HICA Homecare - Grimsby

At the time of the inspection, the location did not provide care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

HICA Homecare - Grimsby is a not-for-profit care agency owned and managed by Humberside Independent Care Association (HICA). The agency provides home care services within Grimsby and surrounding areas to people who may be living with dementia, a learning disability or autistic spectrum disorder, a physical disability, sensory impairment or mental health needs. People using the service lived in their own homes in the community.

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. At the time of the inspection 291 people were receiving personal care.

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

Right Culture: Staff were safely recruited and provided consistent and continuity in care. Staff received an induction and training which included areas of care and support, infection prevention and control, and person-specific training.

Systems to monitor the quality and safety of the service were in place. Staff reported having a positive relationship with the provider and felt communication was effective. Quality monitoring systems allowed for the effective monitoring of the service by the provider, however action plans were not always revisited. We have made a recommendation about this.

Right Support: Medicines were being managed safely, individual and environmental risk assessments had been completed. Systems were in place to ensure allegations of abuse and incidents and accidents were managed. People told us they felt safe when receiving support from staff. Risks to people had been assessed. People accessed specialist health and social care support where appropriate.

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 protected and respected people's privacy and dignity. Staff provided personalised care and support to promote people's wellbeing, enhance their quality of life and to achieve positive outcomes. People's communication needs were identified, and care plans detailed their preferred ways to communicate and make decisions.

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

Rating at last inspection

The last rating for this service was good (published 9 January 2018). The rating remains good.

Why we inspected

This inspection was prompted by a review of the information we held about this service and when the service was last inspected.

Follow up

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

The service had a registered manager in post at the time of 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.

At our last inspection of this service in June 2016, we gave the service a rating of 'Requires Improvement' as the provider needed to make some improvements to aspects of recording and quality monitoring. At this inspection, we found improvements had been made and the rating has improved from 'Requires Improvement' to 'Good.'

People were encouraged to manage their own medication if they were able to. When assistance was required to ensure people received the correct medication, appropriate levels of support were provided by staff that had been trained to carry out this role. Improvements had been made with the standard of recording for some teams of staff and the registered manager was taking action to ensure the recording was consistent across the service.

People were protected from harm or abuse because staff had received training on safeguarding adults and were confident they could recognise any signs of abuse and knew how to report it. Risks to people's health and safety had been assessed, and measures put in place to minimise any risks where possible. Staff followed infection control procedures, wore personal protective clothing such as gloves and aprons and had ample supplies of these.

The service had a safe recruitment system in place. This enabled the provider to select staff that were suitable to work with vulnerable people. There were enough staff to safely provide care and support to people. Staff received an induction which included mandatory training and shadowing experienced care workers.

Staff had received a good range of training relevant to their job roles and had regular supervisions. They told us they felt supported and were able to approach the registered manager with any concerns they might have. Staff understood the importance of respecting people's rights, offering choice and promoting independence. The staff we spoke with demonstrated caring values.

Care plans contained information on the health and social care support needs people had. People told us staff had talked to them about their preferences for their care, although we found some of this information had not always been incorporated into the care plans. This issue had been identified by the registered manager and was being addressed.

The service was operating within the principles of the Mental Capacity Act 2005. People had 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.

Some people required support to ensure they received adequate nutrition. Staff told us they would seek the guidance of healthcare professionals as required. They told us they would speak with people's families and inform the management team if they had any concerns about anyone's health.

We observed staff were caring, patient, courteous and kind when visiting people. They displayed warmth and a good knowledge of the individuals, with whom we saw they had a good rapport. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. The care and support people received was tailored to meet individual needs.

Records of complaints showed the provider had promptly investigated and responded to formal complaints. Most people we spoke with told us they had been satisfied with actions taken by the service in response to any concerns, such as timings of calls and regular care workers, although this was not everyone's experience.

Communication across the service was improving and the majority of people who used the service, their relatives and support workers felt they were well-informed. Most people found office based staff responded promptly to any queries or requests they had. However, a small number of people told us phone calls to the office had been unanswered, which the registered manager was looking into. Staff consistently said they had received good support from the management team who were always available to give advice and guidance.

The management team worked closely with commissioning teams to ensure care packages were allocated and completed as agreed and that staff were supported to do this. They had also implemented a project to trial a new model of care, which was being rolled out throughout the service in January 2018.

The provider's quality monitoring system included asking people for their views about the quality of the service. This was through spot check visits, care review meetings and satisfaction questionnaires. We found the audit programme had been developed and strengthened and the registered manager was taking action to address any shortfalls identified.

The last inspection was completed in February 2014 and the service was found to be compliant with the regulations inspected at that time. This unannounced inspection took place on 27 and 28 June 2016.

The service had a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated

Regulations about how the service is run.

In late 2015 the service had successfully tendered for the local authority commissioners home care contracts which dramatically increased the number of people they provided care to. The service tupeed another organisation's staff who were unsuccessful in the tender process. When HICA Home Care – Grimsby reviewed

care packages and staff training records it became apparent that a large number of people required an annual review and staff required refresher training in a range of subjects. Action was taken during the inspection to ensure this would be rectified in a timely way.

Staff had been trained to protect people from abuse and avoidable harm. Known risks were managed to ensure people were supported safely. Staff were knowledgeable about the registered provider's safeguarding procedures and knew what action to take if they suspected abuse had occurred.

People received support from suitable numbers of staff who had been recruited safely. Staff had been trained to administer medicines safely. People received their medicines as prescribed; however, medication administration records (MARs) were not always completed accurately.

Although staff had completed a range of training such as safeguarding vulnerable adults, health and safety, infection control, food hygiene and nutrition, dementia, mental health awareness, privacy and dignity and fire awareness; a high number of staff required refresher training to ensure their knowledge and skills were up to date. Staff received effective levels of supervision and professional development.

People who used the service were encouraged to eat a healthy, balanced diet. When concerns were highlighted relevant professionals were contacted for their advice and guidance. Staff supported people to attend healthcare appointments when required.

Staff understood the importance of gaining people's consent before care and treatment was provided. The principles of the Mental Capacity Act were followed.