3HA Care Services

3HA is a domiciliary care service providing personal care. The service provided support to 8 people with a learning disability and autistic people and 177 to older people and people with a physical disability.

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

The provider did not have robust processes in place to monitor the service in relation to audits, risk assessments or medicines management to ensure safe oversight and governance of the service. Staff did not always have all the information they needed relating to risks to people.

Staff were not always safely recruited in line with government guidance.

There were enough staff to provide people with their care and support.

Infection control procedures were in place and staff had access to personal protective equipment (PPE) as required.

Staff knew how to safeguard people from harm and people told us they felt safe using the service. People were supported by staff who received an induction and training to meet their needs. Staff ensured people had support with meals and drinks and accessing health and community services.

People and their relatives told us the staff were kind and caring and respected their dignity and privacy.

People were given information on how to complain and feedback was sought through reviews and surveys. No one at the service was receiving end of life care.

Staff described a positive culture within the service and felt well supported by the registered manager and management team.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of 'Right support, right care, right culture.'

Right Support

Staff provided people with the support they needed to live their life as they chose. People’s choices, wishes and aspirations were respected by staff, and they supported people to be as independent as possible.

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.

Right Care

People received kind and compassionate care. Staff treated people with respect and dignity. They knew people well and responded to their individual needs.

Right culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received support that was tailored to their needs.

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

Rating at the last inspection. The last rating for this service was good (published 10 August 2017).

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and support. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to the recording of information about risk assessments and quality assurance and governance arrangements at the service.

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 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.

The inspection was announced and took place on 21 June 2017. 48 hours' notice of the inspection was given because we needed to be sure that the registered manager would be available.

At the time of inspection there was a registered manager in post who was also the registered provider. 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 and associated Regulations about how the service is run.

Staff had received training in how to protect people from the risk of harm so people received care and support from staff who understood their safeguarding responsibilities. Staff recognised the different signs of abuse and knew what action to take if they suspected abuse had occurred.

The service had assessed risks to people and management plans were in place which provided guidance to staff on how to prevent or minimise the risk of people coming to harm.

Those people who required support with medicines were assisted by staff who had been trained and assessed as competent to give medicines safely.

There were sufficient numbers of staff employed who had been recruited safely.

New staff received an induction when they joined the service which included access to training to equip them with the knowledge and skills to care and support people effectively. Supervision and spot checks were completed regularly to continuously monitor and assess staff competency and performance.

The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The legal requirements of the Mental Capacity Act 2005 (MCA) were followed when people were unable to make specific decisions about their care. Staff had received training in the MCA and understood how to help people to make their own decisions.

Where people required assistance at mealtimes, they were supported by staff to have enough to eat and drink which met their preferences and health needs. The service worked with health and social care professionals when they had concerns about people's health and safety so that people received the support required to maintain their health and wellbeing.

Staff were kind and caring and listened to people providing care and support how people wanted. People were treated with dignity and respect and encouraged to be as independent as they could be.

The care and support provided was tailored to meet people's individual needs in accordance with their wishes and preferences. People were supported by regular and consistent staff who knew people well and had formed positive relationships with them.

People had care plans which detailed how they wished to be supported. People were involved in the care planning process and in decisions about their care and treatment.

There were systems in place to support people to make a complaint or raise concerns about the service. Feedback from people who used the service was actively sought to improve the service.

Staff liked working at the service and felt well supported by the provider and the management team who were accessible as they were hands-on providing direct care and support to people.

People and staff were included in the running of the service and there were systems in place to monitor quality and safety and drive improvements.