Hibiscus Domiciliary Care Agency

Hibiscus Domiciliary Care Agency is a domiciliary care agency providing personal care to people in their own homes. The service provides support to older people, people with dementia or mental health needs and those who may have physical or sensory disabilities. At the time of our inspection there were 11 people receiving support with personal care.

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.

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

Systems used to monitor the quality of care people received were not always effective at identifying areas of concern. Audits had failed to identify some concerns with the administration of medicines, inconsistent information about people’s mental capacity, unsafe moving and handling practices, and out of date information in people’s care plans.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People's needs were met by sufficient numbers of staff. Recruitment checks were now in place. Staff followed infection control guidance to reduce the risk of cross infection. Where incidents occurred reviews now took place to reduce the likelihood of reoccurrence.

Staff now received relevant training and felt supported in their role. People’s needs had been assessed and staff understood their risks, as well as preferences. Risks associated with eating and drinking had been assessed and staff worked with other professionals to ensure people’s health needs were met.

The management team had undertaken training to develop knowledge appropriate for their roles. People and staff had been asked for their views on the service provided. People, staff and professionals spoke positively about the service.

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 inadequate (published 3 January 2023). We imposed conditions on the provider’s registration and 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 although some improvements had been made the provider remained in breach of regulations.

At our last inspection we recommended the provider should ensure the wording in care records was personalised and dignified. At this inspection we found the provider had acted on the recommendation and had made improvements to people's care plans and records.

Why we inspected

We carried out an announced comprehensive inspection of this service on 7 and 30 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve managing risks to people, the safe management of medicines, infection control, lack of governance systems, lack of training for staff, poor recruitment practices and failure to display their previous inspection rating. There was also a breach about supporting people to make decisions and following the Mental Capacity Act 2005.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to consent and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 overall rating for this service is ‘requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hibiscus Domiciliary Care Agency is a home care service providing personal care to people living in their own homes in the community and in a single building where people had their own flats, but shared communal facilities. The service provides support to older people, people with dementia or mental health issues and those who may have physical or sensory disabilities. They were also supporting people who had a learning disability and autistic spectrum disorder. At the time of our inspection there were 18 people receiving support with personal care.

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.

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

There was a lack of quality assurance systems in place. There were no audits being undertaken so risks to people and concerns had not been identified. There was a lack of robust recording so poor audit trails. The provider had failed to recognise their own action plan was inaccurate. The provider failed to be compliant with multiple regulations. People and their relatives were not asked for their opinion, so the provider could not continuously learn and improve the service. The nominated individual was not fully aware of the duty of candour.

People were not protected from the risk of harm as risks were not assessed and planned for. Staff were also unaware of some risks to people. Medicines were not managed safely. The provider had failed to fully consider the infection control measures in place with staff. Lessons were not always learned when things had gone wrong; there was no process for reviewing and acting on learning following accidents and incidents. Staff were not recruited safely. Staff understood their safeguarding responsibilities and people told us they felt safe.

The provider had failed to ensure staff had enough training to be effective in their role. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s health needs had not always been fully assessed and guidance was not always in place for staff to follow.

We could not be sure people were always supported to be involved and make their own decisions about care as they were not asked for their opinion. Care was not always personalised, and care plans lacked detail. People had not been given the opportunity to discuss their end of life wishes.

There were enough staff to support people in a timely manner. People were supported to have food appropriate to their cultural needs. People felt well-treated and staff treated people with dignity and respect. People generally had a stable staff team so they could get to know one another. People had access to information in a way that suited them. People were supported to engage in activities, if they wished to. Professionals were complimentary of the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The provider had failed to ensure the management team were aware of and following best practice guidance. No staff had received training in relation to learning disabilities, which is now a requirement for all services.

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 16 July 2019) and there were 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 not been made, the quality and safety of care had deteriorated, and the provider had breached more regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the death of a person who used the service. A decision was made for us to inspect and examine those risks.

This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks.

We found concerns about the management of risk to people at 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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches at this inspection in relation to managing risks to people, the safe management of medicines, infection control, lack of governance systems, lack of training for staff, poor recruitment practices and failure to display their previous inspection rating. There was also a breach about supporting people to make decisions and following the Mental Capacity Act 2005.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have also made a recommendation in relation to ensuring the wording in care records is personalised and dignified.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hibiscus Domiciliary Care Agency provides personal care and support to people who have learning disabilities, physical and mental health needs. People receiving support lived either in the community or at Hibiscus House. At the time of our inspection 13 people received support with personal care.

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

People were not always supported by staff who had been recruited safely and new staff did not have access to training to meet people’s needs. This meant people may not have been supported by staff in the most safe and effective way. We have asked the provider to take action to ensure that people are supported by safely recruited and trained staff.

Quality assurance tools were not being used to effectively identify areas of improvement required within the service. This meant we could not be assured lessons were learned when things went wrong. We have asked the provider to take action to ensure the quality of the service is monitored and improvements are made where required.

People were not always supported to receive their medicines safely and medicines records were not accurately completed. This meant we could not be assured people were receiving their medicines as prescribed. We have made a recommendation about staff training and recording of medicines.

Overall people were supported in the least restrictive way possible and in their best interests and the systems in place to support this practice.

People were supported by staff who knew them well. Feedback about staff was positive and people told us staff were caring. People were supported to maximise their independence and maintain relationships within their community.

Staff knew how to raise concerns if they suspected people were at risk of harm or abuse. Staff reported concerns about changes in people’s care needs to the registered manager.

People’s needs were assessed prior to them receiving care. The provider involved people, their families and professionals in reviews of care where people’s needs changed. The provider supported people to plan for their end of life care.

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

Rating at last inspection

The last rating for this service was Good. (published 1 December 2016).

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 full report.

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

Following the inspection the provider sent us evidence of improvements they had made. We have included this within the ‘Effective’ section of this report.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to the management and oversight and training and staffing at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hibiscus Domiciliary Care Agency provides personal care and support to people who have ill health, learning disabilities, and physical and mental health disorders. People receiving support lived either in the community or at Hibiscus House. At the time of our inspection nine people received support with personal care.

There was a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 said they were well supported by the staff and the registered manager. They told us staff were caring and treated them with dignity and respect. People were supported to eat and drink well, when identified as part of their care planning. Relatives told us they were involved as part of the team to support their family member. People and their relatives told us staff would access health professionals as soon as they were needed and support people to attend appointments. People were supported to receive their medicines by staff that were trained and knew about the risks associated with them.

Staff we spoke with recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns. People told us staff had the skills needed to care for them. The registered manager was in the process of arranging further training to develop staff knowledge. Staff were encouraged to complete vocational awards to recognise their skills and abilities. They always ensured people gave their consent to the support they received. Staff knew people well, and took people’s preferences into account and respected them.

People and their relatives knew how to raise complaints and the registered manager had arrangements in place to ensure people were listened to and appropriate action taken. Staff had regular access to the registered manager to share their views and concerns about the quality of the service. People and staff said the registered manager was accessible and supportive to them.

The registered manager told us the culture of the service was to recognise that people were individuals and to treat them as individuals, encouraging them to be as independent as possible. The registered manager had systems in place to monitor the quality and safety of the care provided. They had identified improvements were taking action in a timely way.

We found that before people received any care or treatment they were asked for their consent by staff who acted in accordance with their wishes. People told us: 'They listen to exactly what I say' and: 'I tell them what I need doing'.

People who used the service told us that the staff were friendly and provided good care. One person told us: 'I'm very happy with the care'. Staff we spoke with told us that they had received training and support and felt there were enough staff to support the needs of the people they provided personal care for.

People were protected from the risk of infection because appropriate guidance had been available and gloves and aprons had been available for staff to use.

The provider was able to demonstrate that they listened to people who used the service. The provider needs to ensure that they have reviewed the risks to people, staff and others.

The provider could not demonstrate that care plans documents could protect people who used the service against the risk of unsafe or inappropriate care.

People were involved in planning their care and told us their needs were met as they preferred. A provider survey showed that people were satisfied but respect could improve by staff using people's preferred names. People told us staff were polite and they felt comfortable and safe with them. One person said, "They help with the things I cannot do and encourage me to do things I should do".

Cultural needs were met and independence promoted. Staff had guidance to reduce known risks but a system was needed to analyse incidents. Daily record keeping was inconsistent about the support delivered. Staff completed inductions and training, some of which needed updating. Support was provided to people with mental health conditions, but staff were not all trained about this. The manager met with staff to make improvements after the inspection, and was taking steps with the provider to arrange ongoing staff training.

We found systems in place to help in keeping people safe from abuse and to respond to complaints that may arise. Staff saw the manager daily and felt well supported. The manager intended to put more formal systems of supervision and appraisal in place . The statement of purpose, a legally required document, was inaccurate.