Headway Shropshire

Headway Shropshire is a domiciliary care agency that provides personal care and support to people with acquired brain injury, living in their own homes in the community. At the time of our inspection eight people were receiving the regulated activity of personal care.

Not everyone using Headway Shropshire received a regulated activity. CQC only inspects the service received by people provided with 'personal care': for example, help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

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

People did not always receive consistent care and support from staff.

People were often supported by staff who had not been introduced to them and did not know their specific needs or preferences.

The provider had assessed the risks to people associated with their care and support. Although most staff members were knowledgeable about these risks there were instances staff had been deployed to support people without the necessary training.

People, their relatives and staff members were not always informed about changes within the organisation or management structure. Staff members were unsure what the vision of Headway Shropshire was or the organisations goals for supporting people.

Staff members did not always feel supported by Headway Shropshire. Although, supervision sessions were arranged for staff members, some felt unsupported and isolated.

The provider had systems in place to review the quality of support they provided. However, these systems needed to be developed in order to ensure people received care based on their preferences and their current needs.

Not everyone’s care and support plans reflected their current needs or preferences.

People were protected from the risks of ill-treatment and abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do to if they suspected wrongdoing.

When required, people received safe support with their medicines by staff members who had been trained and assessed as competent. Staff members followed effective infection prevention and control procedures when supporting people.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests; the application of the policies and systems supported good practice.

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 13 August 2019) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations.

However, the service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Headway Shropshire on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Headway Shropshire is a domiciliary care agency. It provides personal care and support to people with acquired brain injury, living in their own homes in the community. Some people required only minimal support but most people who received the regulated activity had complex care needs and so required 24-hour care packages. At the time of our inspection ten people were receiving the regulated activity of personal care.

People’s experience of using this service:

Although people told us they received good care and support we found several issues that could potentially impact on the quality and safety of the care and support provided.

The provider was not using their auditing and monitoring systems to ensure that the service was providing good quality and safe care. These shortfalls had made people vulnerable to potential harm or abuse. The registered manager had failed to consistently follow safeguarding procedures when people made allegations of abuse. This meant people who used the service were at risk of not being protected from abuse. The risks associated with people’s specific health conditions and care needs were not always identified and managed safely.

Staff were not being safely recruiting into their roles. Staff received required core training, however all had not had refresher training to demonstrate their knowledge was up to date and specialist training was not always provided to enable staff to have a better understanding of the people they supported and offer them safe support. Staff did not feel well supported and communication between the registered manager and senior managers was ineffective. Current staffing shortages were impacting on quality as people were being asked to support people inappropriately possibly placing people and staff at risk of harm.

Not everyone who used the service or who was a relative felt listened to. Staff did not feel they had a say in how the service was run and complaints had not always been responded to or well managed.

People’s care and support needs were assessed, and people were positive overall about the support they received. People’s needs, and preferences were met by staff who, overall, knew them well. Staff worked with, and made referrals to, health professionals when people needed support, or their needs had changed. People received support with eating and drinking and people were currently satisfied with the support they received to manage their medicines, although lack of training had negatively impacted on people. People had opportunities to enjoy activities of their choice and they valued this. People told us they were supported by staff who were kind and respectful. Staff spoke about their roles with compassion and empathy, talking about pride in their work and job satisfaction. Staff worked with health and social care professionals to ensure people’s needs were met consistently.

The service met the characteristics of Requires Improvement in all the five areas. Overall, we have rated the service as Requires Improvement. More information is in the full report.

Rating at last inspection: The service was rated Good at the last inspection (published September 2019). You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Headway on our website at www.cqc.org.uk.

Enforcement: Please see the action we have told the provider to at the end of the end of the report

Why we inspected: This was a planned inspection

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Headway Shropshire is registered to provide personal care to people living in their own homes who have an acquired brain injury. At this inspection Headway Shropshire was providing personal care to 43 people.

Two registered managers were in post and both were present during our inspection. 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 felt safe when staff supported them in their own homes. Staff had received training in and understood how to protect people from any harm and abuse. Systems were in place for staff to follow which protected people and kept them safe. Staff knew how to and were confident in reporting any concerns they may have about a person’s safety. People were supported to take their medicines safely and when they needed them.

People were happy they were supported by sufficient numbers of staff to safely meet their needs. Staff worked in teams and supported the same people to make sure they received a consistency to their care. Checks were completed on potential new staff to make sure they were suitable to care for people in their own homes.

Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training and staff were also supported in their roles by managers and their colleagues. Staff understood the importance of the training they received and how it benefited the people they cared for.

Staff asked people’s permission before they helped them with any care or support. People’s right to make their own decisions about their own care and treatment were upheld and supported by staff. Staff made sure people were involved in their own care and made sure they understood information that was given to them.

People had developed positive relationships with staff and were happy with the care and support they received from them. People were supported by staff who knew them well and had good relationships with them. People were treated with dignity and respect and staff understood how important this was in the way they cared for people.

People were involved in the planning of their care and were encouraged to express their views, preferences and wishes in regard to their care, support and goals. Improving people’s independence was a key part of the service and staff worked with other healthcare professionals to make sure this was achieved.

People were happy with the care and support they received and gave positive comments about the staff who supported them.

People were able to give their opinions of the service and the care they received at through feedback sheets and talking with staff. People felt involved in what happened within the service and felt staff listened to them. Complaints were dealt with and responded to in line with the provider’s policy.

The service had a positive culture where staff worked for the benefit of the people they supported. Staff were happy in their work and were clear about their roles and responsibilities. Systems were in place which assessed and monitored the quality of care and support staff provided at the home. The registered managers and provider all contributed to the running of the service and responded to feedback to make improvements where needed.

People were involved in assessing, planning and reviewing their care and support. They told us that they were 'very happy' with the standard of care and support they received. We saw the service was responsive to changes in people's needs and circumstances.

There were enough staff employed to ensure people received a safe and reliable service. People told us they were informed in advance of the times and names of the support workers who were visiting them. One person said, 'I like the same staff as it takes a long time to get to know them'.

Staff received a range of training to give them the skills and knowledge to keep people safe and meet their specific needs. Most support workers told us they felt supported in their work. One support worker told us, 'I absolutely love my job and definitely gain job satisfaction'. Another told us, 'We enable people to get their life back on track. I love it'.

We found the provider had systems in place to gain people's views and assess and monitor the quality of service that people received.

People were satisfied with the care and support they received from Headway. They were involved and consulted in the way care was given and reviewed. People were supported to retain their independence as much as possible. Staff were described as "very helpful".

Care plans contained clear guidance for staff on people's needs and how these should be met. This was done in a way that reflected people's individuality and preferences.

People were protected from the risk of abuse because staff were trained to recognise and report any concerns.

The agency supplied people with information about how to raise any concerns and complaints in the service user guide.

Systems were in place to make sure that checks were made when new staff started working at the agency to make sure that they were suitable.