About the service:

Homecare Helpline is registered as a domiciliary care agency providing the regulated activity ‘personal care’ to people who live in their own homes in Grantham, Sleaford and surrounding villages. At the time of the inspection visit there were 47 people using the service.

People’s experience of using this service:

People using this service benefitted from a good, safe, caring responsive and well-led service. People and their relatives consistently told us that the service was reliable and provided them with good quality care by staff who were experienced and competent. People and their relatives told us that communication with the management team was straightforward, one relative said, “Things have really improved, we’ve ironed things out and everything is running brilliantly”.

Peoples care and support was planned in a person-centred way and people chose how they liked their care to be delivered. People were supported by staff who were aware of people’s life history and preferences and staff used this information to develop positive relationships.

People were supported by courteous staff who treated them with dignity and respect. One relative told us, “The carers and the staff on the phone are very polite, I have no issues”. Evidence of feedback provided by people and their relatives in quality assurance surveys was consistently positive and had measurably improved during the last 12 months.

Rating at last inspection:

The service was rated as Inadequate in the previous inspection report published on 6 March 2018, this was because:

• The provider had not achieved compliance with our Warning Notice and, as a result, was in continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). This was because the provider had taken insufficient action to improve the organisation of staffing resources and the scheduling of people's care calls.

• There were shortfalls in organisational governance, a continuing failure to ensure people received safe and consistent support with their medicines and a continuing failure to ensure all staff had the training and supervision necessary to support people safely and effectively.

• Action was required improve the communication between office-based and front-line care staff.

At this inspection evidence confirmed that the provider had made significant improvements and was no longer in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA).

Homecare Helpline is registered to provide personal care to older people, people living with dementia and people with a physical disability. Most of the people who use the service live independently in their own home although the service also provides support to some people who live in three ‘extra care’ sheltered housing services in Grantham, Bourne and Sleaford.

We carried out a full inspection of the service on 6 April 2016. At this inspection we found three breaches of legal requirements. This was because there were significant shortfalls in the organisation of staffing resources, the monitoring of service quality and the notification of significant issues. We rated the service as Requires Improvement.

Following this inspection, the registered provider (‘the provider’) wrote to us to tell us what they would do to address these breaches. On 8 December 2016 we undertook a focused, follow-up inspection to check they had followed their plan and to ascertain that legal requirements were now being met. At this inspection we found the provider had not addressed two of the breaches identified at our previous inspection. We issued a Warning Notice for a continuing failure to organise staffing resources effectively and a Fixed Penalty Notice for a continuing failure to notify us of significant issues. The rating of the service remained as Requires Improvement.

We conducted this second full inspection of the service on 21 and 22 June 2017. The inspection was announced. At the time of our inspection, 273 people were receiving a personal care service and 96 staff were employed.

At this inspection we found the provider had not achieved compliance with our Warning Notice and, as a result, was in continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). This was because the provider had taken insufficient action to improve the organisation of staffing resources and the scheduling of people’s care calls.

We also found three further breaches of the HSCA. This was because of shortfalls in organisational governance, a continuing failure to ensure people received safe and consistent support with their medicines and a continuing failure to ensure all staff had the training and supervision necessary to support people safely and effectively.

We also found action was required improve the communication between office-based and front line care staff.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'.

In some areas the provider was meeting people’s needs effectively.

The provider had introduced a new system to ensure CQC was notified of any significant incidents relating to the service and, as a result, legal requirements in this area were now met.

Staff knew people as individuals and supported them to have as much choice and control over their lives. Staff were kind and considerate in their approach and went out of their way to help people. Action had been taken to improve the handling of people’s concerns and complaints.

Care plans were well-organised and provided staff with clear guidance on how to meet people’s needs and preferences. The provider assessed potential risks to people and staff and put preventive measures in place where these were required. Staff worked alongside local healthcare services when this was required. Staff knew how to recognise and report any concerns to keep people safe from harm.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’), they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the HSCA and associated Regulations about how the service is run. The registered manager was respected by her team.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on wha

Homecare Helpline is registered to provide personal care to older people, people living with dementia and people with a physical disability. Most of the people who use the service live independently in their own home although the service also provides support to some people who live in an ‘extra care’ sheltered housing service in Grantham. The service has operated for many years in the Spalding, Stamford and Bourne areas of Lincolnshire. In October 2015, following a reorganisation of domiciliary care services by Lincolnshire County Council, the service expanded significantly to take on a major new contract in the Grantham area.

We carried out an unannounced comprehensive inspection of the service on 6 April 2016. At this inspection we found three breaches of legal requirements. This was because staffing resources were not organised safely, service delivery was not monitored effectively and the registered provider (‘the provider’) had failed to notify us of significant incidents relating to the service.

After this inspection, the provider wrote to us to tell us what they would do to address these breaches. We undertook this focused, follow-up inspection on 8 December 2016 to check that they had followed their plan and to ascertain that legal requirements were now being met. At the time of this inspection approximately 300 people were receiving a personal care service.

This report only covers our findings in relation to these issues. You can read the report from our comprehensive inspection by entering ‘Homecare Helpline’ into the search engine on our website at www.cqc.org.uk.

At our focused inspection of 8 December 2016 we found that the provider had not addressed two of the three breaches of legal requirements we identified in April 2016.

There was an ongoing failure to ensure the safe and effective organisation of staffing resources and scheduling of care calls to meet people’s needs and preferences. There was also an ongoing failure to notify us of significant issues involving people using the service.

We have taken action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements. You can see what action we have taken at the end of the full version of this report.

We found that the provider had made changes to the monitoring and auditing of service delivery and legal requirements in this area were now met. The provider had a clearer understanding of people’s experience of using the service and was committed to addressing their continued dissatisfaction with the deployment of staff and call scheduling.

Homecare Helpline is registered to provide personal care to older people, people living with dementia and people with a physical disability. Most of the people who use the service live independently in their own home although the service also provides support to some people who live in an ‘extra care’ sheltered housing service in Grantham, Bourne and Sleaford. The service has operated for many years in the Sleaford, Spalding, Stamford, Bourne, Deepings and Grantham areas of Lincolnshire. In October 2015, following a reorganisation of domiciliary care services undertaken by Lincolnshire County Council, the service expanded significantly to take on a major new contract. As part of taking on this new contract, a large number of staff who had worked for the previous contractors transferred into the employment of Homecare Helpline.

We inspected the service on 6 April 2016. The inspection was announced. At the time of our inspection approximately 300 people were receiving a personal care service.

There was a registered manager in post at the time of our inspection. A registered manager (‘the manager’) is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’), 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.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff had received training in this area and demonstrated their understanding of how to support people who lacked the capacity to make some decisions for themselves.

During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staffing resources were not organised safely and service delivery was not monitored effectively. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. This was because the provider had failed to notify us of significant incidents relating to the service.

You can see what action we told the registered person to take in respect of these three issues at the end of the full version of this report.

We also identified a number of other areas in which improvement was needed to ensure people using Homecare Helpline were provided with safe, effective care.

Not everyone who used the service received safe and consistent medicines support in line with good practice and national guidance. Further action was also needed to ensure people’s telephone concerns and complaints were handled in a consistent and effective way.

Some staff did not have necessary skills and knowledge to support people effectively. Additionally, the supervision of staff was not being delivered consistently in line with the provider’s staff supervision policy.

We did find some areas in which the provider was meeting people’s needs effectively.

Staff supported people in and in a warm and friendly way. Staff knew people as individuals and supported them to have as much choice and control over their lives as possible. People were treated with dignity and respect.

People’s care plans were written in a person-centred way and were understood and followed by staff. People were actively involved in the preparation and review of their personal care plan.

People were supported to make their own decisions and staff had an understanding of how to support people who lacked the capacity to make some decisions for themselves.

Staff assisted people to eat and drink whenever this was required. The provider took steps to ensure people were sufficiently hydrated during the warmer summer months.

Prior to our inspection we reviewed all the information we had received about the provider.

We sent questionnaires to 61 people who received personal care within their homes to determine their views on the quality of the service. We also asked them to pass on a questionnaire to their relatives and friends to complete. We spoke with the registered manager, the nominated individual and nine members of staff, eight of whom were home care workers. We also looked at service information and care plans.

Homecare Helpline provided care and support to people in their own homes and also to people who lived in Extra Care housing facilities at three sites in central and southern Lincolnshire. As part of our inspection we visited one of these locations.

People who responded to our questionnaire felt the care staff attended their appointments in a timely manner and performed their duties in accordance with their individual care plans. They said they found the care staff treated them with respect and were well equipped and trained to deliver safe care.

People who used the agency told us that they felt confident in discussing any areas of concern with the manager and felt confident their views and opinions would be respected and valued. The provider had in place suitable systems and processes to assess and improve the quality of the service provided.

Any complaints had been handled efficiently and in a timely manner.

We found the service to be well led and managed and that they responded to people’s changing needs.

There had been no registered manager in place since March 2012. We spoke with the managing director of the provider who informed us that a new registered manager had been identified and an application to have the person registered would be made very shortly. We found that the management team in place were experienced and provided sound and efficient leadership in the absence of a registered manager.

People told us they were very satisfied with the quality of the service provided by the agency and that they had been involved in the compilation of their care plans. They also told us that the care staff would always promote their privacy and dignity when providing personal care in their home environment.

People told us that they felt that all staff employed by the agency were suitably trained and performed their duties in a professional manner. One person told us, "I can rely on them (care staff) Sometimes they are a bit late but they always turn up.I understand that sometimes things happen that they can't control."

Another said, "They took away my regular carer, I don't know why. He was very good and we became quite close. The new regular carer I have is good as well but you get quite a few new faces as well. I would rather have the same carers all the time."

People told us that they felt confident in reporting any issues of concern or complaints to the staff employed at the agency and felt that any concerns would addressed effectively by the management team.

We spoke with three people who use the service they told us.

"The carers are very good. They usually turn up on time and do everything they are supposed to do."

"They are very kind, very nice and helpful. I'm pleased with the service."

"I made a complaint about one of the carers and requested they don't come back. The agency have organised for a different carer and things are much better now."

"I'm very satisfied with the care they provide."

"If I ask the carer to come a bit earlier they will. They always stay the amount of time they should. I have no complaints."

As part of our review we undertook a visit to meet people who use the service. One person told that their mother was quite happy with staff and they were good to her. The person told us that their concerns and complaints were dealt with appropriately and managers met with the family to solve issues of concern. Another person told us that the arrangement with Homecare Helpline was working quite well at the moment despite problems in the past.

One family told us that they were sent staff they didn’t like despite repeated requests for particular members of staff. They also told us that they really liked particular members of staff. Another family told us that there was a lot of turnover of carers all the time. One person told us that some staff appeared more competent than others.