Archived: Hartley Home Care

At the time of the inspection the service provided support for 89 people in Camelford, Padstow, Bude, Launceston, Wadebridge and surrounding areas of Cornwall. There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection on 26 and 27 November 2015. At this focused inspection we checked to see if the service had made the required improvements identified at the inspection on 17 June 2015. We also checked if the overall improvements we found in June 2015, to the quality and reliability of the service people received, had been sustained. At the comprehensive inspection on 17 June 2015 we found the effectiveness of the service people received had improved from previous inspections. However, there were inconsistencies in the way systems to monitor the quality of the service were implemented and recorded. Although we did not find any breaches of regulations at the June inspection the service had a history of non-compliance with the regulations under the Health and Social Care Act 2008 since March 2010. This report only covers our findings in relation to the questions: is the service safe and is the service well led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hartley Home Care on our website at www.cqc.org.uk.

At this inspection we found the registered manager had further improved the systems for monitoring the quality of the service provided. They kept an overview of any changes to people’s visits and any concerns raised about the service provided by working closely with the care co-ordinators on a daily basis. Appropriate action was then taken to rectify issues raised and make any system changes to prevent a re-occurrence of specific incidents.

We also found the efficiency of the service people received had been sustained. We received positive feedback from people and their relatives about the quality and reliability of the service provided. Comments included, “The carers are marvellous, I’ve got no worries about them”, “The people who come to my home are very good, they are always courteous to me, they’re lovely” and “I like the girls I have, they’re excellent.”

People told us they had regular staff, received visits at the time of their choosing and staff stayed for the allocated time. People’s comments included, “I have regular carers so I always know who’s coming and I prefer that, it makes me feel safer“, “We get the full time my husband has been allocated”, “They certainly do their job and stay the time” and “I agreed a time that I would like to get up in the morning and they visit within 30 minutes of that time.”

The service gave people details of the times of their planned visits and kept them informed of any changes to the visit times. People told us, “I am sent an email rota for the week telling me who is coming and at what time”, “The carers tell me day by day who will be coming” and “If they are going to be late, they will phone me.”

Staff in the office had worked together to improve the staff rosters and reduce the number of changes made after staff had received their list of work. One care co-ordinator said, “It has made a difference to the rotas that the care co-ordinators work together. If we get the rotas right then there is less chance of change and if there are fewer changes then this reduces the risk of mistakes being made and visits being missed.”

No one told us they had experienced missed visits. However, the registered manager advised us there had been two missed visits during the weekend before our inspection. The registered manager had investigated these incidents and taken appropriate action to minimise the risk of any further re-occurrences.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. There were adequate numbers of suitably qualified staff available to keep people safe.

Staff told us they felt supported by management and were committed to providing a good service for people. Comments from staff included, “The running of the service is a lot better than it was”, “I enjoy what I do” and “We have staff meetings and get regular letters giving us updates on any changes.”

Before people started using the service a manager visited them to carry out an assessment of their needs and discuss how the service could meet their wishes and expectations. A relative of one person, whose care package had started two days before our inspection, told us a manager visited them before the service started. They told us the manager explained about the service and wrote a care plan for the person receiving the service.

People were asked for their views of the service they received and they were confident that their views were listened to and acted upon. People and their relatives told us, “Yes they have occasionally asked for feedback”, “Yes they did act on it”, “I have had the occasional complaint but it has mostly been about their rota times. It has been dealt with immediately”, “I was asked my opinion about the care plan which I was happy with” and “I have received questionnaires from the office asking about my care.”

We visited Hartley Home Care on 2 September 2014. This inspection was announced 24 hours in advance and carried out by two inspectors.

On the day of our inspection Hartley Home Care provided a service to 137 people in their own homes. The service employed 50 care staff. Following the inspection at the offices of Hartley Home Care we spoke with 22 people who used the service and 20 staff.

We considered our inspection findings to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We judged the service was not safe at the time of this inspection.

We discussed the requirements of the Mental Capacity Act (MCA) 2005 with the provider and we were told 'there are no people using our service that require mental capacity assessments.' During our review of care files, talking to people who used the service and the care staff who provided care, we found there were people who suffered from impairments to their ability to make decisions for themselves, and care staff were making decisions on their behalf in their best interests. We did not see any mental capacity assessments or best interest meetings had been held in the files we reviewed. This showed us the service was not working in line with the legislation laid down by the MCA.

One person who received a service, required 24 hour oxygen therapy, this person did not have a risk assessment in their care plan to direct and inform staff about the risks associated with oxygen use. Two further care plans we reviewed did not inform staff the person required the assistance of two care staff to meet their needs or had diabetes. This did not ensure that staff had the required information to support a person safely.

At our last inspection we were concerned that some people who required the support of two carers did not always have two carers visit them. At this inspection we were again told that the service had failed to provide sufficient numbers of care staff to meet people needs. The failure to provide sufficient numbers of care staff to meet people assessed needs did not ensure people received safe care.

Staff and people who received a service from Hartley Home Care reported shortages of staff which impacted on the service provided. We were told many staff were leaving, and the provider advised us they were experiencing difficulties in recruiting staff. Staff told us people did not always get visited at the time of their choice or have the allocated amount of time spent with them. This did not ensure the service met people's needs.

Is the service caring?

We judged the service was not caring at the time of this inspection.

People told us they sometimes experienced missed care visits. People told us they sometimes had to phone the office to find out where their carer was and when they were coming. We were told by one person 'I rang up as no-one came and they told me they did not have anyone to send to me.'

People told us their preferences for either a male or female carer was not always respected.

Some people told us their care visits were sometimes very late. One family member told us 'I tell them I need to be ready to be picked up for church at 10.00 and they come at five minutes to, it's no good, I could not go out due to their lateness.'

We saw from the rotas that staff did not always spend the allocated amount of time with people when they visited.

Some people who required the assistance of two carers to meet their needs experienced only one carer visiting them to provide their care.

Is the service effective?

We judged the service was not effective on the day of our inspection.

We were told the office did not distribute the rotas till late on a Sunday for the first few days of the week. Staff reported to us "the rotas were ridiculous, if I followed the rota as it comes to me I would spend hours driving from one area to another and back again and the service users would not get their visits at the time they expect, so I sort it our myself.'

We were told the office write the rota manually and do not always build in travel time. Staff told us 'in order to get round we have to cut the time we spend with people.'

Is the service responsive?

We judged the service was not responsive at the time of this inspection.

In the diary in the operations room we saw a message dated 27 August 2014, from a member of the care staff stating 'X urgently needs a review.' We did not find this person's name on the care plan review list on the wall in the office. We checked this person's care file, and no review had taken place. This did not ensure this person's care needs were assessed in a timely manner.

We saw accidents and incidents reported in the operations staff diary and in people's care files. We did not see evidence that these incidents had been recorded in the accident report file or that any action taken to review such incidents to try to reduce a re-occurrence.

We saw and we were told complaints and concerns had been reported to Hartley Home Care. We did not always see evidence of action taken to address people's concerns, nor did we see the complaints had been recorded in the complaints book and responded to in line with the service's complaints policy.

Is the service well-led?

We judged the service was not well-led at the time of this inspection.

Rotas were not planned and written in sufficient time for staff to plan their time, and had requested the management issue them a week in advance. We saw at our last inspection that this was acknowledged by management and achieved for one week. At this inspection we were told by staff 'things have just gone downhill again, we don't get them till late Sunday for the next day and only for three days in advance and the rotas are hopeless and don't work'.

We saw messages in the diary in the office requesting specific times for visits. We were told by people who used the service this was not always acted upon.

We were told staff were leaving after a short time with the service. The provider told us 'They just don't come back after the first day of induction,' and 'staff just walk out without notice.'

Providers have a responsibility to comply with the Health and Social Care Act 2008 regulations and submit statutory notifications to the Care Quality Commission (CQC) when any event which may impact on their service provision occurs. No statutory notifications had been submitted since 2011 by the service. The registered manager and the provider were not aware of their responsibilities in this regard. The service had been subject to safeguarding concerns relating to people who used the service and care staff in the past. This is a breach of the regulations.

The management were not assessing and monitoring the service provided and events such as complaints regarding missed/late visits, the wrong gender carer being sent to a person with a particular preference, and single carers attending people who had been assessed as requiring two carers did re-occur.

Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service, relatives, staff and management of Hartley Home Care.

Is the service safe?

During this inspection we found people were not safe because they did not have their rights protected. One person reported to us they 'never know if anyone is coming or not.'

Some people required the support of two carers, they reported single carers arriving and not having their needs met. One person's representative told us 'only one carer comes often, it's hopeless they can't move X on their own.' Another person told us 'when only one comes, my husband has to help them with me, he is 79 and he finds it a struggle.'

Some people preferred to have a carer of a specific gender to provide their personal care. We were told the wrong gender carers were sent to them. One person told us 'it is just not on,' and 'I don't want a male and they keep sending me one.'

Accidents and incidents were not always reported and recorded appropriately. The provider was not aware of all incidents, therefore could not recognise patterns or trends, address them and attempt to reduce reoccurrences.

People, who suffered from a reduced ability to make specific decisions for themselves, did not have their mental capacity assessed in line with the Mental Capacity Act 2005 legislation. This meant staff were not clear how to support a person with some decisions about their daily lives.

Some people did not have their risk assessments completed correctly. One assessment for a partially sighted person stated 'sight v.'

New staff, without previous experience in care, did not always receive an adequate period of induction and shadowing before visiting people alone. This did not ensure people received care and support from appropriately experienced and qualified staff.

Is the service effective?

During this inspection we found the service was not effective because it did not have sufficient numbers of staff to meet people's assessed needs, choices and preferences.

People's choices were not respected. They did not always have their care provided at the time that suited them. People we spoke with reported many late and some missed visits.

All the people we spoke with told us 'the carers are lovely, no problems at all,' and 'I have no issue with the carers, they are very good indeed.'

Since the last inspection staff reported improved levels of supervision and training. Staff reported increased staff meetings which they found very supportive. We saw the provider had taken notice of staff requests to provide rosters one week in advance.

We were told prior to this inspection; people did not always receive care from the right number of carers. We were told the rota did not always allow staff to provide two carers to people at the time they chose. Staff and people who used the service told us, 'One will come alone then have to wait for the other, or we have to phone up to get another person, ' 'Sometimes my husband has to help the carer and he finds it a struggle.'

Is the service caring?

We were concerned to see evidence of one person having had all their calls missed from Friday 9 May 2014 until Monday 12 May 2014. This person required the assistance of two staff four times a day. This person was alone at home and suffered from diabetes. This issue had been raised as a safeguarding alert prior to this inspection following information of concern received.

We were told by staff prior to this inspection; people did not always receive care when they needed it. We were told the rota did not always allow staff to provide two carers to people at the time they preferred. One person told us 'they sometimes ring and say they can't send anyone, other times nothing happens, and I have to get on with it.'

People told us, and we saw, they were involved in their care plan and reviews. We saw people had been given the opportunity to sign in agreement to the content of their care plan.

All the people we spoke with told us 'the carers are lovely, no problems at all,' and 'I have no issue with the carers, they are very good indeed.' We were told by people who received a service from Hartley home care, the care staff were kind and caring, 'it's the office that's the problem.'

Is the service responsive?

During this inspection we found the service was not responsive. We saw entries in the message book from a family member asking for visits to Person B to be cancelled. The visits to Person B continued to be allocated on the rota and carers arrived at the house for four days until family rang the service to advise them.

We saw another message from family stating 'X needs to be ready by 13.00 on 9 June 2014, to be ready to go to respite'. We saw this visit was allocated for 13.20.

Another person required either one male carer or two female carers to meet their needs. We saw this was clearly stated on a notice on the desk in the operations room. We were told by this person a single female carer is 'often sent to me without anyone else to help, happens often.'

A further entry in the message book stated 'Carers not doing enough at X's. Bathroom and kitchen not been touched for weeks.' Next to this message was a space for 'action taken', we saw this was blank. It was not clear if this message had been actioned.

Concerns and complaints raised with the service were not always recorded and responded to appropriately.

Is the service well-led?

During this inspection we found the service was not well-led. Staff and people told us they had raised concerns regarding repeated late and missed visits with the registered manager and the provider but they continued to occur.

Staff told us they regularly called the office to inform them of errors in the rota, when they were rostered to visit a person at the wrong time or to visit a person alone who required two carers. We were told this continued to happen after the issue had been raised.

People who used the service and their representatives told us 'I have given up, nothing changes no matter how often you ring', 'the office needs a jolly good shake up they are all over the place.'

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people received safe care and support from staff supplied by Hartley Home Care. However, people were exposed to significant risk of missed or late care visits as a result of the services poor visit monitoring procedures. Most people were treated with dignity and respected by their care staff.

Care plans were individualised and mostly contained information that directed and informed staff to provide appropriate care and support.

Staff had received appropriate safeguarding training and knew how to respond to safeguarding concerns. The providers safeguarding policy was up to date and accurately reflected local safeguarding procedures.

People did not feel risks were always managed appropriately and some care plans did not include appropriate risk assessments.

Is the service effective?

Hartley Home care did not provide effective care.

We found that numerous care visits had been provided late or had been missed all together. For example a relative of someone who used the service told us 'This is a major problem the carer can arrive any time between 7.30am and 9am occasionally even later so I have to get my husband up myself'. Another said 'Sunday no-one came again, didn't bother to call the office as fed up.'

Relatives of people who required two care staff to meet their care needs told us they had often needed to provide assistance to care staff on occasions where only one member of staff had arrived. Many people we spoke with told us they were not called back when they called the office to report late or missed visits. People told us when they needed to change the times of visits this was not effectively managed by the service.

Care plans reflected people's individual needs, choices and preferences. The service delivered did not always meet those preferences.

People who used the service, and their representatives, were involved in their care plan reviews. We saw people, or their representatives, had signed care plan reviews to show they had read and agreed to the content of the care plan.

Most staff had the skill and knowledge to meet people's assessed needs. Newly appointed staff received an induction prior to starting work which included a period of shadowing more experienced staff. Mandatory staff training was up to date and some staff had received further training specific to the needs of the people they supported.

Is the service caring?

The service was caring, people were supported by kind and attentive staff. People told us the carers were very helpful and willing. One person told us 'we now have two fabulous carers who I cannot praise highly enough'.

Most people told us they were able to do things at their own pace, were not rushed and were treated with dignity and respect by the carers.

Is the service responsive?

The service was not responsive. People had complained to the service and these concerns had not been addressed or responded to effectively. People's comments in relation to complaints they had raised included 'I have given up now it is pointless'.

We found, and people told us that the service had failed to respond appropriately to reasonable and timely requests for flexibility in their visit schedules.

People's views and experiences were not always respected. For example, we found that people's wishes in relation to the gender of their care workers had not been respected.

Is the service well led?

Hartley Home Care was not well led. A number of concerns and complaints reported to the service had not been recorded. Where complaints had been recorded by staff and passed to senior managers for further investigation these investigations had not been completed. Complaints had not been used as an opportunity for learning or improvement.

The provider did not have effective systems in place to enable it to assess and monitor the quality of the service it was providing. Although the provider had introduced new systems for monitoring and recording complaints and missed visits these systems were ineffectual as they did not accurately record details of all complaints that had been reported or details of all visits that had been missed.

There were not sufficient of staff available for work in the services operations room. We saw one member of staff had worked over 80 hours in the operation room during one week. Operations managers told us 'I am so tired' and 'I am terrified we will have an accident on the way home'.

It was clear from our conversations with the provider that he did not have a full and accurate understanding of the services current arrangements for the monitoring of care visits.

We saw that regular staff meetings had occurred, that staff disciplinary procedure had been reintroduced and care staff told us they felt supported.

We found people were protected from receiving their care from unsuitable staff, because there were appropriate checks undertaken before staff commenced working for the service.

We found staff were not properly supported to deliver care and treatment safely and to an appropriate standard. Staff had not received formal supervision.

The service did not have an effective system to assess and monitor the service that was provided. Information received by the provider regarding the service was not recorded, monitored and acted upon effectively

We spoke to the registered manager, the provider, the Human Resources/ training manager, the general manager and 30 people who used the service and/or their representatives. A questionnaire was sent to 61 people, 28 were returned.

Comments included 'I get lots of different carers', 'I am satisfied', 'not bad, I wouldn't rave about it'. Others told us 'The carers are very good' and 'the girls are lovely the problem is the way the office does the rotas'.

We reviewed peoples' care plans. These records had been signed by the person, or their family or representative, and review dates were seen. We saw clear instructions to staff to follow the directions and wishes of the people who used the service.

We found the monitoring of the quality of the service provided by Hartley Home Care had improved since the last inspection, however, this was found to be requiring further improvements regarding the monitoring of missed and late visits.

There was an effective complaints system in place at Hartley Home Care. Comments and complaints made were responded to appropriately.

We reviewed people's care plans. These records had been signed by the person or their relative, and review dates were seen.

We found that appropriate action had been taken to keep people safe from abuse.

We saw that steps had been taken to ensure a training schedule was in place for all staff, and this was monitored and reviewed.

The on-going monitoring of the quality of the service was not effective. We saw evidence that Hartley Home Care had begun the introduction of an electronic call monitoring system to assist with the identification of any missed / late calls.

You can see our judgements on the front page of this report.

Other people were not pleased with the timing of the visits as they said care workers were often late and it felt like they were rushing to get to the next person. Some visits had been missed altogether. The agency was aware of these areas of concern and were hopeful that a newly introduced electronic monitoring system would improve the situation very quickly.

Some care plans we looked at were detailed and up to date where others were not. The agency had an ongoing programme to update the care plans. We saw evidence that this process was underway.

The agency assured us that there were enough staff employed to visit each person they had said they could visit. They were hopeful that the electronic monitoring system would improve how care workers managed their rounds.

Complaints were recorded. The two we looked at during the inspection had been dealt with appropriately.

The ongoing monitoring of the quality of the service had not always been effective in picking up peoples concerns, quality of documentation or staff training needs.