Background to this inspection
Updated
26 February 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 7 January 2019 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We needed to be sure that someone would be in.
The inspection was carried out by one inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise is in services for older people.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help us with the planning of the inspection.
We spoke with nine people who used the service and one relative. We also spoke with the registered manager and the training manager during the inspection.
We looked at 15 care records, medicine administration records for four people, a medicines audit, 15 staff files and other documents relating to the management of the service.
After the inspection, we spoke with two care workers. We spoke to five health and social care professionals from the local authority to obtain their views on the service.
Updated
26 February 2019
This inspection took place on 7 January 2019 and was announced. Harmony Home Aid Services Limited - Unit A2 Broomsleigh Business Park is a domiciliary care agency. The service is registered to provide personal care for people living in their own homes. It provides a service to older adults and younger disabled adults. At the time of the inspection, 103 people were using the service.
The previous inspection of the service was on 3 and 11 October 2017 and we found the service was not meeting all the regulations. Two breaches of regulation were found. One breach related to safe care and treatment because risk assessments did not always identify and manage potential risks for people, systems for the management of medicines were not effective, missed and late visits were not always recorded and there was not always a risk assessment recorded on staff records where this was appropriate. The second breach related to good governance because care records and risk assessments were not regularly checked to ensure they reflected people’s current needs.
We issued requirement notices for each of these breaches. The overall rating for this service was ‘Requires improvement’. We asked and received from the registered manager an action plan that detailed how they would make those improvements to the service.
At this inspection, we followed up on the previous breaches of regulation. We found that the registered manager had taken action to meet all of the regulations we inspected. The overall rating for this service is ‘good’.
The service had 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.
Staff completed assessments with people which identified risks associated with their health and well-being. The management plans guided staff to manage and mitigate potential risks.
People’s medicines were managed in a safe way. Each person had a medicines administration record (MAR). Staff completed these accurately. When a medicine was not administered staff used an appropriate code on the MAR to explain why. Staff completed an audit on MARs and reviewed supplies of medicines to ensure there was enough stock for people’s needs.
Staff understood how to protect people from harm and abuse. Staff followed the safeguarding processes in place to report allegations of abuse. Staff captured and investigated missed and late visits and took action to inform the local authority of these incidents for their investigation.
The provider had safer recruitment processes in place. Newly recruited staff completed pre-employment checks before their employment was confirmed and they were assessed as suitable to work with people using the service. People had enough staff to support them. The staff rota showed people received the assessed care and support required to meet their individual needs. The registered manager supported staff through an induction, training, supervision and an annual appraisal.
People were supported to have 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.
People were provided with enough information for them to give staff their consent to receive care and support.
People said staff were kind and caring. People commented that staff respected them, their home and their privacy.
Staff supported people with their meal preparation and they had enough food and drink to meet their needs and preferences.
Staff completed assessments with people to identify their needs. Each person had a care plan that detailed the care and support people required to meet their needs.
People accessed health care services when their needs changed. Care workers contacted office-based staff to inform them when a person needed emergency health care.
The registered manager had a system in place for people to make complaints about the service. Each complaint was reviewed and responded to in a timely way.
Nobody receiving a service needed end of life care. Staff had training in end of life care and were aware of which health professionals would provide appropriate care, treatment and support for a person if this was required.
People had the opportunity to give their feedback on the care and support received and the service. Staff regularly contacted people to ensure care workers were providing safe and appropriate care.
The registered manager improved the established systems to effectively monitor, review and improve the quality of the service.
Staff were supported by the registered manager and were provided with opportunities to share their ideas with colleagues.
Joint working relationships were established with health and social care services.