Havesters Care Ltd

Havesters Care Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. The service was supporting 92 people at the time of the inspection. 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

People's care plans were up to date and contained person centred information. However, not all people’s risk assessments contained information which would enable staff to understand how to keep them safe and mitigate the risk of harm. This placed people at risk of not receiving the appropriate care and treatment they required. We have made a recommendation about this in the report.

There were quality assurance systems in place based on a range of audits. However, we found these needed to include more detail to enable them to be effective. They had not identified all the concerns identified in this inspection. People and their relatives gave us mixed feedback. While some told us, they were happy with the care provided and staff were caring and compassionate, others felt they did not always get a good service.

Staff did not feel supported in their role and felt they were not listened to if they raised concerns. This impacted on the culture of the service. We have made a recommendation about this in the report.

The management team had processes for monitoring visits. Although some people, were satisfied they received visits on time, others said they were not always told when staff were running late. Staff told us they did not feel they had enough time to travel to visits.

Staff understood the importance of safeguarding people they supported, and they knew how to report any signs of abuse, or any accidents and incidents.

Staff had completed training in the safe administration of medicines and had their competency assessed to do so safely. People were happy with how they were supported around their medicines.

Staff received an induction into their role and had received training that equipped them to support people. Safe recruitment procedures were in place to help ensure only suitable staff were employed.

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. However, further improvements were needed to ensure records were made for all decisions made using The Mental Capacity Act 2005.

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 7 June 2021). 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 some improvements had been made but the provider remained in breach of regulation.

At our last inspection we recommended that the provider consider current guidance on the management of medicines, review current guidance on ensuring staff have skills, knowledge and experience, consider current guidance on supporting people with their nutrition and hydration and consider guidance on the implementation of the Accessible Information Standard. At this inspection we found the provider had acted on these recommendations and made improvements in these areas.

Why we inspected

We carried out an announced comprehensive inspection of this service on 27 April 2021. 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 consent to care, notifying the commission of significant events, fit and proper persons employed and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. In addition, we received concerns in relation to staff training and lack of skills leading to neglect of people receiving a service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. 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 Havesters Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified a continued breach in relation to governance systems at this inspection. In addition, we have identified areas for improvement and have made recommendations in relation to risk assessments, acting on staff feedback and improving the culture of the service.

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

Havesters Care Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. The service was supporting 21 people at the time of the inspection.

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

The provider did not have an effective system to monitor and assess the quality and safety of the service people received. The registered manager had not notified us of all incidents as required in the regulations. A governance system was planned, and the registered manager had used learning from incidents, concerns and feedback from the local authority and this inspection to make improvements.

People and relatives told us the service provided safe care. Some areas of risk had not been assessed or plans put in place to mitigate these in people’s care records. Staff we spoke with knew about people’s risks and described how they provided safe care. However, information about risks to people was not always available to guide staff should they need to rely on this.

Not all the required checks to support the safe recruitment of staff had been carried out. Some staff had limited knowledge in safeguarding people and plans were in place to address this. Records to support the safe management of people’s medicines required improvement including how people preferred to take their medicines and the level of support they required. We have made a recommendation about this.

People’s care plans did not always include all their needs and choices to ensure staff had the guidance to deliver person centred care. Information in people’s care plans was not always accurate and up to date. Although people’s communication needs were assessed their support needs were not easily available to staff in their care plan. We have made a recommendation about the application of the Accessible Information Standard.

We found no evidence that people were not supported to have maximum choice and control of their lives or that staff did not support them in the least restrictive way possible and in their best interests. However, the Mental Capacity Act (MCA) (2005) had not always been consistently applied, in line with legislation and guidance. There were no records to show people had consented to their care plan and people told us consent was not always asked. Processes to support the application of the MCA required improvement.

Staff were using personal protective equipment (PPE) and completing testing for COVID-19 in line with government guidance. There were enough staff to meet people’s needs and people confirmed their care calls were usually on time and for the correct duration.

The provider had introduced a more robust staff training programme to ensure staff new to care completed training to the required standard. Staff supervisions were being completed. We have made a recommendation about the training and support of staff.

Although we identified some issues in this inspection which required improvements to be made, people and relatives spoke positively of the support from staff. Staff we spoke to knew about people’s needs and people told us the care they received met their needs. People told us staff were caring and they were treated with dignity and respect. The registered manager was implementing recorded spot checks to monitor the quality of care delivered.

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

Rating at last inspection

This service was registered with us on 30/10/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment, medicines, quality of care, records and information management and safeguarding. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to, safe recruitment, consent, maintaining accurate and complete records, the governance of the service and submitting notifications to CQC

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.