Hales Group Limited - Norfolk

Hales Group Limited – Norwich is a domiciliary care agency. It provides personal care to adults living in their own homes, so they can live as independently as possible. At the time of this inspection 117 people were using the service.

People's experience of using this service:

The management and staff team worked to ensure people's care and support needs were met. However, feedback from people we spoke with confirmed improvements were still needed. People were happy with staff and the care received but were not happy with the inconsistent call times and not knowing who would attend the calls. People told us they would like to have regular times and staff.

People using the service and relatives confirmed they were happy with the care they received and talked about staff positively. They confirmed staff supported them in a kind and caring way.

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. Systems used to manage visit times did not always support people’s preferences.

The provider had quality monitoring processes to review the service. However, not all people’s support needs were managed appropriately around home visit times and communicating changes.

The registered manager demonstrated their commitment to learn lessons and improve the service where required. People and staff confirmed they were given opportunities to make suggestions and provide feedback about the service.

Rating at last inspection:

The last rating for this service was requires improvement (published 5 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected:

We undertook a focused inspection to review the key questions of Safe and Well-Led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. However, we have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hales Group Limited – Norwich on our website at www.cqc.org.uk

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.

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

People’s experience of using this service:

The service was registered as a location on 20th April 2018. This is the first inspection since being registered.

We found most people received a good service, but some improvements made by the branch were not yet fully embedded in regard to call scheduling and staff stability.

Staff and people reported some initial difficulties with call scheduling and told us not everyone had continuity of care because they did not have regular carers. Care staff said staff responsible for planning and allocating calls did not always have sufficient information about people’s needs or locations which made scheduling challenging. There had been recent changes to management and staff agreed things were improving at the service.

The service used electronic call monitoring which enabled staff to enter ‘live’ data at each call. This meant office staff could see if calls were being delivered as planned and in line with contractual arrangements.

Staff records were robust and demonstrated effective recruitment and support processes were in place.

Staff completed an induction programme as part of their probationary period. Staff completed training considered as ‘mandatory’ in the care sector.

The service established people’s views by sending out feedback forms throughout the year, holding regular reviews and telephoning people in between to ensure everything was satisfactory.

Staff attended training updates, team meetings quarterly and had supervisions, appraisals and spot checks on their performance. Some staff expressed frustration about the lack of communication across the organisation.

The service had policies and procedures in place and provided training to staff, so they knew how to safeguard people in their care and what actions they should take. We reviewed a number of safeguarding concerns and actions taken. These were appropriate to the level of risk, but we found the recording did not provide a clear audit trail of actions. We were provided with all the information we needed to make a judgement at the time of the inspection.

Staff supported people with medicines where required and there were systems and checks in place to help ensure people received medicines as required and at a time they needed them. Staff received training and checks on their competency. A number of errors had occurred, and the service had taken timely actions to address the concerns.

The initial assessments, risk assessments and care plans were robust and contained good detail about people’s preferences, care needs and desired outcomes. They were very individualised and gave good information about how to promote people’s health and meet any health outcomes people might have.

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 supported this. There were very good assessments in place to determine if people had capacity to make decisions about all aspects of their care and welfare.

The service had audits in place to assess the effectiveness of its service. This involved listening to people using the service and acting on any feedback to improve the service. Reward systems were in place to support and encourage good staff practice and motivate the work force.

Why we inspected: This was a planned, comprehensive inspection to give the service its first rating.

Follow up: We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated requires improvement.

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