This inspection took place on 24, 25, 26 and 27 July 2018 with the first day of inspection being unannounced. The inspection was carried out by one adult social care inspector and an expert by experience. On 25 July 2018 we made calls to people who use the service and staff to gain their views and experiences of the service.

Human Support Group – Didsbury, also known as HSG Homecare – Didsbury and referred to as HSG – Didsbury in this report, is a domiciliary care service which provides personal care and support to people in their own homes to help them remain independent. HSG – Didsbury also provides other elements of support such as sit-in services, domestic support and welfare checks.

The service is managed from an office in Didsbury, Greater Manchester with care and support provided for people living in the immediate area and other districts within Greater Manchester, including Burnage, Wythenshawe, Chorlton and Withington. The length of visits for care and support vary depending on the assessed needs of people. At the time of this inspection, 108 people were in receipt of a service. However, not everyone using the service receives regulated activity; the Care Quality Commission (CQC) 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.

At the inspection of May 2017, we rated the service overall as Requires Improvement. At that inspection, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks were not managed properly. We also identified weaknesses in the provider’s recruitment processes as gaps in employment had not been fully explored with applicants and judged that this needed to improve.

At the time of this inspection there was no registered manager in post although an individual had submitted an application to manage this service. 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. The person applying to assume the role of registered manager was currently a registered manager at another branch. As the Didsbury branch of the Human Support Group was also the company head office there was the presence of staff from all areas of the business on a day to day basis, including senior management, and staff attached to the branch felt fully supported.

Following the inspection, we told the provider to send us an action plan detailing how they would ensure they met the requirement of the regulation. At this inspection, we saw the provider had taken action as identified in their action plan. In addition, they had sustained previous good practice in other key areas. As a result of this inspection, the service has an overall rating of Good.

There were more robust systems in place to ensure that risks to people's safety and wellbeing were identified and addressed. Risk assessments included information for staff about the risk and any measures they should take to minimise the chance of harm occurring to an individual.

Electronic call logging was undertaken by staff. The electronic call monitoring records we looked at reflected that the majority of staff were staying for the full commissioned time with individuals. A missed call checklist centred around ensuring the well being of the person who had potentially not received care and support. One missed call had occurred six months before this inspection. Where people needed support with medicines the systems in place were safe. Practical competency reviews were completed with all staff to ensure best practice was being followed.

A programme of training a

This was an unannounced inspection, which took place on 9, 10 and 12 May 2017. This meant the service did not know we were coming on the first day. We returned to the service’s offices for a second day of inspection. On the third day, with prior consent, we visited people in their homes. The service was last inspected in January 2016 and rated ‘Requires Improvement’.

Human Support Group – Didsbury, also referred to as Homecare Support, Didsbury (HSG – Didsbury) is a domiciliary care service which provides personal care and support to people in their homes to help them remain independent. The service also offered practical care tasks such as sit-in services, domestic support and sleeping/waking night services. HSG – Didsbury supports people living within the Greater Manchester. Prior to this inspection the service supported people in living in Manchester and Stockport. The care manager told us due to recruitment issues and concerns about the quality of care suffering as a result, the provider made the decision to stop service provision in Stockport from 31 March 2017. The provider facilitated the smooth transfer of 16 people being supported to suitable alternative providers with the support of the Stockport Council. This helped to ensure people supported were not adversely affected. At the time of our inspection, the service supported 109 people.

At the time of this inspection, the service had not had a registered manager since September 2016. 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 current care manager had been in post since November 2016 and was in the process of registering with the CQC.

People told us they felt safe with the care and support provided by the service. They told us there was a regular team of care staff who visited them during the week but that this was variable at the weekend. This meant people were not always supported by people who knew their specific care needs.

We noted the provider had systems in place to help ensure suitable candidates. Where adequate references were not collected, we saw no evidence that had potential risks had been considered and appropriate steps taken to mitigate these.

Risk assessments did not always provide clear and specific information to help staff deliver care and support safely. This meant people were potentially at risk of harm.

Staff were aware of safeguarding principles and knew what to do in the event they suspected abuse was taking place. We noted the provider’s safeguarding policy referred to outdated legislation which meant staff were potentially referring to documents that were not completely fit for purpose. The care manager showed us they referred to current local authority safeguarding policies and procedures.

People and relatives told us care staff demonstrated good hygiene practices by using personal protective equipment (PPE) such as gloves and aprons, and washing their hands as required. If used appropriately, this practice should help to prevent cross contamination and the spread of infection.

Where required people and relatives told us they were safely supported to take their medicines. The service used a medication support plan and risk assessment which helped staff to support people in a safe and effective way.

We noted there was an effective system of reporting and monitoring accidents and incidents that took place within the service. We saw that lessons learnt were shared across the provider’s network of services.

People and relatives told us staff were competent in delivering care and support.

We checked to see how the service ensured the principles of the Mental Capacity Act 2005 were adhered to. In some people’s care plans we saw relatives h

An inspector visited this service on 6 June to carry out an inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During the inspection we spoke with three people who used the service. We visited these people in their own homes. We spoke with one relative, three care staff, and members of the office management team. We also spoke with the manager and looked at records. Below is a summary of what we found.

Is the service caring?

All the people we spoke with happy with the care and support provided by the Human Support Group. People told us that the service engaged with them to ensure that their needs and wishes were met. Some comments included; "They are great at helping me, they check I’m comfortable" and "They’re really wonderful." Staff spoken with were all positive regarding the care that was delivered. One staff member said;

“I love the fact that people are in their own home and can be because of our support" We spoke with one relative who confirmed they were happy with the care and support provided to their family member. They said; “It’s marvellous.”

Is the service safe?

We spoke with three people who used the service who all told us that they felt safe. One person told us; “I struggled when I decided I needed help, after all they are coming into my home. But I can honestly say that I trust them implicitly.” The relative we spoke with told us they had no concerns regarding their family member’s safety. We saw that the service had systems in place to identify and respond to allegations of abuse and we checked that staff were knowledgeable of these and the actions to take if they had concerns for a person's safety. We viewed records which showed us that a safe and effective recruitment process had been followed which should help to make sure that only suitable staff were employed. We considered that the service had effective systems in place to ensure that people were protected from the risk of harm and abuse.

Is the service responsive?

All the people we spoke with told us they felt that the service listened to them. Comments we received included; "They’re very flexible to my needs" and "They’re brilliant. They take on board everything I say.” This showed us that people were consulted in the development of a care plan which met their needs. They also told us that if they needed to change any area of their agreed care and support plan, this was accommodated by the service. This showed us that the Human Support Group was responsive to people’s needs.

Is the service effective?

We saw that people who received care and support from The Human Support Group had a care record that included assessments of their individual needs and risks. The care plan had been developed to meet those assessed needs. The records we viewed had been reviewed on an annual basis, or earlier if required. Prior to people receiving care and support, we saw that information regarding the person's health needs was obtained from other health professionals, such as social workers and a member of staff visited the person to carry out an assessment of their needs. This meant that people could feel confident that the service could meet their individual and personal care needs. We viewed records which showed us training and development was provided to staff to enable them to deliver support safely and to an appropriate standard. We spoke with three people who used the service who told us staff were knowledgeable about their individual care needs and they were confident in staff abilities when support was being given. This showed us staff had access to appropriate development opportunities to enable them to deliver safe and effective care and support

Is the service well led?

A review of our records showed that the manager of The Human Support Group was currently applying to the Care Quality Commission to become registered by us. We saw the service had systems in place to ensure people were regularly consulted about their views and ideas on how the service should be run. This was done by means of telephone consultations with people and individual meetings. We saw quality assurance systems were in place and managed by an internal compliance department and that if improvements were identified, these were actioned as appropriate and staff were informed of any changes required. The people we spoke with told us that the management team were approachable and they had received a copy of the complaints procedure prior to joining the service. The documentation we viewed, together with people’s comments, showed us that the service was well led.

Our expert by experience spoke with five people who used the service and one relative. In their report, our expert by experience told us: “Overall everyone was pleased with their care”. People told us that staff were “very reliable” and came at a time to suit their needs. One person said: “They are such lovely people and say how pleased they are to see me”. Another person told us carers were “fantastic”.

Before the inspection we received information of concern relating to staffing levels and that staff received limited information about the care and support people required. Concerns were also raised that staff were not always being provided with personal protective equipment (PPE) such as gloves and aprons.

We found that people were involved in making decisions about their care and support. The provider took steps to ensure that care and support was provided with due regard to people’s rights and preferences. People experienced safe, effective and appropriate care.

The provider had suitable systems in place to manage the prevention and control of infection and staff were provided with appropriate equipment to protect them from the risk of exposure to infections.

The provider had taken reasonable steps to address staffing issues and people’s needs were being met by sufficient numbers of appropriately trained staff. The provider had a suitable system in place for identifying, handling and responding appropriately to complaints or comments.

We spoke to one person who uses the service, one relative and two members of staff who provide care and support to people. All spoke very positively about the service. One person who uses the service told us that the two carers who support them were “both lovely girls, absolutely pleased to be doing what they’re doing”. They told us that staff were courteous and respectful and usually punctual. A relative told us, “They are good people”.

The staff we spoke to told us that they enjoyed working for the service and that there was nothing that they would change. They told us that staff morale was good and that they felt supported by their managers.

We found that The Human Support Group had taken steps to achieve compliance since our last inspection. The provider had suitable arrangements in place to ensure that service users are safeguarded against the risk of abuse and that staff are properly supported to provide care to people who use the service.

The people we spoke with were happy with the care they received. They told us that they felt very well cared for. They said they felt confident staff knew how to their job. They told us staff nearly always turned up on time and stayed for as long as they should. Comments included: "I have no complaints at all. They are fantastic. I couldn't manage without them at all." "I've never had a missed call. They have been coming for about three years. They phone and tell us if they're going to be late. It's good. We have some fun -a talk and a laugh." "We're happy with the service- all of us, all the family."

We carried out an inspection at The Human Support Group Didsbury on 12, 14 & 15 January. The first day of our inspection was unannounced which meant the provider did not know we were coming. The second and third day of the inspection we visited a number of people who used the service and carried out observations about the quality of care and support they received. We also spoke with people who used the service and with staff over the telephone to ascertain their feedback about the quality of care provided by The Human Support Group Didsbury.

The Human Support Group Didsbury, also known as Homecare Support, provide personal care services to 217 people in their own homes. Visits range from fifteen minutes up to an hour. The frequency of visits range from one visit per week to four visits per day depending on people’s assessed need.

There was no registered manager at the time of our visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. However a manager had recently been appointed and had submitted their application to register with The Care Quality Commission.

We received feedback from 20 people who used the service about the care they received. Most people said they were fully satisfied with the service being provided by Homecare Support. People made very positive comments about the regular staff and the care they received if they had regular care workers providing all or some of their care. People told us they wanted regular call times and regular care workers who were properly trained and knew about what care they needed. We found the service had not always made sure the staff had the right knowledge and experience to support people to an appropriate standard at all times.

The service completed regular care plan reviews with people using the service. We found individual risk assessments were completed for people so that identifiable risks were managed.

Staff were able to describe how they respected people’s privacy and treated people with dignity and respect. They told us however that they were concerned people could not always be supported in the correct way because they did not have the time. They said they sometimes felt rushed because they did not have sufficient travel time planned into their rotas. People who used the service confirmed this and we saw rotas did not allow sufficient time between visits or take into account anything which may cause delays such as road works taking place in the local area. We have made a recommendation that appropriate travel time is given to staff which does not impact on the quality of care.

Staff received induction training for their roles. However, people who used the service told us they were concerned that new staff had not been properly trained to enable them to deliver care to an appropriate standard. We found that staff were not given an opportunity to read through people’s care plans before starting to work with them. This meant some staff we spoke with did not feel confident in supporting people with complex care needs. It also meant that people who used the service did not feel confident in the skills and abilities of the people supporting them. We have made a recommendation that all staff have access to care files before visiting people in their own homes.

Staff training records were out of date and during the previous twelve months arrangements had not been made to ensure all staff received regular supervisions which meant their performance was not formally monitored and areas for improvement may not have been identified. This meant the service had not ensured staff received appropriate training, professional development, supervision and appraisal. However we were shown records which had recently been introduced by the new manager which outlined when supervisions and appraisals would be taking place over the next year. This meant the provider had ensured improvements would be made in this area.

The provider had a complaint’s process in place. This was robust and there was an effective system for identifying, receiving, handling and responding appropriately to complaints and comments made by people or persons acting on their behalf. People we spoke with who used the service told us they were satisfied their complaints were dealt with properly.

There were effective systems in place to monitor and improve the quality of the service provided and feedback from people who used the service was positively encouraged