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. A decision was made for us to inspect and examine those risks.

We carried out an announced comprehensive inspection of this service on 17 December 2020. 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 staffing, safe care and treatment, safeguarding and governance.

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 deteriorated to Inadequate. This is based on the findings at this inspection.

We have found evidence at this inspection that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

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.

The provider was taking some action to mitigate the risks but this had not always been effective.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hales Group Limited-South Tyneside 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 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 the safe care and treatment, staffing, safeguarding and good governance. This puts people at an increased risk of harm.

Following the inspection, and the continued breaches, we had serious concerns about the safety and quality monitoring systems of this service and so we took enforcement action.

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 are working alongside the provider 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.

Special Measures

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.

Hales Group Limited South Tyneside is a domiciliary care agency providing personal care to over 350 people at the time of the inspection.

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

People and relatives had significant concerns about the care Hales Group South Tyneside provided. People were not provided with information to let them know which carer was attending at what time. They told us they did not have consistent care workers, and care workers regularly arrived later or earlier than expected or did not stay for the full length of the call. People and relatives gave numerous examples of how this impacted on personal care and medicines, potentially placing people at risk of harm. Care rotas corroborated these experiences, including for time critical calls. There were also occasions where two carers were required to attend, but the second carer was significantly late.

Most people confirmed care staff were caring. However, the manner in which rotas were managed significantly impacted people’s wellbeing and quality of life. Some people described how they did not feel their dignity and respect were a priority.

The provider described how they were working to improve the situation following challenges relating to the transfer of care from the previous provider and the COVID-19 pandemic.

Some safeguarding concerns had not been reported, or not reported in a timely way, to keep people safe. The provider had also delayed in making statutory notifications to the Commission about these incidents. Most staff had completed safeguarding training and knew how to raise concerns.

Management of rotas was identified as the root cause for most complaints and safeguarding referrals. However, the improvements the provider introduced to date had not yet delivered sustained improvements. Staff gave similar feedback about rotas being unmanageable, often planned late and constantly changing.

New staff were recruited safely. The provider was renewing Disclosure and Barring Service (DBS) checks for all staff who had transferred to the service.

Due to the number of early and late calls, people did not always receive their medicines when they needed them. Risk management plans for managing medicines safely and to mitigate other risks contained generic statements which were not specific to people's needs. The provider was reviewing care records for all people to ensure they were suitable to meet their needs.

Most people told us staff followed personal protective equipment (PPE) guidance. Staff gave positive feedback about the provision of PPE and said they had access to the supplies they needed.

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.

Most staff told us they did not feel supported working for Hales Group Limited South Tyneside. The provider was making progress with plans for all staff to complete training, to update their knowledge across a range of care related topics. However, staff providing stoma care required more in-depth training and support. People were mostly supported with having food and drinks of their choice.

People and relatives described how they received poor responses following complaints and had raised the same issues repeatedly with no improvement.

Care records lacked personalisation and contained a high level of standard statements. Since recently taking over the service, the provider was making good progress with reviewing people’s care plans. Although, staff had access to personalised information through an app on their mobile phone. The quality of recording in daily logs was inconsistent.

Staff gave mixed feedback about the culture of the organisation. Some staff did not feel able to approach management, felt their views were not always listened to and did not get feedback about their suggestions. Staff also described staff morale as very low.

People, relatives and staff all raised concerns about difficulties in getting through to the office and the attitude of office-based staff. They also had concerns about the lack of local out of hours arrangements. This was in part due to circumstances outside of the provider’s control. The provider had acted to continually monitor and resolve this situation. This included providing additional phone lines and customer service training for office staff.

The provider’s current systems of quality assurance had not been successful in improving the experiences of people using the service. The quality improvement plan had been updated following our visit to the service.

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 25/09/2020 and this is the first inspection.

Why we inspected

The inspection was prompted due to concerns received about poor management of care calls which impacted on people’s safety and wellbeing, poor communication and lack of response to concerns and a failure to resolve issues. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe; effective; caring; responsive and well-led sections of this full report.

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

The provider has taken action to mitigate risks to people. However this has not been effective, and people remain at risk of harm.

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.

We have identified breaches in relation to safe care and treatment, safeguarding people, staffing and good governance.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider 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 provider 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.