Verity Healthcare - Haringey

Verity Healthcare – Haringey is a domiciliary care agency. The service provides personal care and support to people living in their own homes.

Not everyone using Verity Healthcare – Haringey receives personal care; 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 our inspection there were five people receiving personal care.

The provider is also registered to provide Treatment for Disease, Disorder and Injury but as at the last inspection they advised us they were not delivering this at the time of our inspection and had not done so since the last inspection.

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

We found improvements had been made since the last inspection. There were some minor inconsistencies in some record keeping which the provider had identified and were working to resolve.

Staff understood how to protect people from abuse or neglect. The registered manager and staff understood their role in safeguarding adults.

Risks to people were assessed and staff had guidance on how to minimise risks where they were identified.

People received support from staff to take their medicines safely. There were enough staff to meet people’s care needs. Robust recruitment checks were carried out before staff started work to protect people from unsuitable staff.

Staff followed government guidance in relation to infection prevention and control. Staff had received training on COVID 19 and the use of personal protective equipment (PPE).

Staff received the training and support required to meet people’s needs. People received support from staff to maintain a balanced diet, where this was part of their support needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People using the service told us they were treated in a caring, manner and staff treated them with dignity and respect and encouraged their independence. They said staff sometimes stayed longer than the planned care time and acted to support them above and beyond their planned care.

People had a person-centred plan for their support which they told us was regularly reviewed. They told us they had not needed to complain but knew how to make a complaint if they were unhappy with the service.

People had access to information about the service in a format that met their needs. Staff received training in end of life care and understood how to meet people’s needs.

There were systems in place to monitor the quality of service that people received. Regular audits and spot check were carried out. Staff said they received good support from the registered manager and care coordinator.

People and their relatives’ views about the service were sought regularly through telephone monitoring, spot checks and satisfaction surveys. Feedback they received was used to improve the service.

The provider had introduced a number of initiatives including the purchase of interactive water bottles which helped remind people of the importance of staying hydrated. These helped to improve the quality of people's care.

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 inadequate (Report published 03 December 2021) and there were breaches of regulation.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 03 December 2021. During this inspection the provider demonstrated that 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Verity Healthcare- Haringey on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People and their relatives provided mixed feedback about the management of the service. This location has two registered managers. Feedback about one of the registered managers was that they were at times aggressive and rude and this impacted their experience of using the service negatively. Feedback from professionals such as the local authority was also that one of the registered managers was aggressive and difficult to work with.

Positive comments were received about the care coordinator but people did not seem to know who the other registered manager was. Some carers were described as respectful, but others as abrupt and rude. People told us they had not been asked to complete satisfaction surveys.

Following the factual accuracy process, the provider sent us 145 pages of surveys and an analysis. We have reviewed these and note that the majority of the surveys were positive. Comments included ‘I am very happy with my carers’ and ‘In general they are prompt, committed and friendly.’ However, we also saw less positive comments such as ‘Occasionally not respectful to patient, speed overriding sympathetic handling’ and ‘A little more sharing of information (such as rotas) would have been welcome. NB information was always provided when requested but could have been volunteered more often.’

We found that the registered managers were open to having discussions about our findings during the inspection in a professional manner. However, as we identified more concerns, the registered managers cooperation decreased. They showed a lack of accountability when we raised concerns, placing the blame on others, including service users and their families and relatives.

The provider was not routinely notifying us of notifiable events without delay.

Risk assessments were not always robust enough to protect people from harm and we found not all risk assessments were accurate or up to date.

Medicines were not always managed safely. There was no written guidance for staff about when to administer medicines on an as required basis putting people at risk of not getting medicine when they needed it.

The registered manager had not completed monthly medicine audits in line with the provider's expectation and the management team did not have satisfactory oversight of the people they supported with medicines.

People did not receive continuity of care as the deployment of staff did not consider their needs effectively. We could not be assured that care was delivered in line with the contractual hours or in accordance with people’s plan of care where two staff members were required.

We found multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 18 September 2019).

Why we inspected

We carried out this inspection due to an increase in whistleblowings, complaints and safeguardings. The inspection was also prompted in part due to the increase of concerns including concerns about the management of the service.

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 multiple breaches of regulation. These were in relation to staff deployment, medicines, risks assessments and the overall management of the service.

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.

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.

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.

Verity Healthcare – Haringey is a domiciliary care agency. It is registered to provide personal care and treatment of disease, disorder or injury to older adults, people with dementia, a learning disability or autistic spectrum disorder, people with an eating disorder, physical disability, and sensory impairment.

Not everyone using Verity Healthcare – Haringey receives regulated activity; 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 inspection, the service was providing personal care to four people living in their own houses and flats in the community.

The service had 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.

People told us they felt safe with staff. The provider ensured people were safeguarded against harm and abuse. Risk assessments were individualised and regularly reviewed. They gave staff information on risks to people and how to provide safe care. There were sufficient and suitable staff to meet people’s needs safely. People were appropriately supported with their medicines needs. Staff used personal protective equipment to avoid spread of infection.

People’s needs were assessed and told us their needs were met by staff. Staff were knowledgeable about people’s needs and abilities. They were provided with sufficient induction, regular training and supervision to provide effective care. People were happy with nutrition and hydration support.

People told us staff treated them with dignity and were caring and helpful. People were involved in the care planning process. Staff encouraged people to remain as independent as they could.

People’s care plans were comprehensive and regularly reviewed. Staff were provided with information on how to provide personalised care. They were trained in equality and diversity, and treated people as individuals. The provider promoted lesbian, gay, bisexual and transgender people to use the service. People and the relatives were encouraged to raise concerns and were happy with the complaints process. The provider had processes in place to support people on end of life care.

People told us they were happy with the service and would recommend it. Staff told us the management was approachable. The provider had efficient monitoring, auditing and evaluating systems and processes to ensure people’s safety and the quality of the service. The management worked with other organisations and professionals to improve the care delivery.