The inspection took place between 26 February and 19 March 2018. The visit to the office on 19 March was announced.

Hales Group Limited – Thetford is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It can provide a service to people who may be living with dementia, younger disabled adults and children. The information supplied to us by the agency, showed that none of the people using the service were under 18 years of age.

At the time of the inspection, 140 people were using the service. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Everyone using the service were being provided with 'personal care'.

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.

At this inspection we found improvements had been maintained and we rated our key questions is the service caring and responsive as being, ‘Good’. However, we rated the key questions is the service safe, effective and well led, as ‘Requires Improvement’. We identified two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the service was in breach of one regulation of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.’

Following the last inspection in November 2016, we asked the provider to complete an action plan to show what they would do to improve the service from Requires Improvement in all areas and to meet four separate regulations. These related to staffing, safe care and treatment, person centred care and good governance.

Risks associated with people's needs had not always been fully assessed to enable staff to have the required information to manage known risks.

Staff had received an induction and took part in a programme of training; however they had not received regular supervision.

The registered person had not notified the CQC of two incidents where a service user suffered abuse or an allegation of abuse had occurred.

Staff followed the provider's safeguarding procedures to identify and report concerns to people's well-being and safety. However, further work was needed to ensure systems; processes and practices always safeguarded people from abuse.

People were supported by a sufficient number of staff who underwent appropriate recruitment checks. However people and relatives had mixed views about the punctuality and the consistency of staff. Systems were in place to monitor this and the provider acted on people's concerns.

The provider had improved their quality monitoring processes to promote the safety and quality of the service. Further development of quality assurance systems and audits were required and planned in order to continue to improve the service.

People received the support they required to take their medicines. Staff were aware of their role and responsibilities to protect people from the risks associated with cross contamination and infection. Accidents and incidents were recorded and responded to by staff and these were reviewed to consider lessons to learn to reduce further risks.

People were involved in the planning and review of their care. Staff delivered people's care in line with their changing needs, preferences and best practice guidance.

People were encouraged to maintain a healthy diet and to have sufficient food to eat and drink. Staff supported people to access healthcare services when required.

People were supported to have maximum choice and control of their

This was an announced inspection that took place on 15, 16, 17 and 25 November 2016. On 15 November 2016 we visited the provider’s office. On 16, 17 and 25 November 2016 we contacted people who used the service, their relatives and staff who worked for Hales.

Hales provides domiciliary care services to people in their own homes. At the time of the inspection, the service provided care and support to 186 people.

We last inspected Hales Group Thetford in October 2015 where we rated the service as ‘good’ overall however we rated it as ‘requires improvement’ in well-led due to there being failure in the provider’s systems to make sure that there were always enough staff to meet people’s needs.

We re-inspected the service in November 2016 as we received a number of concerns about people not receiving their care as planned and a high number of late and missed care calls. This meant that people were not receiving the care they required.

There was no registered manager in post in day-to-day charge of the service as required by the provider's registration conditions. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The service did not employ enough staff to meet people's needs. This meant some people had not always received their planned visits or visits were late. This resulted in risks to people's dignity, welfare and safety. Some people who needed two care staff at each visit had only one staff member arrive. This meant care could not be carried out as required, or safely; or relatives were supporting the care staff to deliver care. This placed people and staff at risk of injury or harm.

There were robust recruitment processes in operation, which contributed to protecting people from the employment of staff who were unsuitable to work in care.

Medicine administration records were not always completed accurately and medicines were not always administered as the prescriber intended.

Risks to people were assessed and there was guidance for staff about how they should minimise these risks while they were delivering care.

People and their relatives were not always positive about the skills, experience and abilities of staff who worked in their homes. Care was not provided in a way that always promoted people's dignity and respected their privacy. Not all people received personalised care and support that met their changing needs and took account of their preferences.

Staff had received suitable levels of initial training but their competence had not always been checked in the delivery of care and support. Supervision and observation of practice had not been completed routinely. Staff did not always receive appropriate support.

The company had a suitable complaints procedure. The procedure had not always been followed but the regional manager was ensuring that any outstanding responses were dealt with.

The staff understood their legal obligations when making decisions on behalf of people who could not make them for themselves. They were also knowledgeable in recognising signs of abuse and were aware of the procedures to follow to safeguard people from harm.

People were complimentary about their regular care workers but felt the care provided by new workers did not always meet their needs.

Management arrangements at the service were inconsistent. There had been a number of management changes meaning a lack of consistent leadership and support. This had affected staff morale and the quality of the care being provided to people who used the service.

We found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to ta

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us that they were provided with a reliable service that met their needs. They said that the staff assisted them to keep their homes clean and hygienic. They confirmed that the staff used disposable gloves and aprons when visiting them. There were enough domiciliary care staff provided to cover all of the visits and meet the needs of the people using the service.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living in their own home in the community.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). No applications had been submitted but policies and procedures were held. Staff had been trained and relevant staff knew how to ensure that a DoLS application was submitted.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. We noted that the staff understood the care and support needs of the people they visited. One person told us, “I get all the help I need from staff who know what they are doing.” Staff had received training to meet the needs of people using the domiciliary care agency.

Is the service caring?

People told us they were supported by staff who used a kind and attentive approach. Staff said that they used a relaxed approach and encouraged people to be as independent as possible. People told us that the staff were sometimes given additional visits to make but did not rush them and stayed the whole time expected. A relative said, “I am happy with the care my family member receives. The members of staff are reliable, polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed before people begun to use the service and when their needs had changed. A record was not held of people’s preferences and diverse needs. However, plans of care were being reviewed and updated to ensure they were complete. People told us that staff members consulted them and encouraged them to make their own decisions. Some of the people using the service were supported to take part in community activities and events.

Is the service well led?

Staff spoken with had a good understanding of the ethos of the domiciliary care service. Quality assurance processes were in place. People using the service and their relatives told us that they were asked for their feedback about the service provided. They told us that they had filled in a satisfaction questionnaire survey. Staff said that they had felt listened to when they had raised their concerns. People told us that their views and wishes had been taken into account. They confirmed that they were sent a weekly list of the names and times a staff member would visit them the next week.

We found that the plans of care held in the office and people’s homes contained up to date information. We saw that they contained the information staff members needed to ensure that the health and safety of people was promoted.

People using the service told us that they had received the care and support they needed and that staff were excellent.

We saw that the people’s individual medication was available and monitored and found that the provider was taking action to ensure it was administered safely and recorded accurately.

People using the service told us that staff members were kind and respectful towards them.

We found that staff had completed training and that the provider was taking action to ensure all staff had completed updated training. Staff work practise was monitored though regular spot checks, supervision and staff meetings.

People using the service and their relatives told us that their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people using the service.

At the last inspection visit the provider was found to be non-complaint in how they supported workers. We carried out a follow-up inspection visit to check that improvements had been made.

People spoken with told us that improvements had been made. We found that staff members were trained and were supported to provide an appropriate standard of care through increased spot checks, supervision and staff team meetings.

This was an announced inspection that took place on 21 and 28 October 2015. On 21 October we visited the central office of the service and on 28 October we made phone calls to people who used the service to obtain their feedback on the care that was being provided.

Hales Group - Thetford is a service that provides personal care to people in their own homes. At the time of this inspection there were 97 people using the service.

There was a manager working at the service and she is in the process of registering with us. 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 and associated Regulations about how the service is run.

People received care from staff who were kind and caring and who treated people with dignity and respect. The staff were well trained and the provider had systems in place to protect people from the risk of abuse. There were enough staff to meet people’s needs.

People received their medicines when they needed them and staff asked them for their consent before providing them with care. The staff acted within the law when providing care to people who were unable to consent to it themselves.

The staff were happy working for the provider and felt supported in their role. The provider had promoted an open culture where both staff and people using the service could raise concerns without fear of recriminations. People knew how to complain and any complaints were investigated and responded to.

The provider learnt from incidents that had occurred or complaints that had been received, to improve the quality of the service that people received.

The systems in place to monitor the number of staff required to meet people’s needs had not been effective in the past. This had meant that some people had not received the care they required. Improvements in relation to this had been identified by the provider and were being implemented.