About the service: Hales Group Limited - Letchworth is a domiciliary care service that provides care and support to people in their own homes. 84 people received support at the time of this inspection.

People’s experience of using this service:

People were safe and protected from avoidable harm because staff knew how to identify and report any concerns relating to the risk of abuse. They were familiar with how to report concerns to agencies outside of the organisation. Risks to people`s health, safety and well-being were assessed and measures put in place to remove or reduce the risks. People were supported by staff who had been safely recruited through a robust process.

People’s medicines were managed safely. Staff had received appropriate training and had their competency assessed to help ensure they were sufficiently skilled and knowledgeable in this area. Staff had received training in infection control practices and personal protective equipment such as gloves and aprons was provided for them. The management team took appropriate actions following any incidents and learning was shared with the staff team.

Before care delivery started assessments were undertaken to make sure people`s needs could be met by Hales Group - Letchworth. Care plans were developed from these assessments for each person’s identified needs and staff had clear guidance on how to meet those needs. Staff received training and support to enable them to carry out their roles effectively.

People told us staff prepared simple meals for them as needed and encouraged them to take fluids to maintain their health and wellbeing. Staff and the registered manager knew people well and were able to promptly identify when people`s needs changed and they sought professional advice appropriately. Staff were proactive in identifying if people were unwell and contacted appropriate healthcare professionals as needed. Mental capacity assessments were carried out where needed to establish if people had the capacity to make decisions affecting their health and wellbeing.

People and their relatives praised the kind and caring nature of staff. People received consistent care from a small team of staff. People knew about their care plans and could decide what care and support they needed. People’s records were held securely in a locked cabinet within a locked office to help promote confidentiality.

People received care and support as they wished. People told us they would be confident to raise any concerns with the management team. Everyone we spoke with during this inspection was satisfied with the care and support they received.

The registered manager understood their responsibilities under the Duty of Candour and was committed to providing a high standard of care for people as well as support for the staff team. People, their relatives and staff members spoke highly of the registered manager and told us that they were always available and supportive. People told us that they were often asked for their views about the quality of the service.

Rating at last inspection: The service achieved a Good rating at the last inspection. Report published 02 August 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We carried out an announced inspection on 22 June 2016 where we attended the offices for Hales Group Stevenage. We also made telephone calls to staff and people who used the service on 28 and 30 June 2016. We also received post inspection incident information on 27 July 2016, 1 and 2 August which was also investigated.

Hales group limited in Stevenage provides care and support to people in their own homes. At the time of the inspection, there were 93 older people receiving care and support in the Stevenage area and 23 older people receiving care and support in the Watford area.

There was 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew their likes and dislikes and daily routines. Relatives we spoke with described the staff as good and caring.

People had been assessed prior to support being provided, and care plans took account of their individual needs, preferences, and choices. Staff supported people to access health and social care services when required.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

We received information of concern regarding the training and support provided to members of staff, the levels of care a person had received and about how the service was operated and managed.

The Inspector gathered evidence in response to the concerns raised and to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 27 June 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

We looked at care records that related to four people who used the service. We saw that proper steps had been taken to ensure that people were protected against the risks of inappropriate or unsafe care and support. This was because people’s needs had been assessed and care had been planned and delivered in a way that met those needs and ensured their welfare and safety.

Is the service effective?

We saw that risk assessments had been completed and regularly reviewed in relation to a range of issues relevant to people’s care needs and personal circumstances. These included moving and handling requirements, skin and pressure area care and the management of people’s medicines.

Suitable arrangements were in place to ensure that staff were appropriately trained and supported to perform their roles. For example, we saw that a comprehensive induction programme, based on nationally recognised standards, was used to train and develop all members of staff. This meant that people who used the service were safe and had their health and welfare needs met by competent staff.

Is the service caring?

We spoke with people who used the service and some of their relatives who were all very positive about the levels of care and support provided. They told us that staff were normally punctual and stayed for the agreed length of time. One person said, “They [staff] are always on time and are very good people. I have no complaints at all, the staff I have are always kind and caring. They have got to know me well and how I like things done.”

Is the service responsive?

Care records showed that people’s needs, preferences and support plans had been documented, reviewed and updated to reflect people’s changing needs and personal circumstances. They were personalised and gave staff good guidance about the care and support people needed. This included detail about people’s daily routines, medicines, personal care, nutrition, mental health and continence needs.

Is the service well led?

We saw that risk assessments had been completed and reviewed in relation to a range of issues relevant to people’s care needs and personal circumstances. These included skin and pressure area care, mobility and the environment. This meant that people who used the service had experienced effective, safe and appropriate care and support that met their needs.

The provider had systems in place to assess and monitor the quality of services provided and to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home.

A relative of a person who used the service told us, “When I did contact the office about a concern about a particular carer [member of staff] they were excellent and very responsive to our concerns, genuinely very kind and caring. They made sure that carer was not used for [relative] again.”

This meant that the service was well led and people benefited from safe quality care and support due to effective quality assurance, decision making and management of risks.