Hafod Care in the Community

Hafod Care in the Community is a domiciliary care service providing personal care to people with a variety of needs including dementia, physical disability and sensory impairment. People are supported in their own homes, at the time of this inspection, 15 people were receiving personal care from the service.

People’s experience of using this service and what we found

At our last inspection the registered manager had failed to ensure staff rota planning was effective in supporting staff to carry out their duties, staff training was not planned effectively to support staff and auditing systems in place did not provide oversight of the service. At this inspection we found improvements had been made, but more worked needed to be done.

Safeguarding concerns, accidents and incidents were reported and acted upon. Audits were in place to identify any trends or lessons to be learnt. Work was underway to improve the information documented in peoples care records, but this had not been consistently completed and information was still missing in some plans. Staff were aware of the risks to the people they cared for and people felt safe supported by the same group of staff.

People felt safe when staff attended to them and confirmed staff wore PPE (personal protective equipment) when entering their home and supporting them.

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.

Staff worked in partnership with external healthcare professionals to ensure people’s healthcare needs were met.

People were happy with the service they received. People did not experience any missed calls and were supported by a consistent group of staff who knew them well. People’s views of the service were sought.

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 6 May 2020) 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 found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider 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 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 remained as requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hafod Care in the Community on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hafod Care in the Community is a domiciliary care service providing personal care to people with a mixture of needs including dementia, physical disabilities and sensory impairments. People are supported in their own homes, at the time of this inspection19 people were receiving 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

At our last inspection the registered manager had failed to ensure staff rota planning was effective in supporting staff to carry out their duties, staff training was not planned effectively to support staff involvement, and the auditing systems did not identify the support staff required to carry out and develop their roles effectively. At this inspection we found these issues had not been addressed.

Safeguarding concerns, incidents and accidents were not investigated. Not all of people’s risks were assessed or mitigated. People told us they were involved in care planning but care plans were not up to date and did not demonstrate that people had been involved in planning their care. Care plan reviews did not explore people’s outcomes of the service provided or record their views.

Staff understood their responsibilities in relation to mental capacity and gained consent from people before supporting them.

Although people were not always supported to have maximum choice and control of their lives, staff supported them in the least restrictive way possible and in their best interests; the policies in the service supported this practice, although the processes did not.

Staff worked in partnership with external health care professionals. Referrals to health care professionals were not followed up by the service and outcomes were not always recorded. Therefore, care plans did not always have the most up to date information and people were at risk of not receiving the care they needed.

People said they were well treated and cared for by staff but the providers systems did not always support this. People were at risk of their equality and diversity not being supported. People were not always supported to express their views or make decisions about their care.

People’s care plans did not always set out which methods of communication would be effective or people’s preferred method of communication. The provider had a complaints policy in place and understood their responsibilities in relation to their duty of candour.

The providers governance systems were not effectively operated, therefore failed to identify multiple areas of concern identified at this inspection, or mitigate risk. The lack of quality assurance meant opportunities to identify areas for improvement within the service, was lost.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 19 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence the provider needs to make significant improvements. Please see all the sections of this full report. Following this inspection the provider has taken some action to mitigate the risks identified at this inspection. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for this service has changed for Good to Requires Improvement.

Enforcement

We have identified breaches in relation to relation to risk management, staff training, and good governance, 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hafod Care in the Community is a community based adult social care service, registered to provide personal care for persons within their own home. They currently provide a service for 23 people.

There was a registered manager in post at the time of our inspection. 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.

Hafod Care in the Community were last inspected in May 2015 and were rated as a ‘Good’ service, but were seen as requiring improvement in the domain of Well Led.

Staff rotas were not effective to ensure that staff had sufficient time to attended care visits. Training planning was ineffective, as staff were given insufficient notice, resulting in courses being cancelled and rescheduled. Auditing processes had not identified these issues.

People were kept safe. Staff had received training and understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm. People were kept safe by staff who were able to recognise the signs of abuse and raise concerns if needed. Staff were provided with sufficient guidance on how to support people’s medical needs.

People were supported by staff that had been safely recruited. People felt they were supported by staff with the appropriate skills and knowledge to care and support them.

Staff had the knowledge and skills to enable them to care for people in a way that met their individual needs and preferences. People were supported to make choices and were involved in the care and support they received. Staff had an awareness of the Mental Capacity Act and Deprivation of Liberty Safeguarding (DoLS).

Staff were caring and treated people with dignity and respect. People’s choices and independence were respected and promoted and staff responded to people’s care and support needs.

People and staff felt they could speak with the provider about any concerns and felt they would be listened to and their concerns would be addressed.

The provider ensured that all policies and procedures were kept up to date with current guidance and legislation. There were quality assurance and auditing systems in place to ensure continual development of the service for the people being supported by the provider.

People received care that met their needs. All three people spoken with told us that they had not experienced missed care calls. One person told us, I am happy with the staff that comes, they are kind and jolly'

The provider had systems in place to support people using the service to make comments or complaints. One person told us, 'The staff are very good, never had a cause to complain, I know I can ring the office and they would sort it out'.

The provider did not have adequate systems in place to ensure people using the service received their calls as specified by their initial assessment of their care needs.

Staff spoken with were able to tell us about people's care needs so that they were cared for appropriately. One person told us 'I am pleased with the service I have, the staff look after me well, I am very happy to see them''. All four people using the serivce told us that do what is asked of them. This meant people received the care they wanted

We saw that systems were in place to keep people safe from harm.

Staff received a range of training so that they had up to date knowledge and skills in order to support people safely.

There were systems in place to monitor and seek feedback from the people using the service to ensure people received a quality service.