Archived: Harmony Home Aid Services Limited - Unit A2 Broomsleigh Business Park

The previous inspection of the service was on 3 and 11 October 2017 and we found the service was not meeting all the regulations. Two breaches of regulation were found. One breach related to safe care and treatment because risk assessments did not always identify and manage potential risks for people, systems for the management of medicines were not effective, missed and late visits were not always recorded and there was not always a risk assessment recorded on staff records where this was appropriate. The second breach related to good governance because care records and risk assessments were not regularly checked to ensure they reflected people’s current needs.

We issued requirement notices for each of these breaches. The overall rating for this service was ‘Requires improvement’. We asked and received from the registered manager an action plan that detailed how they would make those improvements to the service.

At this inspection, we followed up on the previous breaches of regulation. We found that the registered manager had taken action to meet all of the regulations we inspected. The overall rating for this service is ‘good’.

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.

Staff completed assessments with people which identified risks associated with their health and well-being. The management plans guided staff to manage and mitigate potential risks.

People’s medicines were managed in a safe way. Each person had a medicines administration record (MAR). Staff completed these accurately. When a medicine was not administered staff used an appropriate code on the MAR to explain why. Staff completed an audit on MARs and reviewed supplies of medicines to ensure there was enough stock for people’s needs.

Staff understood how to protect people from harm and abuse. Staff followed the safeguarding processes in place to report allegations of abuse. Staff captured and investigated missed and late visits and took action to inform the local authority of these incidents for their investigation.

The provider had safer recruitment processes in place. Newly recruited staff completed pre-employment checks before their employment was confirmed and they were assessed as suitable to work with people using the service. People had enough staff to support them. The staff rota showed people received the assessed care and support required to meet their individual needs. The registered manager supported staff through an induction, training, supervision and an annual appraisal.

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 practice.

People were provided with enough information for them to give staff their consent to receive care and support.

People said staff were kind and caring. People commented that staff respected them, their home and their privacy.

Staff supported people with their meal preparation and they had enough food and drink to meet their needs and preferences.

Staff completed assessments with people to identify their needs. Each person had a care plan that detailed the care and support people required to meet their needs.

People accessed health care services when their needs changed. Care workers contacted office-based staff to inform them when a person needed emergency health care.

The registered manager had a system in place for people to make complaints about the service. Each complaint was reviewed and responded to in a timely way.

Nobody receiving a service needed end of life care. Staff had training in end of life care and were aware of which health professionals would provide appropriate care, treatment and support for a person if this was required.

People had the opportunity to give their feedback on the care and support received and the service. Staff regularly contacted people to ensure care workers were providing safe and appropriate care.

The registered manager improved the established systems to effectively monitor, review and improve the quality of the service.

Staff were supported by the registered manager and were provided with opportunities to share their ideas with colleagues.

Joint working relationships were established with health and social care services.

The last time we inspected this service on 15 and 20 December 2016 the service was not meeting all the regulations. Three breaches of regulations were found. We found that the service was in breach of regulations in relation to safe care and treatment and good governance. We issued warning notices for each breach. The registered provider was also in breach of the regulation related to notifications. We issued a requirement notice for that breach of regulation. The overall rating for this service was ‘Inadequate’ and the service was placed in ‘special measures’. You can read previous inspection reports for the service, by selecting the ‘all reports’ link for Harmony Home Aid Services Limited - Unit A2 Broomsleigh Business Park on our website at www.cqc.org.uk.

At this inspection, we followed up on the breaches of regulations to see if the registered provider had made sufficient improvements. We found that the registered provider had taken some action to meet the regulations. The registered provider now met the regulation relating to notifications. They had also taken action to manage risk management plans, the management of missed and late visits, the management of medicines, the quality assurance process and improvements in the management of the service. However, further improvements were required.

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 had assessments which identified risks associated with their health and well-being. However we found that the control measures in place to manage risks were not always followed to keep people safe.

People’s medicines were not always managed safely. People’s medicine administration record (MARs) charts were not always accurate or up to date. People were at risk of receiving medicines that were not administered as prescribed. The registered manager had implemented a new medicine audit tool. However, this was not effective as it had not identified the concerns we found.

The registered manager had systems in place to monitor, review and improve the quality of people’s care records and risk assessments. However this system was not effective because information contained in people’s care records was not always accurate.

Missed and late visits were recorded and monitored. However, there was evidence that staff were not always reporting missed visits to the local authority.

The registered provider had a recruitment system in place. Staff followed the recruitment process to ensure staff had pre-employment checks carried out to assess their suitability to work with people. However, we found that on two occasions the provider had not followed up information contained in pre-employment checks to ensure that staff were safe to work with people. The provider sent us further information following the inspection to evidence how they had addressed this.

Staff had regular training, supervision and an annual appraisal. Newly employed staff had an induction which helped them familiarise themselves with the service and the expectations of their role before they started working with people.

There were enough staff to meet people’s care needs. The rota showed sufficient staff were deployed to meet people’s care and support needs safely.

The registered provider had safeguarding processes in place that staff followed to help keep people safe.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had training in the MCA and understood how to raise a concern if they thought a person’s ability to make decisions for themselves had changed. 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 practice.

People were supported to make decisions about their care and support needs and consented to their care and support where possible. Relatives were involved when people were unable to consent to care from the service where this was appropriate.

People had an assessment of their needs. Information from care needs assessments was used to develop a plan of care. When people’s health needs changed staff ensured they had appropriate support from health care services.

People commented that staff treated them with thoughtfulness and compassion. Staff spoke about people with empathy demonstrating that they were kind and caring.

The registered provider had a complaints policy in place at the service. People had the support to make a complaint about the service if they needed to. People told us they would speak with the care worker and office based staff if they had any concerns about their care.

Staff routinely obtained people’s views of the service. There were systems in place which meant people were able to provide feedback to the registered provider about the quality of care they received.

Staff prepared meals for people. Staff completed shopping tasks so people had enough food and drink. Meals met people’s needs and preferences. Staff supported people to be as independent as possible and supported people in their local communities as they chose.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We found two continued breaches of regulation in relation to safe care and treatment and good governance, however, improvements in these areas had been made since the last inspection. You can see what action we told the provider to take at the back of the full version of the report.

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.

The last time we inspected this service on 8 January 2014 the service was meeting all the regulations we inspected.

At this inspection, we found the provider had breached three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to safe care and treatment, good governance and notifications. CQC is considering the appropriate regulatory response to resolve the problems we found in respect of these regulations. We will report on action we have taken in respect of these breaches when it is complete.

There were no processes in place for the monitoring, and reviewing incidents of missed call visits to people. People we spoke with told us that they had either late of missed care visits. They said sometimes the office staff would contact them and other times no contact was made. The service could not appropriately manage missed care visits because there were no records of the numbers or details of them or accurate numbers of people using the service.

The registered manager did not always effectively manage the service. They did not have insight of the quality of care because there were no systems in place that gave an overall view of the service. The Care Quality Commission were not informed of safeguarding incidents that should have been reported to us by law.

Risks to people‘s health and well-being were identified. Risk management plans were not always effective because they did not often relate to the identified risk. Staff were not able to manage risks to people because risk assessments did not give clear guidance to manage and mitigate them.

People’s medicines were not always managed safely. The management of people’s medicines were not safe because staff did not always complete Medicine administration records (MARs) accurately. There were no processes in place to collect completed MARs from people’s homes on a regular basis, therefore the quality audit of these could not be reviewed promptly. The registered manager could not detect medicine errors and take action to reduce the likelihood of unsafe medicine management.

The quality assurance systems were not effective. Checks and monitoring of the quality of care at the service took place. This included feedback from people using the service, staff observations and spot checks. However we found that people’s care records and risk assessments were not regularly checked to ensure they were of a good standard and reflected people’s current needs.

A recruitment process was used by the service to ensure staff employed had appropriate checks carried out before working with people. The registered manager did not always formally follow up results from criminal records checks appropriately to ensure the continued safety of people.

Staff had access to an induction, training, supervision and an appraisal. Staff underwent and induction and shadowed experienced staff. There was a training programme in place that ensured staff completed mandatory training. Supervision meetings occurred with staff and their manager. These identified issues with staff employment and these were recorded but staff or the supervisor did not always sign these records. Staff completed self-appraisal that discussed their progress within their role over the past year. There were not processes in place for staff requests made in their self-appraisal to be considered or followed up by a manager.

There was sufficient staff to meet people’s care needs. Records showed when people’s care needs required a certain number of staff. However people told us that they had missed care visits and staff were often late.

The registered provider had safeguarding policies and processes in place to give staff guidance to protect people from abuse. Staff understood what abuse was and was able to act promptly by raising an allegation of abuse promptly.

Senior staff had an awareness of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff supports them in the least restrictive way possible; the policies and systems in the service support this practice. Staff we spoke with had not completed training in MCA. There was training in MCA offered and arranged for staff in February 2017.

People gave staff their consent to receive care and support. Any concerns with a person’s ability to give their consent were recorded and discussed with the local authority. A mental capacity assessment would be completed to assess their decision making ability. People were supported to make decisions about their care and support needs. Care records reflected the views and opinions of people that showed that they made care decisions.

Assessments of people’s care needs were recorded. Assessments were person centred and showed clearly what the person’s health and support needs were. People’s contributions were gained to ensure they were relevant and were used in the planning of their care. Care delivered was regularly reviewed to ensure these accurately met people’s needs. Care records contained personal information about people. These records were stored appropriately and kept locked when they were not in use.

Staff supported people to access health care when required. People who required healthcare in an emergency was acted on by staff. When people’s health needs changed appropriate advice and support was sought to manage the change.

People were treated with kindness and compassion by staff. People we spoke with told us staff were kind and caring. Staff spoke about people in a way that showed they respected them and understood their needs and wishes.

The registered provider had systems in place for people to complain about the service or aspects of their care. The service user’s handbook had a copy of the provider’s complaints policy and process. The provider sought people’s feedback on the service. People and their relatives had opportunities to give their views about the quality of care. Staff gave their feedback meetings about any concerns regarding their role and in the quality of care.

People had their meals provided by staff, which met their needs and preferences. When required staff helped people with shopping and preparing meals of their choice during their care visits.

People said staff treated them with kindness and compassion. Staff delivered care in the privacy of people’s homes. People told us that staff showed respect to them and their home.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The provider had systems in place to gain consent from people before providing care. We found care plans and support plans in people's records and one person said 'I am happy with my carer she is helping me.'

The provider had an infection control policy in place and staff completed infection control training. Staff had access to personal protective equipment such as disposable gloves and aprons and all the people and relatives we spoke with told us staff used these when providing personal care.

The provider had a complaints policy in place. People were supported to provide feedback on the service they received through regular quality monitoring visits and an annual survey. People told us that when they had raised a concern it had been responded to.

We found the agency had enough qualified and experienced staff to meet people's needs. Staff told us they get to know the needs of people they are allocated to. People told us that they had regular care workers who visited them at home.

The agency had high retention levels for carers which contributed to consistency in the service. A person receiving the service said,"I was reluctant to allow a carer provide for my personal care needs, but my views have changed, the carer made me feel me at ease and reassured me, I would be lost without her assistance now".

People were treated with respect and were involved by the agency in decisions about their care arrangements. They found that care staff generally arrived on time and stayed for the time required. Any concerns raised by people with the agency such as timekeeping were responded to promptly and addressed as appropriate.

The agency had experienced members of staff dedicated and assigned to the roles of planning and overseeing the care delivery. This helped to ensure that care was planned and delivered to meet individual needs at the agreed times, care staff felt their workload was manageable as good planning made allowances for travel times from people's homes.