The inspection took place on 21 February, 5 March and 19 March 2018 and was announced. We gave the provider 48 hours’ notice of our inspection. This was because the location provides a domiciliary care service and we needed to be sure the registered manager and staff would be available to support the inspection process.

Hales Group Limited - Grimsby is a domiciliary care agency located close to the town centre of Grimsby in North East Lincolnshire. It provides personal care to people living in their own homes in Lincolnshire and North East Lincolnshire. It provides a service to older people, people with learning disabilities, physical disabilities and people living with dementia. At the time of our inspection, the service was supporting 279 people. Not everyone using Hales Group Limited - Grimsby received a regulated activity; the Care Quality Commission only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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 Act 2008 and associated regulations about how the service is run.

At our last inspection on 10 and 12 February 2016, the service was rated Good overall. During this inspection, we identified shortfalls throughout the service in relation to medicines management, quality monitoring of the service, records and staff support, supervision and training. These included breaches of Regulation 12 Safe Care and Treatment, Regulation 17 Good Governance and Regulation 18 Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we asked the provider to take at the back of the full version of the report.

The provider did not have effective systems to ensure risks to people were fully assessed, monitored and reviewed. Accidents and incidents were recorded, but lacked detail of any actions taken to reduce risk and prevent reoccurrences.

People did not always receive person centred care in line with their preferences as not all care plans were regularly reviewed. They did not accurately reflect the care and support people required. People’s care plans did not always contain suitable guidance to ensure staff could meet their needs effectively and consistently.

Improvements were needed to ensure that staff received appropriate on going or periodic supervision in their role to make sure their competence was maintained. We saw that although a supervision plan was in place, 87 staff had only received 373 supervision sessions since our last inspection in February 2016. The provider had not always ensured competency checks were completed for all staff to evidence they had the necessary skills to safely meet people’s needs.

Staff had not always completed the necessary training to deliver the care and support the people who used the service required. People using the service expressed concerns that not all staff had the required skills to meet their needs for example; stoma care, catheter care and people receiving their nutrition through a tube directly into their stomach. People told us they had not had positive experiences with staff who were unfamiliar with their needs and on occasion had been left wet and uncomfortable, when their regular carers were not available to support their care delivery.

Improvements were needed to make sure all records maintained for people were accurate and completed to show care instructions had been followed so that people received the care and support they required in line with their individual needs. The manager did not always have access to care records completed by staff stored in people'

Hales Group Ltd Grimsby is a domiciliary care agency located close to the town centre of Grimsby in North East Lincolnshire. The service provides personal care and support to people living in their own homes in Lincolnshire and North East Lincolnshire. The service supports adults with a range of conditions including older people, learning disabilities, physical disabilities and people living with dementia. At the time of our inspection the service was supporting over 300 people.

This announced inspection took place on 10 and 12 February 2016. The service was registered in February 201 and this was the first inspection to take place since they registered with the Care Quality Commission (CQC). Prior to registration the service was operated by another registered provider in a different name.

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.

People who use the service were protected from the risk of harm and abuse because staff had received safeguarding training and knew what action to take if they suspected abuse was occurring. People had risk assessments in place regarding their health and wellbeing and home environment. This helped to keep all parties safe.

People’s health needs were assessed and kept under review, where necessary. Staff received training in a variety of subjects which enabled them to support people safely and meet their assessed needs. Staff were supported with supervisions and appraisals which helped develop their practice and identify learning needs.

Staff understood if people lacked capacity to make their own decisions then the principles of the Mental Capacity Act 2005 must be followed.

Staff had been recruited safely and employment checks had been completed to ensure they were suitable to work with vulnerable people. Staff had completed an induction when they were first

employed at the service and they were provided in sufficient numbers to support the needs of the people currently using the service. Staff had completed a range of training in key areas which helped them to meet people’s needs effectively.

Support plans detailed people’s likes, dislikes and preferences for their care and support. Staff contacted relevant health care professionals for advice to help maintain people’s wellbeing. People told us staff treated them with respect and were kind and caring. Staff demonstrated they understood how to promote peoples independence whilst protecting their privacy and dignity.

Staff felt supported and listened to by the registered manager and registered provider. Staff received supervision and attended regular team meetings to ensure they were included and updated about changes happening within the service.

The service had a complaints procedure in place and people felt they could raise concerns and they would be addressed efficiently. The service completed regular audits to ensure practice was reviewed and remained safe and effective.