This inspection took place on 18, 20 and 21September 2018 and the first day of inspection was unannounced. The inspection was carried out by one adult social care inspector and an expert by experience. On 20 September 2018 we made telephone calls to people who use the service to gain their views and experiences of the service.

Human Support Group – Sale, also known as HSG Homecare - Sale and referred to as HSG - Sale 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 - Sale also provides other elements of support such as sit-in services, domestic support and welfare checks.

The service is managed from an office in Sale, Trafford with care and support provided for people living in the areas of Trafford, for example Altrincham, Stretford and Sale. The length of visits for care and support vary depending on the assessed needs of people. At the time of this inspection, 94 people were in receipt of a service and 70 staff were employed on the day of our inspection. 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 time of this inspection 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 the inspection of April 2017, we rated the service overall as Requires Improvement. At that inspection, we found breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks were not managed properly and support plans did not contain detailed information for staff to provide person centred care.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well led to at least good.

During this inspection, we saw the provider had taken the measures 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.

People supported with medicines were kept safe and received the correct medication. Practical competency reviews were completed with all staff to ensure best practice was being followed.

The manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected. People had access to healthcare services and received healthcare support, sometimes as a result of intervention or advice from care staff.

The service worked with relatives and others to raise the awareness of dementia. Two planned Dementia Awareness sessions went ahead and were attended by relatives, staff and a health professional. People were supported with the preparation of meals and drinks where this had been identified as a care and support need during the assessment process and any specific dietary needs were documented.

Staff were kind and patient in their approach and did not rush people, letting people do things at their own speed. People were treated with dignity and respect and received care and support specific to them, dependin

This was an unannounced inspection, which took place on 24 and 25 April 2017. This meant the service did not know we were coming on the first day. By arrangement, we returned for a second day of inspection. The inspection was prompted by the outcome of a coronial investigation dated December 2016 into the death of a person who had received care and support from this service from February 2014 to January 2016. Coronial investigations (or inquests) are undertaken to determine the cause or manner of a person’s death. We also had concerns about missed visits and what systems were in place to prevent reoccurrence, and failure to report notifiable incidents.

Prior to our inspection visit, we contacted the nominated individual to request information on how they had addressed the concerns raised by the coroner. A nominated individual is a person employed as a director, manager or secretary of an organisation with responsibility for supervising the management of the regulated activity. Given the serious nature of the concerns raised by the coroner, we wanted to be sure the service was doing everything possible to mitigate risks to other users of the service. The service was last inspected in November 2016. We identified no breaches in regulation at that time and the service was rated ‘Good’.

Human Support Group – Sale (HSG – Sale), also referred to as Homecare Support, is a domiciliary care service which provides personal care and support to people in their homes to help them remain independent. HSG – Sale supports people living within the Trafford borough of Greater Manchester and Salford. There is also a reablement service called SAMS (Stabilise and Make Safe) which provided short intervention care for up to three weeks. The majority of people using this service had been discharged from hospital and the aim of the reablement team was to help them to regain and maximise their previous level of independence. SAMS was only operated within the Trafford area. The service also offered practical care tasks such as shopping, laundry and ironing. HSG – Sale is also registered to provide treatment of disease, disorder or injury but was not currently providing these services. At this inspection, the service supported 220 people, 27 of whom received support from the SAMS service.

At the time of this inspection there was a manager in place who had registered with the Care Quality Commission (CQC) in January 2017, having been in post since November 2016. 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.

People told us they felt safe with the care and support provided by the service.

Risk assessments did not always provide clear and specific information to help staff deliver care and support people safely. We noted that support plans did not contain sufficient information about administering particular medication. This meant people were potentially at risk of harm.

Staff were aware of safeguarding principles and told us they would report any concerns in this area to the relevant authorities. 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.

There were adequate systems in place to help ensure missed and late visits were minimised. People and relatives told us missed calls were infrequent.

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 the spread of infection or cross-contamination. We did receive one piece of negative feedback in relation to

This inspection took place on 23, 24, 25 and 28 November 2016. The Human Support Group Limited is a domiciliary care service which provides personal care and support to people in their own home.

The service also offers re-ablement services which provide short intervention care for up to six weeks. The majority of people using the service had been discharged from hospital and the aim of the re-ablement team was to help them to regain and maximise their previous level of independence.

At the time of our inspection a service was being provided to 200 people living within the Trafford borough of Greater Manchester. In addition, 25 people were being supported through the SAMS service.

The service had been without a registered manager for over six months and the area manager had applied for registration with the Care Quality Commission until a suitable candidate was recruited. 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.

People were very satisfied with all aspects of the service provided and spoke highly of both staff and managers. People who used the service told us they were treated with compassion and kindness and that their privacy and dignity were respected.

People who used the service and relatives we spoke with told us they felt staff provided safe and effective care. Staff we spoke with had a good understanding of the various types of harm and their roles and responsibilities in reporting any safeguarding concerns. Staff had also received safeguarding adults training.

We saw staff had received Mental Capacity Act and DoLS training as part of the induction training that was provided by the organisation’s training department.

People's care plans reflected their individual needs and personal wishes. Most people told us they were involved in the development of their care plans and were enabled to express their views on an on-going basis.

Staff were carefully recruited and were required to undergo a number of background checks prior to starting their employment. This helped to ensure that only people with the required skills and of suitable character were employed.

On the fourth day of our inspection, we visited three people in their own homes. They told us they felt their dignity and privacy were respected by staff. One person said, “I have staff that know me, this matters to me as I have built up good relationships with them and I trust them.”

People told us they received their medication as prescribed. Medicines administration records (MAR) checked confirmed this.

Staff received regular supervisions and annual appraisals and were able to reflect on the care and support they delivered and identified further training requirements. The management team encouraged feedback from all people involved with the service.

This inspection took place on 11 May 2015. We gave the provider 48 hours’ notice of the inspection visit to make sure that the staff we needed to speak with were available.

Human Support Group Ltd – Sale is a domiciliary care agency which provides personal care services to people living in their own homes. Human Support Group Ltd – Sale also provide a reablement service with the aim of supporting people to prevent a hospital admission or to enable an early discharge from hospital. The service is arranged via the local authority and is usually provided for up to six weeks. The reablement team consists of a manager, a qualified occupational therapist, a senior carer and a team of care staff.

On the day of the inspection, the agency was supporting 165 people on a long term basis. In addition 20 people were being supported by the reablement team.

This service moved into this office on 18 October 2013 and this was the first inspection of the service at this location. The service provides personal care to people living in their own homes in the Sale, Partington, Altrincham, Stretford, Timperley and Urmston areas of Trafford.

There was a manager in post who had submitted an application to register with the Care Quality Commission. The previous registered manager was promoted to area manager and was still based at the Sale office. 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 service had a robust recruitment process in place. Staff were not employed before appropriate safety checks such as a check with the Disclosure and Barring Service had been carried out. This made sure that staff were safe to work with people who could be at risk.

All new staff had an induction before they started working with people who used the service. The staff we spoke with told us this had provided them with the knowledge and skills to carry out their role.

There was a training programme in place and staff told us they received support and guidance from the manager, the area manager and the director of the company. Staff were supported in their roles through regular supervision and annual appraisals.

The Mental Capacity Act 2005 (MCA) is legislation to protect people who are not able to make decisions for themselves, particularly personal welfare, healthcare and financial matters. The manager understood their role and responsibilities in relation to the MCA and DoLS and the importance of maintaining peoples rights. Staff understood their roles and responsibilities to seek peoples consent to care in line with the requirements of the MCA.

People’s needs had been assessed, and any risks to their health and safety had been identified. Care plans took account of people’s abilities, preferences, and choices.

There was a complaints policy and procedure and people knew how to make a complaint or raise concerns.