Archived: Here2Care Limited

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 the last inspection we identified issues with staff deployment and a lack of quality assurance processes that could have identified issues and helped to drive improvement. We also made a recommendation about making information accessible for people.

At this inspection improvements had been made in the management and oversight of staff deployment and people were happy with their care calls. We also found changes had been made which made information more accessible to people.

At this inspection risks to people had not always been recorded and person-centred guidance about managing risks to people and meeting their care needs were not always detailed within people’s care records. The registered manager began to address this following our inspection.

Staff recruitment records contained pre-employment checks however references did not always contain the dates of staff’s previous employment. Therefore the registered manager could not be assured they had staffs full-employment history to ensure safe recruitment practice.

The registered manager had systems in place to monitor the quality of the service however audits had not identified the areas for improvement regarding recruitment and person centred records. Quality monitoring and governance did not include trends analysis to aid learning and improving. The registered manager began to address the governance issues following our inspection.

People told us they were happy with their care. Staff knew how to meet their needs and staff had good knowledge of the people they supported. Therefore, there was no impact from the lack of person-centred information in the records.

People and their relatives told us they felt the service was safe and well managed. People were safeguarded from the risk of abuse by staff who knew the signs and symptoms of abuse to look out for. The registered manager followed their system when dealing with any potential safeguarding concerns.

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.

Medicines were being managed safely by competent staff with oversight from the registered manager. Infection control and prevention procedures were in place and followed by staff.

Staff and the registered manager understood their roles and duties. There was a positive culture within the service encouraged by the registered manager who had made improvements to the service and had further plans to do so.

The registered manager had sought feedback regularly from people and staff about the service. The registered manager worked in partnership with other healthcare professionals and external agencies where required to meet people’s needs.

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 18 February 2020). There were two 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 some improvements had been made and the provider was no longer in breach of regulation 18. Issues relating to the breach of regulation 17 from the last inspection had been rectified however the provider was still in breach of regulation 17 due to new issues found at this inspection.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 12 December 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and good governance.

We undertook this focused inspection to check they 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 and Well-led which contain those requirements. We also targeted information related to the recommendation we made under Responsive at the last inspection.

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 the same. 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 Here2Care Limited on our website at www.cqc.org.uk.

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 monitor the service.

We have identified breaches in relation to good governance in the form of record keeping 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 for 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.

People’s experience of using this service:

People were not supported by effectively deployed staff and they were not always supported in line with the care and support that had been planned for them. Staff rostering records showed staff were not always given enough time to travel between the calls, which impacted on their ability to arrive promptly or stay the full length of time with people as planned for. The provider’s quality assurance systems were not effective. The provider had not always monitored and analysed staff rostering, travel time between calls, short calls, or late visits, so patterns could be identified, and improvements made. People who required accessible information was not always presented in formats that met their communication needs.

We made one recommendation in relation to making information accessible for people.

People and their relatives gave positive feedback about their safety and told us that staff treated them well. The registered manager and staff understood what abuse was, the types of abuse, and the signs to look for. Staff completed risk assessments for every person who used the service. There was a system to manage accidents and incidents and to reduce them happening again. Staff administered prescribed medicines to people safely and in a timely manner. People were protected from the risk of infection. There were effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff that were unsuitable.

The provider trained staff to support people and meet their needs. The provider worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care. 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.

People’s needs were assessed to ensure these could be met by the service. Where appropriate, staff involved relatives in this assessment. Staff supported people to eat and drink enough to meet their needs and staff supported people to maintain good health. The provider worked with other external professionals to ensure people received effective care. Staff supported people and showed an understanding of equality and diversity and people were treated with dignity, and their privacy was respected.

Care plans were person centred and contained information about people’s personal life and social history, their health and social care needs, allergies, family and friends, and contact details of health and social care professionals. The provider had a clear policy and procedure for managing complaints and this was accessible to people and their relatives. The provider had a policy and procedure to provide end-of-life support to people.

The registered manager and staff worked well together and acted when things went wrong. People who used the service completed satisfaction surveys. The provider developed an action plan in response to the feedback from the survey to show how the identified concerns were addressed. The provider completed checks and audits on accidents and incidents, complaints, staff training, and safeguarding. The registered manager and the provider remained committed to working in partnership with other agencies and services to promote the service and to achieve positive outcomes for people.

Rating at last inspection: Good (report published on 12 June 2017).

Why we inspected: This was a planned inspection based on the last inspection rating.

Enforcement

We have identified breaches in relation to staff deployment, rostering and call monitoring including effective quality assurance system and process 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 for 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.