Date of Assessment:24Novemberto13 January2026. The service is a care at home service registered to provide support to older people and younger adults, including people who may live with dementia, mental health, sensory impairment, eating disorder, misuse drugs and alcohol, physical disability or learning disability needs. An inspection has been undertaken of a specialist service that is registered for use by autistic people or people with a learning disability. At the time of inspection, the service was not used by anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At this inspection we found the service was predominantly meeting the underpinning principles of Right support, Right care, Right culture. We identified some improvements to roster management to ensure people received the right support from a consistent staff team. At the time of inspection there were37 people using the service and all of the people were receiving the regulated activity personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. A registered manager was in place. A registered manager is registered with the Commission and is legally responsible to ensure that the service is compliant with legal and regulatory requirements. At our last inspection, we identified breaches of legal regulations in relation to good staffing, meeting nutritional and hydrational needs and good governance. At this inspection, improvements had been made, and the provider was no longer in breach of legal regulations. Staffing capacity was sufficient to ensure people's needs were met in a safe way. Improvements had been made to roster management. However, improvements made needed to be sustained, with systems in place when there was a change in management, so all people received consistent care from staff members familiar to them. Systems were in place for people to receive their medicines in a safe way. There were enough staff with the necessary skills, qualifications and experience to meet people’s needs. Staff were safely recruited. People were treated with kindness and compassion. Staff protected their privacy and dignity. Risk assessments were in place, and they identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Records were up-to-date and reflected people's care and support needs. People’s mental capacity and ability to consent was taken into account. People and their representatives were involved in planning their care and support. There was evidence of collaborative working and communication with other professionals to help meet people's needs. Most people, relatives and staff were confident about approaching the registered manager and management team if they needed to. However, not all felt that their views and feedback were valued and respected and used to support service development. This had been identified and was being addressed by the registered manager. Processes were in place to manage and respond to complaints and concerns. Improvements had been made to governance since the last inspection. Systems were in place to monitor the quality and safety of the service, however some improvements were identified.
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Hales Group Limited - South Tyneside improved from Inadequate to Requires Improvement and exited Special Measures, with progress in medicines management, safeguarding and staff training. However, continued breaches of Regulations 14, 17 and 18 remained due to poor rota management causing late calls, missed mealtimes and medication timing issues, alongside ineffective governance and a culture lacking person-centred care.
Concerns (10)
criticalMissed or late visits: “People were at risk of harm as there was impact to people's safety and well-being where calls were very late.”
criticalStaffing levels: “Rotas were not managed effectively so people received care when they needed it. This placed people at risk of harm.”
criticalGovernance: “The provider did not have effective systems in place to monitor and improve the quality and safety of the service.”
criticalOther: “People were not always supported to have enough to eat and drink at regular intervals.”
moderatePerson-centred care: “The culture of the organisation did not promote a person-centred approach to delivering care or an openness which empowered staff and people.”
moderateCommunication with families: “People were not routinely informed when their call was going to be late.”
moderateMedication management: “improvements were still required to medicines management to ensure all people received their calls at the scheduled times.”
moderateIncident learning: “the provider had failed to ensure learning and take decisive action to improve the care people received.”
moderateComplaints handling: “Complaining and getting a response is a lottery but the issues are not resolved.”
moderateLeadership: “the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
Strengths
· Improvements made to medicines management; no longer in breach of Regulation 12
· Safe and effective recruitment practices were followed
· Substantial reduction in safeguarding concerns; no longer in breach of Regulation 13
· Staff training improved including Care Certificate induction and specialist training
· Staff received regular supervision and described management as approachable
Quality-Statement breakdown (16)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceGood
The service deteriorated to Inadequate and was placed in special measures, with continued breaches of regulations 12, 13, 14, 17 and 18 due to poor rota management causing missed and late calls, unsafe medicines administration and ineffective safeguarding. Leadership, governance and culture were significantly poor, with people and staff feeling unheard despite repeated complaints.
Concerns (14)
criticalMissed or late visits: “There was impact to people's safety and well-being where calls were missed or were very late.”
criticalStaffing levels: “Rotas were not managed effectively so people received care when they needed it. This placed people at risk of harm.”
criticalMedication management: “Medicine Administration Records (MARs) showed that there were occasions medicines were not given to people at the prescribed and scheduled times.”
criticalSafeguarding: “Systems were either not in place or embedded to ensure appropriate and timely action was taken to safeguard people at risk of abuse.”
criticalGovernance: “The provider did not have effective systems in place to monitor and improve the quality and safety of the service.”
criticalLeadership: “There were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalIncident learning: “Safeguarding incidents were investigated but they did not show evidence of effective lessons learned as there was no sustained improvement and there were recurring themes.”
criticalOther: “Rotas were not managed effectively so people received food and drink at regular intervals. This placed people at risk of dehydration and malnutrition.”
moderateStaff training: “Effective systems were not in place to ensure staff were trained and competent to carry out their role to ensure people's care and safety.”
moderateStaff competency: “Several staff members reported they did not feel competent to provide some care.”
moderatePerson-centred care: “The culture of the organisation did not promote a person-centred approach to delivering care or an openness which empowered staff and people.”
moderateCommunication with families: “79% of people and relatives and 65% staff commented that communication was ineffective.”
moderateComplaints handling: “I have complained by phoning the office who apologise but nothing changes. I have completed a questionnaire, but no response or changes made.”
moderateRecord keeping: “Care records were electronic, they were not backed up so when there were technology failures, information was not available to ensure people's needs were met.”
Strengths
· Safe and effective recruitment practices were followed to help ensure only suitable staff were employed.
· Staff had been trained in safeguarding people from harm.
· Most people and relatives were complimentary about the direct care provided by support staff; staff were kind, caring and supportive.
· Systems were in place to reduce the spread of infection and staff had access to regular supplies of PPE.
· Staff had developed links with health care professionals to obtain specialist advice and support.
Quality-Statement breakdown (15)
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law