About the service:

Heathbank Support Services is a small charitable organisation based in Oldham. The service provides personal care and support to enable people to live as independently as possible within their own home. The service provided personal care to seven people at the time of our inspection.

People’s experience of using this service:

People and relatives were very positive about the service and gave numerous examples of kind and caring practices.

The staff we spoke with had a good understanding of the people they supported and knew how to provide appropriate support.

People were fully assessed, and care records contained information about people’s needs, abilities and preferences.

There were risk assessments in place which were detailed and specific to the individual.

There were suitable systems in place to recruit staff safely.

Staff received the training they needed to support individuals with their specific health and social care needs.

The service worked closely with other health care professionals and supported individuals to access appropriate health care services when needed.

People, relatives and staff felt able to raise concerns with the registered manager and felt these were addressed quickly and effectively.

People, families and healthcare professionals were invited to regular review meetings to ensure care plans remained appropriate and relevant.

The service had developed a number of systems to improve oversight and governance within the service. Paperwork was regularly reviewed by the registered manager to ensure it was up to date.

The service had various strategies for improving practice and sharing learning, including networking with other services and an active committee board to whom the registered manager reported.

Rating at last inspection:

At the last inspection the service was rated as Good (13 September 2016).

Why we inspected:

This was a planned inspection to check that this service remained Good.

Follow up:

We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for services rated Good.

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

This inspection took place on 21 and 22 June 2016 and was announced. The inspection was announced 48 hours prior to our visit to ensure that the registered manager or other responsible person would be available to assist with the inspection.

We last inspected Heathbank Support Services in October 2015, when we undertook a comprehensive inspection. During this inspection we found the provider was in breach of five regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These breaches were in relation to: The safe management of medicines. Care planning was not always coordinated to ensure the health, safety and welfare of people. Care provided did not always meet the individual needs of people and reflect their preferences. Consent was not always sort in line with legislation particularly in relation to covert medication. Governance systems and processes were not effective to ensure the delivery of safe, quality care. There was insufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of people being supported. The provider had to send us a report detailing what action they were going to take. The service was rated inadequate overall, which meant that it was placed into “Special measures.” During this inspection we found significant improvements had been made.

Heathbank Support Services provides care to people in their home. Since our last inspection the registered manager of the service had changed and a new registered manager was in post.

Heathbank Support Services is required to have a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like the registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the health and Social Care Act 2008 (Regulated Activity) Regulations 2014 about how the service is run.

Heathbank Support Services is a small charitable organisation based within the Oldham, Greater Manchester area. The service provide personal care and support to enable people to live as independently as possible within their own home and supported living accommodation. At the time of our visit, Heathbank was providing a Domiciliary Care Service to 8 people living independently within the community and support to 5 people Living in Supported Living Accomodation. All 13 people had a range of health and social care needs.

We found the contents of care records we reviewed were detailed and contemporaneous. The care records contained information to demonstrate that potential risks to people’s health and wellbeing had been fully assessed, monitored and managed.

Appropriate arrangements were in place to ensure the proper and safe management of medicines. All care workers had been trained to administer medicines to people.

Care workers were recruited safely and appropriate training was provided to enable them to carry out their role effectively and care for people safely.

Care workers were able to demonstrate their understanding of the whistle-blowing procedures and they knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

Relatives of people using the service spoke warmly about the care workers. We saw that the relationship between people and their support worker’s on the day of the inspection was good. We saw people were happy with the care and support they received and spoke positively of the kindness and caring attitude of the care workers.

We found that people using the service and their relatives were involved in making decisions about their care. Care was being planned and delivered to ensure it met the individual needs and preferences of people who used the service.

All systems and processes had been updated to reflect current care practices. Records were being effectively stored, monitored or maintained.

The new mana

We visited two people in their own home. Both had complex health care needs such as a learning disability. This meant they were unable to tell us about their experiences of receiving a service. However, we heard about the things people did with their time such as going shopping, attending physical activities and going out for lunch.

We saw that people were settled and comfortable. People recognised staff and we saw that relationships were established and positive. There was a good rapport with people and staff spoke with people in a respectful manner.

We spoke with two representatives of people who the agency supported. They spoke positively about the staff supplied by Heathbank Support Services. One person said that staff adapted their approach to the different needs of people who required support. Another representative said when there were issues the manager of the agency responded to these.

The three support staff we spoke with demonstrated a good understanding of providing individual support to people. Staff told us how they promoted people’s rights to privacy and dignity by using appropriate communication methods and respecting people’s wishes. They confirmed they had received training for infection control and used protective clothing such as gloves and aprons to minimise the risk of cross infection.

We saw that staffing numbers were monitored and people were asked for their feedback about the service they received.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us about their experiences. However we saw that people were relaxed and settled and had positive friendly relationships with staff.

We spoke with three relatives who were representatives for people who received care and support from the agency. We heard comments such as “Absolutely wonderful”; “I have no concerns about the quality of care” and “They [the staff] are brilliant with [my relative]". The relatives we spoke with confirmed that there was good communication with the agency. We heard that people were confident that any concerns they raised would be dealt with promptly.

Health and social care professionals said “They [the agency] provide an excellent service” and “We have no concerns about the care provided. They [the staff] communicate very well”.

We saw that people’s health and wellbeing was assessed at least monthly and people’s representatives and other professionals were consulted as required. Records provided evidence that people’s preferences were taken into account during the planning of their care.

We saw that records were up to date. Robust recruitment procedures were in place and staff did not start work until all the appropriate checks were completed. Records showed that staff received appropriate training and regular individual support.

Due to the complex needs of some of the people who received services we were not able to get comments directly. We were however able to talk to representatives and parents of people.

One relative told us that they were pleased with how well staff had supported their relative in sometimes difficult circumstances,

People told us that they were happy with the care and support that people using the service were receiving.

One professional said the service was exemplary. A relative said that the person being supported had settled well and were doing the things they could for themselves.

A staff member said that they have a communication dictionary for people receiving care and the individuals’ way of communicating informs staff if they are happy with things or not so happy.

Relatives told us staff were quick to call the doctor or other healthcare professionals if people using the service were unwell. One person said their relative had received very good care from the physiotherapist, community nurse and staff who had all worked together well.

A number of professionals spoken to as part of this review said that staff take on board their comments, instructions, advice and views and act on them.

One person told us that staff at Heathbank asked for advice as opposed to doing things that they think may be right, which they felt was the correct way to do things as “getting the right advice safeguards people and makes sure they get the help and support they need”.

Relatives told us that staff were kind and treated people who use the service well. One professional said that they had always seen staff being respectful to people using the service and they always went that extra mile.

The people we spoke to told us that their relative’s received support to take their medication. They were happy and understood the necessity for support staff to take responsibility for the management of their medication and felt confident that they were being given it correctly.

We were told by people that their experience with Heathbank Support Services was that they wanted to make sure that they had the right staff with the correct training and personality to meet the needs of the people using the service and that this was very important to them.

Relatives told us they trusted the staff and they felt confident knowing that their relative received support from them. One person told us the support their relative received was flexible and changed to meet the persons needs when it was necessary.

Professionals told us they had observed staff working with people and saw that they had good communication skills and had gained the trust of the people they were supporting.

People spoken with confirmed they knew who to speak to if they had any concerns about the care and support provided by Heathbank and felt that they would be listened to.

This inspection was carried out over three days on the 19, 20 October and 10 November 2015. Our visit on the 19 was unannounced.

We last inspected the service on 10 July 2013. At that inspection we found the service was meeting all the regulations we reviewed.

Heathbank Support Services is a small charitable organisation based within the Oldham, Greater Manchester area providing personal care and support to enable people to live as independently as possible within their own home and supported living accommodation.

At the time of our visit, Heathbank was providing a Domiciliary Care Service to eight people living independently within the community and supporting five people living in supported living accommodation. All 13 people had a variety of health and social care needs.

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.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found the contents of care records were not accurate or complete and did not contain information to demonstrate that potential risks to people’s health and wellbeing were being fully assessed, monitored, managed or reviewed. This meant that people using the service may receive care and support that does not meet or support their individual care needs and does not identify and minimise potential risks to their health and wellbeing, placing them at further risk.

We found seven people who were being supported by Heathbank Support Services, in the community did not have any care records in place. This meant that people were at risk of receiving care and support that did identify nor meet their individual needs and staff lacked important information to help them support people appropriately and safely.

Support workers demonstrated they were knowledgeable about the people they supported.

The systems in place to manage and administer medicines did not give us confidence that medicines were always being managed and administered safely.

We found that “Covert Medication” was being administered to a person without a capacity assessment or best interest meeting being held, to ensure that such a procedure was in the best interest of the person. Lack of a capacity assessment and best interest meeting being held could mean this person was being deprived of their liberty unlawfully.

A robust system was in place to ensure staff was recruited safely.

We found no evidence to show the service matched support workers skills to people’s needs, so that person centred care could be delivered.

Staff were able to demonstrate their understanding of safeguarding and whistle-blowing procedures and knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

Relatives of people using the service spoke warmly about the support workers. We saw that the relationship between the person and the support worker’s on the day of the inspection was good.

We saw people were happy with the care and support they received and spoke positively of the kindness and caring attitude of the staff.

We found the involvement of people and their relatives in making decisions about their care variable. Where people had made suggestions about how they wanted their care to be delivered, these requests were not always put into practice.

We found inadequate systems and processes in place to ensure the delivery of high quality care. Issues identified within care records had not been identified and addressed through a robust system of audit. All of the care records we looked at contained incomplete records which had not been signed or dated by the support workers or the registered manager.

Records were not being effectively stored, monitored or maintained. This meant that such records did not always contain detailed and complete information to ensure staff could effectively care for people and therefore could place people’s health and wellbeing at risk if not being met and monitored appropriately.

Management tried to encourage a positive culture amongst support workers. However, most support workers we spoke with and relatives told us they felt many of their concerns with the service were the result of ineffective management.

We found a lack of person centred information within all care records we reviewed to demonstrate that people’s wishes were considered and planned for.

There was a lack of up to date and current policies and procedures being in place, that are critical to ensure that health and safety, legislation and regulatory requirements are adhered to and prevent people from the risk of receiving unsafe and inappropriate care.

Support workers were not provided with appropriate training to carry out their role and ensure the delivery of safe care and support to people using the service.

Staff had not received regular support necessary for them to carry out their role and responsibilities effectively.

Staff were able to demonstrate a good understanding of The Mental Capacity Act 2005.

The overall rating for this provider is ‘Inadequate’. This means it has been placed into “Special measures” by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.