HLC Care Agency Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found people were not being supported safely by HLC Care Agency. Incident and accident processes were not robust to ensure lessons learnt could be shared or identify trends and actions. People were not safeguarded from abuse as safeguarding processes were not robust. Staff had not been recruited following robust recruitment processes. Not all staff had the skills, knowledge and competence to support people safely with their health needs. Processes were not robust to ensure the safe management of medicines. We found four breaches of legal regulations in relation to safe care and treatment, safeguarding, staffing, and fit and proper persons employed.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, incidents and accidents were not well managed.

Staff told us they would let the manager know of any incidents or safeguarding. However, not all staff had completed safeguarding training so we were not assured that staff fully understood incident reporting procedures to ensure they were raised appropriately and to the right people. When we spoke to the registered manager about incidents and lessons learnt, they told us there had only been a few incidents, but was not knowledgeable about any process they needed to follow in terms of reporting, taking action, updating risk assessments or ensuring lessons were learnt. We reviewed the incident folder and it was not clear what lessons were learnt for the incidents that were recorded: processes were not effective, and this had an impact on people's safety.

There was not an effective system in place to review and analyse incidents and accidents to ensure any actions or learning could be identified. We looked at incidents that had been recorded, however it was not always clear the action that had been taken or the lessons learnt from the incident. For example, one incident highlighted that staff had delayed seeking medical attention and called the registered manager first. There was no information recorded as to the action the registered manager took to ensure the staff member understood their responsibilities around seeking medical assistance. No changes had been made to people’s care plan following incidents and there was a lack of oversight of the incidents from the registered manager and provider.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, robust safeguarding processes were not in place and not all staff had completed safeguarding training. People could not be assured that they would be appropriately supported when they felt unsafe or experienced abuse or neglect.

Staff and leaders did not have a strong understanding of safeguarding or how to take appropriate action. One staff member told us it would depend on what the safeguarding was, whether they would report it or not. We were not assured that robust safeguarding procedures had been implemented by the registered manager and that staff fully understood their responsibility.

People were not safeguarded from the risk of harm and/or abuse. We were not assured the registered manager fully understood their safeguarding responsibilities. The registered manager had failed to fully investigate safeguarding concerns and it was not clear what action they had taken to keep the person safe. For example, one incident was document as potential self harm, however there was no record of this being reported to the local safeguarding team. Records also showed that the registered manager had failed to accurately document safeguarding concerns, including adding dates and times of the alleged incident. The registered manager had not ensured that all staff carried out safeguarding training prior to supporting people. Documentation was poor and there was no evidence to confirm that all staff had completed safeguarding training. The registered manager was not able to tell us which staff members carried out the care calls and therefore could not evidence which staff had completed safeguarding training and who had been assessed as competent.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, staff did not fully understand people’s health risks, including the registered manager.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. People were supported by staff who were not competent. For example, staff did not fully understand people’s health risks, including the registered manager.

People's health risks were not well managed. Risk assessments and care plans were not always in place or reflected people’s current needs. For example, risk assessments for epilepsy did not contain enough detail to provide staff with information on how to support someone with epilepsy. Risks assessments regarding people’s mobility was not reflective of their currents need and contradicted other information in the care plan. For example, one person had a fall but their care plan detailed they were not at risk of falls and there was no risk assessment to provide information to staff on how to support them with their mobility.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, people could not be assured they were supported safely: the provider and registered manager had not undertaken robust recruitment checks for staff or assessed staff skills and competency.

Staff told us they had completed some of their training. However, the registered manager could not provide evidence that the training needed to safely support someone with their health needs, had been completed. Although staff had completed some training, their knowledge regarding people and their health risks was inadequate. For example, staff’s knowledge around epilepsy was poor. The registered managers knowledge around manual handling and the required training was poor. For example, they told us staff didn’t need practical manual handling, however staff supported people who needed help with transferring from wheelchairs.

People were not supported by staff who were suitably skilled or competent to meet the needs of people and keep them safe. Staff had not always completed training that was relevant to their role and the people they support. For example, one staff member had not completed epilepsy training but supported someone with lived with epilepsy. Staff had not completed practical manual handling training or deemed competent to support people with their mobility which left people at risk of harm. Staff had not received training to support people with a learning disability or autistic people. Since 1 July 2022, all registered health and social care providers have been required to provide training for their staff in learning disability and autism, including how to interact appropriately with autistic people and people who have a learning disability. Staff had not been recruited following robust recruitment processes. Recruitment checks such as references, right to work in the UK, full work history and oversees DBS checks had not been obtained by the registered manager. We were not assured that people were getting their calls when and how they wanted. Daily care notes did not detail what time the care call was, if there was any late calls or which staff member attended the call. The registered manager and client welfare officer did not have any oversight of the care logs so could not be assured people were receiving safe care and support.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, information about people’s medicines was not reflective of their current health needs, or what was currently prescribed, supplied or administered. People did not receive safe support as the provider and registered manager's oversight of people's medicines was inadequate.

The registered manager and provider had inadequate oversight of people's medicines. The registered manager was not able to tell us whether a person still needed support from staff for the application of pain patches. The persons care plan detailed they needed support with the application of pain patches. However, the registered manager was unable to tell us this was up to date information. The registered manager could not evidence whether they did or did not need support with this medication until they spoke with the person. The registered manager then confirmed that the information in the care plan was incorrect and they had not needed support with this medicines for over 2 years.

Safe medication processes were not in place. One persons care plan detailed they needed staff to support with apply creams. However, body maps and recording charts were not in place for people who needed support with the application of creams. The registered manager was unable to provide evidence that staff were recording the management of creams. People’s care plans also did not detail what creams people needed, when they were to be applied and any risks associated with those creams.