This inspection took place on 17 and 21 September 2018 and was announced. At the last inspections in June 2017 and February 2018, we rated the service Requires Improvement. We found breaches in regulations which related to Regulation 12 (Safe Care and Treatment), 17 (Good Governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at our last inspection in February 2018. We asked the provider to complete an action plan after both of our inspections to show what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. At this inspection, we found the service had made some improvements and was no longer in breach of the regulations, however the overall rating for the service remains requires improvement.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults.

Not everyone using Hales Group Limited – Leeds receives regulated activity; 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.

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.

The service had improved the quality monitoring systems since our last visit, and where errors in medicines administration records (MARs) were found, we saw evidence that they were dealt with appropriately. However, some inconsistencies remained with standards of recording.

We have made a recommendation about the management of records.

The service did not always operate under best practice guidance for the Mental Capacity Act (2005). The service conducted capacity assessments that were not decision-specific and where people were determined to lack capacity there was no evidence of what the outcome was for the person.

We have made a recommendation about the implementation of the principles of the Mental Capacity Act (2005).

Although the service conducted telephone surveys, and individual issues identified were chased up, it was not clear that this information was collated and analysed in a meaningful way or any actions taken as a result. Following our inspection the provider told us that feedback from care workers and people using the service had been analysed and used to introduce some new initiatives into the service. For example, the provider has told us that more focussed supervisions were carried out and people were involved in the recruitment process.

People told us they felt the service was safe, and that they had not experienced missed visits. The service had procured an electronic monitoring system to help sustain improvements made.

Risk assessments were carried out appropriately and up to date, with clear information for staff to follow to mitigate risk. There was plenty of personal protective equipment such as gloves and aprons available, and staff completed basic infection prevention training.

People said they received their medicines safely. Staff were knowledgeable and staff competency was checked before they administered medicines unsupervised.

Staff were supported with regular training, supervisions and appraisals. Staff told us they felt well supported and could approach senior staff if they felt they needed help. The service supported new staff with an induction process which monitored staff progression.

People told us they felt their health and wellbeing was well supported, that their nutritional choices were taken into account and

We carried out an announced comprehensive inspection of this service in June 2017. After that inspection we received concerns in relation to safeguarding, staffing and governance arrangements at the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hales Group Limited - Leeds on our website at www.cqc.org.uk

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of our inspection there were 139 people using the service.

Not everyone using Hales Group Limited - Leeds receives regulated activity; 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.

There was a registered manager in post at the time of the inspection. 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.

Systems and processes in place to support people to take their medicines were not robust, and there had been a number of safeguarding alerts raised where people had not received medicines. The provider told us after the inspection that they had identified the majority of these safeguarding concerns themselves through auditing of medicines practices, but quality assurance systems and processes needed to be improved to ensure they were robust, identified all shortfalls, and that they were used to drive improvements within the service.

Risk assessments were not always robust. They were incomplete or did not have enough detailed information on how to mitigate risks to people.

There were not enough staff to provide care effectively and we identified a number of people experienced missed calls. The staff team told us there was a high turnover of staff and the registered manager reflected that they had approximately 20 vacancies for extra staff to which they were actively recruiting. The provider told us following our inspection that missed calls were related to poor communication, poor management and poor staff practice, as opposed to a lack of staff. Nonetheless, poor deployment and monitoring of staff practice had led to numerous missed care visits, which meant people had not received the care they needed.

The service’s quality monitoring systems were not robust. The service was unable to analyse information such as medication administration records (MARs), care notes and safeguarding alerts for trends and themes.

The service did not have the capacity to carry out audits in a planned and thorough way, and where audits were carried out, they did not always identify and act upon issues found.

The service had action plans in place to integrate the newly acquired Bradford service into the Leeds team and tackle issues identified under previous management, however, there were no timescales in place for when actions had to be completed and the plan would have benefited from this. The plan had been shared regularly with relevant stakeholders since December 2017 and was used to monitor progress against the improvement areas needed

Staff were recruited safely, and had been trained in safeguarding vulnerable adults. Staff were able to describe how they would use the service’s safeguarding and whistleblowing procedures to protect people from harm.

There were contingency plans in place in the event of a significant disruption to the service such as a flood or communications f

This was the first inspection of the service since it was registered in June 2016.

Hales Group Limited Leeds is a domiciliary care agency that is registered to provide personal care and support to people in their own homes in the Leeds area. At the time of this inspection the service was providing personal care and support to 165 people in Leeds, together with a further 66 people who were living in the Bradford area.

At this inspection we found shortfalls associated with the operation of systems and processes to monitor and assure the safety and quality of the service. We judged this to be a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager for the service at the time of this inspection, following the previous manager for this role leaving in January 2017. A Regional Manager was managing the service in the absence of a registered manager and a replacement for this post had been appointed. We were told an application was in the process of being submitted to the Care Quality Commission. 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.

Whist care staff were safely recruited and knew how to recognise and report different types of abuse, there had been delays in thoroughly investigating safeguarding issues and ensuring actions were taken to minimise these from reoccurring.

People received their medicines from care staff who had been trained on this element of their role. However, some people’s medicines administration support records had not always been regularly returned to the office, which meant these could not be checked. We have made a recommendation about this.

People told us that overall they felt safe although we found some experienced inconsistencies in relation to times of their visits from care staff who provided their support.

Training and development opportunities were available for staff. However, we found supervision and appraisals of their skills had not regularly taken place to ensure they were competent to perform their roles.

People confirmed their consent was obtained prior to care staff undertaking personal care interventions and that overall they were treated with dignity and respect and their independence was promoted.

Appropriate guidance was in place to ensure people received enough to eat and drink and systems were available for involving health care professionals when people’s needs changed.

People’s care and support was delivered in line with their assessed needs, however we found these were not always reviewed on a regular basis.

A complaints policy was in place to enable people’s concerns to be responded to and addressed, however we found concerns had not always been actioned and addressed in a timely way.