Archived: Headway Devon

Headway Devon provides support, care and social reintegration for people with acquired brain injuries in Devon. The enabling service provided by Headway Devon is not regulated by the Care Quality Commission and was therefore not covered in this inspection. At the time of this inspection there were just two people whose support included assistance with their personal care needs in their own homes. Our inspection mainly focussed on these two people.

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 last inspection we found medicine administration systems were not safe. Medicine administration records (MAR) contained unexplained gaps, which meant people were not fully protected from medication errors or omissions. At this inspection we found systems had been developed with the aim of ensuring people received their medicines safely. However, despite the introduction of these systems we found they were not yet fully embedded. There were some gaps in recording the administration of creams and an error, which had not been picked up by spot checks or audits.

At the last inspection we found risk assessments were not always accurate or dated, and did not always contain the information staff needed to support people safely. These failings in recording and documentation had not been picked up by the quality monitoring system. At this inspection we found improvements had been made. Care plans contained risk assessments with measures to ensure people received safe care and support. They were dated, current and had been reviewed regularly. Risk assessments also supported people to take positive risks, enabling staff to promote their independence and do what they wanted to do in a safe way.

At the last inspection we found care staff had not received face to face support for some time due to a lack of supervisory staff. They told us they felt isolated and unsupported, and that managers did not listen to them. At this inspection we found improvements had been made. A service manager and two full time supervisors were in post, as well as the registered manager. This meant there were now sufficient supervisors to provide the support each member of staff needed to do their jobs effectively. The supervision and performance management policies had been reviewed and a new supervision format introduced. Staff had one to one supervision every six weeks, and regular ‘spot checks’ to evaluate their practice. A supervisor told us, “I make sure I’m available to staff. They can always ring the office or another supervisor if necessary”. The majority of staff told us they now felt well supported. We saw from the minutes of the monthly managers meetings that supervisions and spot checks were monitored regularly, to ensure they were kept up to date.

At the last inspection staff told us that although training was provided, it was difficult for them to attend because of their workload. Training records were inaccurate, which meant it was difficult for managers to see which staff had completed training and which training was due. At this inspection we found improvements had been made. A new learning and development policy and training programme were in place, training records were maintained workloads were better managed, enabling them to attend training courses. Staff spoke positively about the training. Comments included, “Headway are brilliant. The training is awesome” and, “I’ve had loads of training. They were good courses, very helpful.”

People told us they felt safe. One person told us, “I fell down one day and couldn’t get up. They got me up, no bother at all”. The risk of abuse to people was reduced because there were effective recruitment and selection processes for new staff. Before commencing work all new staff were thoroughly checked to make sure they were suitable to work with vulnerable people. Staff were able to recognise different forms of abuse, understood the provider's safeguarding and whistle blowing procedures and knew who to contact if they had any concerns. Accidents, incidents and complaints were documented and analysed to ensure any wider actions needed to keep people safe were identified, and allowed the service to learn from any mistakes.

People were supported by a consistent team of staff who knew them well. We observed people were relaxed and at ease with the staff supporting them, and they and their relatives spoke highly of their care, professionalism and kindness. Staff had a good understanding of each person’s individual needs and treated them with dignity and respect. They understood the importance of encouraging and supporting people to make their own decisions about all aspects of their lives, asking for their consent before providing care. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. There were also regular opportunities for them to give feedback about the quality of the service, for example via individual reviews, user consultations and sitting on the board of trustees.

People were supported to eat and drink if they required assistance. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

The registered manager had been proactive in addressing issues raised at the last inspection. They had also developed an action plan in response to recommendations made during a commissioned audit of human resource policies and processes, and in an ‘Investors in People’ report. This included reviewing and revising policies and processes to improve the operation of the service and the quality of the support provided to people using it and to staff.

The registered manager and staff team were proactive in keeping their knowledge and skills up to date and using this knowledge to develop and improve the service for the benefit of the people using it. They were also working to raise awareness and knowledge of ABI (acquired brain injury) by hosting conferences attended by staff and external professionals.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Headway Devon provides support, care and social reintegration for people with acquired brain injuries in Devon. The enabling service provided by Headway Devon is not regulated by the Care Quality Commission and was therefore not covered in this inspection. At the time of this inspection there were just two people whose support included assistance with their personal care needs in their own homes. Our inspection mainly focussed on these two people.

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 time of the inspection, care staff had not received face to face support for some time due to a lack of supervisory staff. Several staff told us they felt isolated and unsupported, and that managers did not listen to them. They were concerned that a lack of accountability and monitoring meant people were at risk of receiving poor care. A new supervisor had been recruited and the registered manager believed the situation would now improve.

Training was provided by the learning and development manager, who was a qualified trainer in most topics considered mandatory by Headway Devon. However, staff told us it was difficult for them to attend because of their workload. Training records were inaccurate, which meant it was difficult for managers to see which staff had completed training and which training was due.

People’s medicine administration records (MAR) contained unexplained gaps, which could be because the person did not want to take their medication, or it was given to them by their family when they visited. This was not always recorded, which meant people were not fully protected from medication errors or omissions. Risk assessments were not always accurate or dated, and did not always contain the information staff needed to support people safely. These failings in recording and documentation had not been picked up by the quality monitoring system. This shows the system was not effective in ensuring the service continued to meet people’s needs and to keep them safe.

Staff were kind, cheerful and understanding of each person’s individual needs, treating people with dignity and respect. They understood the importance of encouraging and supporting people to make their own decisions about all aspects of their lives, asking for their consent before providing care. People told us, “The girls are very good. I know them all. They treat me with respect. Very good they are. They listen to what I say.”, and, “I look forward to them coming. I’ve no complaints. They know me quite well”. Relatives told us, “They are all very pleasant…all very good and understanding. My relative has never complained”, and “I can’t praise the carers highly enough”.

Safe procedures had been followed when recruiting new staff. Checks and references had been carried out before new staff began working with people. People chose who they wanted to work with them. The agency matched care staff and the people they supported according to their preferences, experience and shared interests.

People were supported to eat and drink if they required assistance. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

There were regular opportunities for people to feedback about the quality of the service, for example via individual reviews, user consultations and sitting on the board of trustees.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At our last inspection we found improvements were necessary to the care and welfare of people who used the service, the management of medicines, and assessing and monitoring the quality of service provision. After our inspection the provider sent us their action plan. During this inspection we checked to make sure the actions had been carried out and were effective.

We visited four people who received a personal care service and spoke with them about the service they received. We spoke with three care workers on the telephone. We also met with the registered manager, the nominated individual and an administrator at the agency offices in Exeter.

The questions we asked on this visit were:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

Is the service safe?

The service was safe because up to date information about all aspects of each person's health and care needs was available to care workers. Risks to people's health and welfare had been assessed and the records explained to staff how people wanted to be supported to minimise the risks. Incidents and accidents were reported and the provider reviewed the reports to identify where improvements were necessary to reduce the risk of recurrence.

Safe methods of recruitment were followed. Care workers did not begin working until sufficient references and checks had been carried out to show they were suitable for the job.

People told us the care workers were competent and well trained. We saw evidence to show care workers had received training on health and safety related topics and understood how to keep people safe.

Is the service caring?

People told us the care workers were always caring. Comments included 'The carers are all lovely, I wouldn't be without them', 'Headway carers are excellent. They are caring, discreet and professional,' and 'I am being very well looked after'.

Care workers were given information and instruction about each person's preferences. This meant care workers understood each person's individual needs and understood the importance of listening to people and providing a caring service tailored to each person's wishes.

Is the service effective?

Each person's needs had been assessed at the start of the service and a plan had been drawn up and agreed with them about how the service they required. Care workers were given sufficient information about how each person wanted to be assisted.

Daily reports completed by care workers showed that required tasks had been completed and needs had been met.

Is the service responsive?

People's care needs were reviewed every six weeks and care plans updated where necessary. This ensured that care workers were given sufficient information about any changes to the care each person required.

Is the service well-led?

People's views had been sought and their preferences and requests were taken into account. There were systems in place to monitor all daily routines, for example checklists were completed by care workers on each visit to confirm the tasks they had completed. These were checked by supervisors every few weeks and returned to the agency office to provide evidence that care needs had been met. We saw evidence of a variety of methods used to monitor the quality of the service, and where actions had been taken to improve the service where necessary.

Care workers received regular training supervision and support. Care workers told us improvements had recently been made to the communication systems between the agency office, care workers, and people who used the service. We also heard there was a 24 hour 'on call' system which care workers or people who used the service could ring outside of normal office hours if assistance was needed in an emergency.