Archived: Heath Lodge Care Services Limited Surrey

This announced inspection took place on 1 November 2018.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. There was a registered in post who assisted us with our inspection.

We last carried out a comprehensive inspection of this service on 13 and 14 February 2018 when we rated the service as Inadequate overall. We also took some enforcement action, in the form of warning notices, against the registered provider as we had found continued breaches of regulations from the previous inspection. Following this inspection, the registered provider submitted an action plan telling us how they planned to address our concerns. We carried out this inspection to see if the registered provider had acted in line with their action plan. As such we checked to see if there were sufficient staff, people were receiving safe care and kept free from abuse, people received person-centred care, their consent was sought and good governance was in place. We found overall the service people received had improved, however the registered manager and provider needed to ensure sustainability of those improvements.

Staffing levels at the agency were sufficient, however we found that staff were leaving people early to get to the next person. This was because no travel time was allowed in between calls. People confirmed with us that staff did not stay the full time. The registered manager and senior management took immediate action to address this.

The registered manager was aware of their statutory requirements to notify us any safeguarding concerns or serious injury. Care records for people were very detailed and demonstrated a person-centred approach. People’s consent was sought in line with the Mental Capacity Act 2005.

Risks to people were identified and managed and people received the medicines they required. Accidents and incidents were recorded and lessons learnt. Pre-assessments were completed to ensure the agency could provide appropriate care. Where people required food provided to them or input from health care professionals this was done.

People told us staff were kind and caring. They said they had seen staff following good infection control processes. People were cared for by staff who had been recruited through appropriate channels. Staff were sufficiently trained and supported to manage people’s needs. Staff had regular supervisions with their line manager.

The registered manager worked with other professionals to ensure people’s needs were met. Complaints and comments received by the registered manager were responded to in an appropriate manner.

The provider’s senior management and the registered manager were open and transparent about the shortfalls within the service and committed to continuing to take action to improve. Feedback at our inspection resulted in them taking prompt action to address the lack of travelling time for staff. Quality assurance processes were more robust and despite the short time the registered manager had been in post improvements had already taken place. People, relatives and staff felt the service had improved since the registered manager had taken up post. Staff felt supported and told us the culture within the team had got better.

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.

During our inspection we found one continued breach of regulation. You can read the action we have asked the provider to take at the end of this report.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager registered with CQC on 8 February 2018.

We last carried out a comprehensive inspection of this service in December 2016 when we rated the service as Requires Improvement overall. We found breaches of regulation in relation to a lack of risk assessments, recruitment processes, person-centred care and quality assurance. Following that inspection the registered provider submitted an action plan to us telling us how they planned to address our concerns. We carried out this inspection to see if the registered provider had taken action in line with their action plan. We found that despite being told all concerns would have been addressed by May 2017, this was not the case.

Risks to people’s safety were not always identified or staff were not provided with sufficient information in order to help keep people safe. Where incidents that had occurred which were potential safeguarding concerns, these had not been acted upon. Staff did not take appropriate action or learn from accidents and incidents. Staff did not always use the appropriate personal protective equipment when carrying out personal care to people and there was a lack of staff to meet people’s needs. Staff did not always stay the time they were allocated to do so.

Where people lacked capacity to make decisions we found that staff had not followed the legal requirements in relation to consent. There was a lack of person-centred information in people’s care plans to help ensure people received responsive care. Care plans were not always reviewed as often as they should be and staff did not always know about people’s individual needs.

People had been given information on how to make a complaint, however not all complaints had been logged as such and it was unclear from the records whether or not complaints had always been resolved.

Although the registered manager had a clear vision for the service we found there was still a lack of robust quality assurance monitoring processes in place. This meant the registered provider could not guarantee people were receiving a good standard of care. Staff did not always feel supported or valued by the registered provider.

People were cared for by staff who showed kindness, care and attention. People told us they communicated well with staff and they encouraged them to make their own decisions and remain independent.

People received the medicines they required as well as sufficient food and drink. People were cared for by staff who had appropriate training and had been recruited through robust recruitment processes. Staff had access to the training they required to undertake their role. In addition, they had the opportunity to meet with their line manager on a regular basis.

People were supported to access healthcare professionals when they needed them. Before the agency started to provide care an assessment was carried out to ensure they could meet a person’s needs. People were asked for their feedback about the agency and they told us that on the whole they felt the agency was well-managed.

As a result of our findings we have made one recommendation to the registered provider and found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed 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.

Heath Lodge Care Services Limited is a domiciliary care agency providing personal care for people in their own homes. This includes people that may be living with dementia, some that are old and frail, (that may have disabilities) and younger people with disabilities. There were 135 people using the service at the time of the inspection.

There was 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 were not being protected against all risks and action had not always been taken to prevent the potential of harm. The provider did not always follow safe recruitment practices, so they did not know that all staff were suitable for the job. The provider was not able to demonstrate that all staff were interviewed for their role.

Staff were available to meet the needs of people however the provider was actively recruiting additional staff to cover for absences. Because of staff pressures and travel time some people did not always receive the full time they were contracted to receive.

Medicines were managed safely and people received their medicines when they needed.

People's rights were not protected because the staff did not act in accordance with the Mental Capacity Act 2005 (MCA). There was no evidence of anyone's capacity being assessed in relation to any decision and staff lacked knowledge of the MCA.

Staff did not always have the updated training they needed to meet people’s needs or have their competency checked to ensure their practice was to the expected standards. However people were positive about the care staff gave them. New staff were supported to complete an induction programme before working on their own, and people were supported by staff that had supervisions (one to one meetings) with their line manager.

Staff did not always have access to a fully personalised care plan including people’s history, needs and communication needs to use to guide their work.

The provider did not have effective systems in place to monitor the quality of care and support that people received. Field spot checks were not always carried out to ensure people received quality care and results of a customer satisfaction survey were not actioned. Staff reported because of lack of travel time they were sometimes late providing support to people.

Staff were aware of people's dietary needs and preferences, and people’s care records showed people's health care needs were met effectively.

People and their relatives told us that staff were caring and they were happy with the care they received.

People were actively involved in making decisions about their care, treatment and support, were supported to remain independent and were treated with dignity and respect.

People's concerns and complaints were encouraged, investigated and responded to in a timely manner. They were used as an opportunity for learning or improvement.

Staff were aware of the aims of the service and received a regular newsletter from the provider.#

During the inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made three recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

We used an expert by experience to undertake surveys with 21 people who used the service. An expert by experience is a person who has had experience of using services.

People who used the service told us that staff asked for their permission before they undertook any tasks.

People told us that care staff treated them with respect and dignity. One person told us, 'They [care staff] are lovely.' Another person told us, 'They [care staff] treat me like they were my daughters.'

Most people we spoke to told us that they knew what their medicines were for and staff supported them with this.

People told us that care staff treated them in a way that reflected their individual needs. They told us that they thought the care staff were adequately trained.

People who used the service told us that they were consulted about their views on the service on a regular basis.

People who used the service told us that they made choices every day, and that their carers encouraged them to make choices. We were told that staff always attended to their personal care needs in private, and that the staff respected their privacy and dignity. They told us they had a care plan and they were aware of the contents. People told us that staff treated them with respect. One person told us, 'The staff are very friendly and I get on with them well.' Another person told us, 'staff treat me like a normal human being.'

People told us that they were very happy with the care they received from the agency.