Archived: Human Support Group Limited - Sale

Human Support Group – Sale, also known as HSG Homecare - Sale and referred to as HSG - Sale in this report, is a domiciliary care service which provides personal care and support to people in their own homes to help them remain independent. HSG - Sale also provides other elements of support such as sit-in services, domestic support and welfare checks.

The service is managed from an office in Sale, Trafford with care and support provided for people living in the areas of Trafford, for example Altrincham, Stretford and Sale. The length of visits for care and support vary depending on the assessed needs of people. At the time of this inspection, 94 people were in receipt of a service and 70 staff were employed on the day of our inspection. However, not everyone using the service receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of this inspection 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.

At the inspection of April 2017, we rated the service overall as Requires Improvement. At that inspection, we found breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks were not managed properly and support plans did not contain detailed information for staff to provide person centred care.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well led to at least good.

During this inspection, we saw the provider had taken the measures identified in their action plan. In addition, they had sustained previous good practice in other key areas. As a result of this inspection, the service has an overall rating of Good.

There were more robust systems in place to ensure that risks to people's safety and wellbeing were identified and addressed. Risk assessments included information for staff about the risk and any measures they should take to minimise the chance of harm occurring to an individual.

People supported with medicines were kept safe and received the correct medication. Practical competency reviews were completed with all staff to ensure best practice was being followed.

The manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected. People had access to healthcare services and received healthcare support, sometimes as a result of intervention or advice from care staff.

The service worked with relatives and others to raise the awareness of dementia. Two planned Dementia Awareness sessions went ahead and were attended by relatives, staff and a health professional. People were supported with the preparation of meals and drinks where this had been identified as a care and support need during the assessment process and any specific dietary needs were documented.

Staff were kind and patient in their approach and did not rush people, letting people do things at their own speed. People were treated with dignity and respect and received care and support specific to them, depending on individual preferences. People told us that staff were caring and carried out additional tasks when they needed extra support.

People received a service that was based on their personal needs and wishes. Care plans were written in the first person and contained information about people’s histories and past lives. This gave care workers insight into those they were caring for and helped shape the delivery of care.

People benefitted from a service that was now well led. The vision, values and culture of the service were clearly communicated to staff and the registered manager invested time with staff to make sure these were understood.

There were processes in place to monitor quality and understand the experiences of people who used the service. Staff we spoke with were complimentary about the service and their colleagues and proud of the work they did.

The service had forged links with the community and a local befriending charity, owned by the Human Support Group but operated independently, had an on-site representative based at the Sale branch. The service referred or signposted people to this charity.

Prior to our inspection visit, we contacted the nominated individual to request information on how they had addressed the concerns raised by the coroner. A nominated individual is a person employed as a director, manager or secretary of an organisation with responsibility for supervising the management of the regulated activity. Given the serious nature of the concerns raised by the coroner, we wanted to be sure the service was doing everything possible to mitigate risks to other users of the service. The service was last inspected in November 2016. We identified no breaches in regulation at that time and the service was rated ‘Good’.

Human Support Group – Sale (HSG – Sale), also referred to as Homecare Support, is a domiciliary care service which provides personal care and support to people in their homes to help them remain independent. HSG – Sale supports people living within the Trafford borough of Greater Manchester and Salford. There is also a reablement service called SAMS (Stabilise and Make Safe) which provided short intervention care for up to three weeks. The majority of people using this service had been discharged from hospital and the aim of the reablement team was to help them to regain and maximise their previous level of independence. SAMS was only operated within the Trafford area. The service also offered practical care tasks such as shopping, laundry and ironing. HSG – Sale is also registered to provide treatment of disease, disorder or injury but was not currently providing these services. At this inspection, the service supported 220 people, 27 of whom received support from the SAMS service.

At the time of this inspection there was a manager in place who had registered with the Care Quality Commission (CQC) in January 2017, having been in post since November 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe with the care and support provided by the service.

Risk assessments did not always provide clear and specific information to help staff deliver care and support people safely. We noted that support plans did not contain sufficient information about administering particular medication. This meant people were potentially at risk of harm.

Staff were aware of safeguarding principles and told us they would report any concerns in this area to the relevant authorities. We noted the provider’s safeguarding policy referred to outdated legislation which meant staff were potentially referring to documents that were not completely fit for purpose.

There were adequate systems in place to help ensure missed and late visits were minimised. People and relatives told us missed calls were infrequent.

People and relatives told us care staff demonstrated good hygiene practices by using personal protective equipment (PPE) such as gloves and aprons, and washing their hands as required. If used appropriately, this practice should help to prevent the spread of infection or cross-contamination. We did receive one piece of negative feedback in relation to the use of PPE and brought this to the registered manager’s attention. They told us this would be addressed during spot check visits.

We found the provider’s recruitment processes were robust, ensuring that all appropriate checks were done before staff started working with people. This should help ensure suitable staff were recruited.

We noted there was an effective system of reporting and monitoring accidents and incidents that took place within the service. We saw that lessons learnt were shared across the provider’s network of services.

People and relatives told us staff were competent in delivering care and support.

The registered manager had a good understanding of Mental Capacity Act 2005 and how this legislation should be used to protect people. The service had systems in place to help ensure people who lacked capacity were helped to make decisions that were in their best interests.

The service had formal systems in place to train and support staff. We noted not all staff had undertaken required refresher training according to the provider’s policy. There were gaps in key areas such as moving and handling, falls awareness, and effective communication/record keeping. This meant some care staff were not up to date with the knowledge and skills needed to support people safely and effectively.

People and their relatives told us they knew care staff would support them if they needed any medical attention. Care staff told us if they observed that people needed healthcare support they would report these concerns to the office and record them in people’s daily comments book. This showed staff could be proactive in making sure people received the right health care when they needed to.

People and relatives were happy with the quality of care and support they received from HSG –Sale. They told us they thought of the care staff as friends or family. People appreciated they had regular carers because this encouraged relationship building and trust. One relative raised concerns about the weekend staff not always demonstrating caring and compassionate support. Staff told us they had a good understanding and knowledge of the people they cared for. People and relatives we spoke with confirmed this.

People and relatives told us they had been involved in care planning decisions and care plans we looked at confirmed this. They said care staff supported them to maintain their independence according to their abilities. Care staff were able to give us examples of how they did this.

Each support plan contained personal and medical information about people, their preferences, personal goals and how they wanted to be supported. Some care plans we looked at contained detailed descriptions of support provided. However we found examples where the service did not ensure that support and care provided was responsive to that individual’s needs.

There was a robust complaints process in place and everyone we spoke with knew how to raise a complaint. People told us they had opportunities to provide feedback on the service they received through a questionnaire regularly sent out. The registered manager told us actions were taken as appropriate. We saw summarised results of surveys sent out in May 2016 and December 2016 but were not provided with the actual number of people who responded and what action, if any, had been taken to help improve the service provision.

The provider had established a befriending service which was registered as a charity. This service was free of charge and provided a responsive approach to helping to address issues of loneliness and social isolation amongst people using their service but also the wider local community.

People told us they would recommend this service to others and some had done so. They found the office staff were helpful when they had to contact the office. Staff said they felt supported by their managers. The registered manager said they had the support of the senior management team.

We saw various changes and improvements to processes and documentation had been made to help ensure concerns raised in a coronial investigation were addressed. However we were not assured that these had been embedded thoroughly. We will check at our next inspection to see how these changes have been sustained.

The provider had quality assurance systems in place to monitor, for example, staff performance, care plans and medication administration. However these did not consistently identify areas requiring improvement. This meant the registered manager and provider could not be consistently assured all aspects of the service provision was safe and effective.

The registered manager told us staff meetings were held four times a year. Staff meetings give staff the opportunity to discuss their work and share information with managers and colleagues. Some staff told us their team had not had a meeting for some time but that they felt supported by management.

We made a recommendation that the provider ensures operational policies and procedures are reviewed and updated as appropriate.

During this inspection we identified two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment and person centred care. You can see what action we told the provider to take at the back of the full version of the report.

The service also offers re-ablement services which provide short intervention care for up to six weeks. The majority of people using the service had been discharged from hospital and the aim of the re-ablement team was to help them to regain and maximise their previous level of independence.

At the time of our inspection a service was being provided to 200 people living within the Trafford borough of Greater Manchester. In addition, 25 people were being supported through the SAMS service.

The service had been without a registered manager for over six months and the area manager had applied for registration with the Care Quality Commission until a suitable candidate was recruited. 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.

People were very satisfied with all aspects of the service provided and spoke highly of both staff and managers. People who used the service told us they were treated with compassion and kindness and that their privacy and dignity were respected.

People who used the service and relatives we spoke with told us they felt staff provided safe and effective care. Staff we spoke with had a good understanding of the various types of harm and their roles and responsibilities in reporting any safeguarding concerns. Staff had also received safeguarding adults training.

We saw staff had received Mental Capacity Act and DoLS training as part of the induction training that was provided by the organisation’s training department.

People's care plans reflected their individual needs and personal wishes. Most people told us they were involved in the development of their care plans and were enabled to express their views on an on-going basis.

Staff were carefully recruited and were required to undergo a number of background checks prior to starting their employment. This helped to ensure that only people with the required skills and of suitable character were employed.

On the fourth day of our inspection, we visited three people in their own homes. They told us they felt their dignity and privacy were respected by staff. One person said, “I have staff that know me, this matters to me as I have built up good relationships with them and I trust them.”

People told us they received their medication as prescribed. Medicines administration records (MAR) checked confirmed this.

Staff received regular supervisions and annual appraisals and were able to reflect on the care and support they delivered and identified further training requirements. The management team encouraged feedback from all people involved with the service.