Humble Healthcare Limited

About the service

Humble Healthcare Limited is a domiciliary care agency providing personal care and support to people living in their own homes. At the time of our inspection 30 people were using the service and they all received support with personal care. Most people were older adults and adults with physical disabilities. The provider also offered a service to 2 younger adults and a child with learning disabilities.

This is the only branch of this private limited company. The director of the company was also one of the registered managers.

People’s experience of using this service and what we found

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support: The service supported people to have the maximum possible choice, control, and independence. Staff focused on people's strengths and promoted what they could do. People were supported to pursue interests when this was part of their planned care. The staff did everything possible to avoid restraining people. Staff supported people to make decisions about their own care. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a safe way.

Right Care: Staff promoted equality and diversity in their support of people. Staff understood people's cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood how to protect people from abuse and poor care. The service worked well with other agencies. The service had enough skilled staff to meet people's needs and to keep them safe. People who had individual ways of communicating were able to interact with staff and make choices. Care plans reflected people's needs and preferences. Staff had assessed the risks people might face and where appropriate, staff encouraged and enabled people to take positive risks.

Right culture: People's values and views were respected. People received good quality care and support. People were supported by staff who understood best practice. Staff knew people well and understood their needs. The agency engaged with people and their families to enable them to contribute their views. There were systems for monitoring and improving the quality of the service.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (Published 28 March 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 16 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Humble Healthcare Limited is a care agency based in the London Borough of Hounslow providing care and support to people living in their own homes. They care for adults and children, including people with learning disabilities, autism, physical disabilities, older people and people with dementia. The company is privately owned, and this is the only branch.

At the time of our inspection 41 people were using the service. Not everyone who used the service received 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.

People’s experience of using this service and what we found

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

The provider did not always assess the risks people were exposed to. This meant there were no plans to manage these risks and to help keep people safe. The staff sometimes restrained people but there were no plans for this, the staff had not been trained to do so safely and the provider did not investigate, reflect on or analyse these incidents. Staff supported people to make decisions and to have control over their lives, although some of the records to describe people's mental capacity and regarding their choices and consent were incomplete. The provider had helped people access other health and social care resources when needed. The staff supported people to take their medicines, but some of the information about these was unclear so we could not be assured people always received their medicines safely and as prescribed.

Right Care

People were involved in planning their own care and making decisions, but these were not always well recorded and there was not always enough information for staff. The staff did not always have the right skills to care for people safely. There was not enough information about people's communication needs to help staff understand how to communicate well with them when they could not communicate with speech. When it was part of people's commissioned care, the staff supported them to pursue different activities which reflected their interests and needs.

Right culture

The provider's systems for monitoring and improving the service were not always implemented effectively. They had sometimes failed to identify and plan for risks people were exposed to. They had not provided enough skilled and knowledgeable staff to safely meet people's needs. The staff did not always have thorough inductions or supervision. The provider did not check on them enough to make sure they were providing consistent, safe and good care. People using the service and their relatives liked their individual care workers. They also felt their needs were being met and they had good support from the agency and management team.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Why we inspected

We carried out an inspection of this service on 5 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing and fit and proper person's employed .

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

Enforcement

We have identified continuing breaches in relation to person-centre care, safe care and treatment, good governance, staffing and fit and proper person's employed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Humble Healthcare Limited is a domiciliary care agency providing personal care and support to people living in their own homes. At the time of our inspection, 52 people were using the service.

Not everyone who used the service received 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.

People’s experience of using this service and what we found

People were not always safely cared for. Risks to their safety and wellbeing had not been assessed, planned for or monitored. Medicines were not always safely managed and the provider did not ensure support with financial transactions and shopping was assessed, monitored or recorded.

People did not always receive personalised care. Care plans gave basic information, and these were sometimes inaccurate and about other people.

The provider's systems for monitoring and improving the quality of the service were not always operated effectively. Records were not always accurate or complete and the provider had failed to identify this.

The provider did not always ensure sufficient numbers of suitable staff were deployed and they did not always operate their recruitment processes effectively.

Most people using the service and their relatives told us they liked their individual care workers, although some told us care was not delivered on time or care staff could not provide the care they wanted.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at the last inspection was good (published 23 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management and how the service managed risk, following two safeguarding alerts.

We carried out monitoring of the service by speaking with the registered manager and requesting certain documents on 2 September 2021. We were not assured that the standards of quality and safety were being met. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Humble Healthcare on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care and treatment, protecting service users from abuse, good governance, staffing and fit and proper persons employed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Humble Healthcare Limited is a domiciliary care agency providing personal care and support to people living in their own homes in the London boroughs of Hounslow and Southwark and in Surrey. At the time of the inspection, six adults were using the service. Not everyone who used the service received 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.

People’s experience of using this service and what we found

People were happy with the service they were receiving. They explained that care workers were kind, caring, arrived on time and respected their wishes. People told us they were involved in planning their care and they had opportunities to feedback about their experiences.

There were procedures which made sure the staff who were recruited were suitable and had the training and information they needed to provide effective care. The registered manager regularly met with the staff and observed them carrying out their duties. This made sure the staff felt supported and also assured the provider that care was being delivered appropriately.

People's needs and choices were assessed and care plans were developed to reflect these. The care plans included personalised information about how they wished to be cared for and any specific individual needs. The risks to people's safety and wellbeing had been assessed and there were plans to mitigate any risks of harm. The staff made records of care they had given, and these showed that plans had been followed.

There were suitable systems for monitoring the quality of the service and making improvements. People using the service and their relatives told us the registered manager was approachable and addressed any concerns promptly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The rating at the last inspection was requires improvement (Published 4 June 2019) and we identified breaches of Regulations relating to good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out the inspection to monitor the improvements being made at the service. At previous inspections we had identified serious concerns which led us to take enforcement action. Whilst we found improvements had been made at the inspection of 30 April 2019 (Published 4 June 2019), we needed to make sure improvements were sustained and further improvements were made.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

There had been improvements in the way the service was managed. These included improved record keeping, staff supervision and training.

However, there were a number of areas where improvements were still needed. For example, some care plans did not always clearly describe people's needs. The provider was in the process of changing from paper records to a computerised system for care planning, recording care provided, medicines records and call monitoring. At the time of the inspection, some of information was not clear because of this change over.

At the last inspection of the service we identified that the provider was not carrying out effective recruitment checks. There had not been any new staff employed since the last inspection, so we could not judge whether improvements had been made in this area.

People who had the mental capacity to make decisions about their care had consented to this. However, when relatives had been involved in making decisions, the processes for this and whether they had the legal authority to do so, had not always been clearly recorded.

People using the service and their relatives told us that they received personalised care which met their needs. They were cared for by the same regular staff, who they liked and had good relationships with. They said that the care workers arrived on time for care visits and did everything that was expected of them. They had the support they needed about what they ate, and they were able to make decisions about their own care.

There had been improvements in the way staff were supported, supervised and trained. They had undertaken a range of different training courses and there was a plan to make sure they received ongoing training and support. The registered manager regularly met with the staff and carried out observations of the care they provided and assessments of their skills and knowledge.

People using the service and their relatives told us they knew how to make a complaint and felt confident speaking with the registered manager. They said that they had regular contact with the registered manager who asked them about their experiences. The registered manager had introduced new systems for monitoring the quality of the service and acting on feedback from others.

We identified breaches of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to good governance. You can see what action we have asked the provider to take within our table of actions.

Rating at last inspection: The service was rated as inadequate at the last inspection of 2 October 2018 (Published 13 November 2018). The service had been placed in 'special measures' since May 2018, when it was also rated inadequate. Since the registration of the service, the service has been inspected six times, in July 2016, July 2017, November 2017, May 2018, October 2018 and this inspection. The provider has failed to achieve a good rating at any of these inspections.

Why we inspected: This inspection was carried out in line with our schedule of planned inspections based on the previous rating of inadequate and because the service was in 'special measures.'

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Follow up: We will continue to monitor the service and make sure improvements continue and are sustained. We will carry out another inspection in line with our scheduled plan of inspections, and sooner if needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last inspection of the service was on 11 May 2018, when we rated the service inadequate and placed it in special measures. We identified breaches of five Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing.

Following this inspection of 11 May 2018, we asked the provider to complete an action plan to show what they would do and by when to improve to at least ‘good’. The provider completed an action plan.

At the inspection of 2 October 2018, we found some improvements had been made. However, we identified continuing breaches of Regulations relating to safe care and treatment, staffing and good governance. In addition, we identified two new breaches relating to fit and proper persons employed and the provider's failure to comply with the Regulations in carrying on the regulated activity of personal care. The questions, 'Is the service safe?' and 'Is the service well-led?' continue to be rated inadequate.

Humble Healthcare Limited 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 people and younger adults with physical disabilities, learning disabilities and mental health needs. At the time of our inspection seven people were using the service. People lived within the London Boroughs of Southwark and Hounslow. Some people's care was commissioned by the local authorities. Humble Healthcare Limited is the only location for this provider.

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 and associated Regulations about how the service is run.

The provider did not have effective systems and processes for recruiting staff to make sure they were suitable, competent, skilled or experienced. Furthermore, they had failed to ensure the staff received the appropriate support, training, supervision or appraisal to delivered effective care. This meant that people were placed at risk of inappropriate or unsafe care.

The risks to people's safety and wellbeing had been identified, but the provider had not always developed processes to mitigate these risks. For example, the guidance for staff was not detailed enough for them to provide safe care and treatment. The risks to people's wellbeing was further exacerbated by the risks associated with having staff who did not have the training or support to develop the skills, competence, qualifications or experience to care for people safely.

The provider's systems for monitoring and improving the quality of the service, as well as identifying and mitigating risks, were not always effective. Whilst they had made improvements in some areas, these were not enough to ensure people were being safely cared for. Furthermore, the provider has a history of failing to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They had sourced two different consultants to support them in making the improvements but these improvements were not sufficient.

People using the service were happy with the care and support they received. They liked their care workers and told us they were involved in planning and reviewing their care. They told us their individual needs were being met. They felt able to contact the provider and raise any concerns or speak about their care.

The staff told us they liked working at the service. They said that they found the registered manager supportive and they liked the work caring for people.

There had been improvements in the way people's care needs were assessed and how care plans were recorded. Information was more personalised and took account of individual needs and wishes. The provider had been responsive to people's needs and made sure they had access to healthcare services when they became unwell.

There had been improvements to the way in which medicines were managed and the records of this were more robust and clear. The provider undertook regular audits of the medicines administration records and followed up when the records indicated that medicines had not been administered. The provider had also increased spot checks on staff and quality monitoring with people using the service to make sure they were happy.

We identified breaches of five Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, staffing, good governance and fit, proper persons employed and failure to meet the Regulations of the Act.

We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

At the last inspection of 8 November 2017 we rated the service Requires Improvement overall and in the key questions of Safe and Well-led. 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 and Well-Led to at least ‘good’.

At this inspection of 11 May 2018 we found they had not made the required improvements and have rated the service Inadequate overall and in the key questions of Safe and Well-led. We have rated the key questions of Effective, Caring and Responsive as Requires Improvement.

Humble Healthcare Limited is 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 people and younger adults with physical disabilities, learning disabilities and mental health needs. At the time of our inspection 24 people were using the service. All the people lived within the London Borough of Southwark and their care was commissioned by this local authority. Humble Healthcare Limited is the only location for this provider.

There was a registered manager in post; they were also the owner of the company. 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 and associated Regulations about how the service is run.

The provider had not made suitable arrangements to ensure that people received their medicines as prescribed and in a safe way.

The provider's governance arrangements had failed to identify when things had gone wrong and take action to put this right. For example, we found medicines administration records which had errors. These had been audited by the registered manager, although the errors had not been identified or investigated.

Some people were supported by staff who undertook shopping for them. There was no system to ensure that people were not financially abused because the staff did not keep records of expenditure and the provider did not carry out checks on this.

Records about people were not always accurate or complete. The provider had used the same information in a number of different people's care plans and this was not relevant to them and did not describe their needs. Therefore, there was a risk that people would receive care and treatment which was not appropriate and did not meet their needs.

Where risks had been identified by the local authority, the provider had not ensured that these were recorded within risk assessments or care plans and there was no guidance for the staff on how to minimise these risks.

The provider was unable to evidence that staff had been suitably trained and supervised to provide care and support to people who used the service.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The provider had procedures for recruiting staff but was not always able to evidence they had made the necessary checks on staff suitability.

Following the inspection visit the provider updated some of the care plans and risk assessments as a result of our feedback and sent us evidence of this.

Most people using the service were happy with the service they received. One person raised significant concerns but the provider spoke with this person to resolve these and they reported that they were satisfied with this. Some other people felt that the service did not meet their needs, whilst others were very satisfied and felt the provider did a good job. People told us that care workers did not always arrive on time but most people did not mind this and they said the care workers stayed for the agreed time. Most people explained that they usually had the same care workers, who they had a good relationship with and liked. A few people felt the attitude of some care workers needed to be improved but most people told us that care workers were kind, caring and compassionate.

The majority of people told us that their needs were being met. The relatives of some people explained how they felt the agency offered peace of mind and that they had seen improvements in people's health and wellbeing since they started receiving support from the agency. The provider was able to meet people's requirements about visits at certain times of the day. At the previous inspection we spoke with a representative from the local authority and they told us that this flexibility regarding visit times was something other agencies did not offer. The feedback from people using the service and their representatives at this inspection confirmed this was still the case.

A small number of people felt that communication from the agency needed to improve but most people using the service, their relatives and staff told us that the registered manager was available when they were needed. Some people said that they had called the registered manager to request something, such as a change in the time of visits, and this had been arranged. The care worker we spoke with said that they could ''Ring [the manager] at any time, even two in the morning, and he answered the phone.'' They told us they felt supported by this. The provider also obtained regular feedback from people about the service they received, through telephone monitoring and asking them to complete surveys about their experiences.

The registered manager had recognised that they needed support and guidance to make sure the governance at the service was suitable. They had employed a consultant who had started to offer them advice and support. The consultant explained that they would continue to work with the provider to make improvements.

The inspection took place on 7 November 2017 and was unannounced.

The last inspection took place on 12 July 2017 when we rated the service Requires Improvement. We rated the key question of Safe as inadequate, the key questions of Effective, Responsive and Well-Led as Requires Improvement and the key question of Caring as Good. We issued three warning notices and made two requirements because the provider was not meeting five of the Regulations we checked.

At the inspection of 7 November 2017 we found that improvements had been made in all areas. However, the provider needed to make further improvements to their systems for auditing how care was provided and record keeping. The service has been rated Requires Improvement in the key questions of Safe and Well-led and overall. We have rated the key questions of Effective, Caring and Responsive as Good.

Humble Healthcare Limited is a domiciliary care agency registered to provide personal care to people living within their own homes. At the time of the inspection 19 people were using the service. People using the service lived in the London Borough of Southwark. The majority were older people (over the age of 65 years). There were 14 active care workers at the time of our visit. Humble Healthcare Limited is the only location for the provider of the same name. The service is privately owned and has been operating since 2016.

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 and associated Regulations about how the service is run.

The provider's audits of medicines administration records had failed to identify when these records showed that medicines may not have been administered as prescribed. Four people using the service at the time of our inspection were being supported by the agency to take their medicines. Records for three of these people included gaps where no administration had been recorded. In one case the records indicated an additional dose of one medicine had been administered. The provider had audited all these records but had not identified any areas of concern and therefore had not investigated what had happened.

Some of the provider's records were not appropriately maintained. For example, we found information relating to one person in the care notes of other people.

We found breaches of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service and their representatives were happy with the care they received. They told us that care workers arrived on time and stayed the agreed length of time. They explained that care workers did everything they asked and offered them choices. They were happy with support they received with medicines and in preparing meals, as well as with support with their personal care. People told us that the care workers were kind, polite, caring and compassionate. They said that their privacy was respected and they were happy with all aspects of the service.

The staff told us that they received the information they needed to carry out their jobs. They were supported to attend training and had meetings with the registered manager. The care workers explained that the registered manager observed them when they were providing care during spot checks to make sure they were doing everything right. The care workers told us they could contact the registered manager and ask for help whenever they needed.

Care plans were clear and showed the support people needed. Individual preferences were included within the plans. There was evidence that the plans had been discussed with the person, and/or their representative and they had consented to the plans. Care notes made by the staff showed that they followed planned care and that visits took place at the same regular times each day.

The provider had assessed the risks to people's wellbeing. These assessments included information for the staff on how to minimise the risks and support people safely. There were procedures designed to safeguard people from abuse and the staff were aware of these. The provider's recruitment procedures included making checks on the suitability of the staff.

The provider had made improvements to the way in which the service was led. These included improving policies and procedures, updating care plans and risk assessments, improving staff recruitment checks, improving record keeping and carrying out audits. Whilst we identified that further improvements were needed in some of these areas, we also noted that the improvements had ensured that staff had clear information about the people who they were caring for. The provider regularly contacted people using the service and staff to ask for their feedback. This was documented and confirmed by the people who we spoke with. People told us they knew how to make a complaint and that the provider was responsive when they wanted any changes.

The inspection took place on 12 July 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.

The last inspection took place 5 July 2016 when we rated the service Requires Improvement. We made breaches in respect of safe care and treatment, fit and proper persons employed and good governance. At the inspection of 12 July 2017we found that there had not been enough improvements in any of these areas. In addition we found other areas of concern which included the management of medicines, supervision of staff and the assessment of people's needs.

Humble Healthcare Limited is a domiciliary care agency registered to provide personal care to people living within their own homes. At the time of the inspection 28 people were using the service. People using the service lived in the London Boroughs of Southwark and Hounslow. The majority were older people (over the age of 65 years). Four people had been using the service since 2016. The other 24 people started using the service between March and June 2017. There were 16 active care workers at the time of our visit. Humble Healthcare Limited is the only location for the provider of the same name. The service is privately owned and has been operating since 2016.

The owner of the company was also the registered manager. 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 and associated Regulations about how the service is run.

The risks to people's safety and wellbeing had not been assessed and there was no guidance to ensure the staff minimised these risks.

Medicines were not managed safely so people were at risk of harm.

The provider had not undertaken all the required checks on the staff employed. Therefore people were at risk of receiving care from staff who were not suitable. The provider did not ensure that staff were suitably supervised to make sure they were competent.

The provider had not assessed or planned for people's needs. Therefore there was a risk that they would receive care which was not suitable.

Records were not accurately maintained. Therefore staff did not have clear information about how they should meet people's needs.

The provider's systems for monitoring the quality of the service, mitigating risks and making improvements were insufficient and this meant people were at risk of receiving care which was not safe and did not meet their needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For the breaches of Regulations in relation to person centred care and staff support you can see what action we have asked the provider to take at the back of the report. We are taking further action against the provider for breaches of Regulations in relation to safe care and treatment, good governance and fit and proper persons employed. Full information about CQC’s regulatory response to the concerns found during this inspection is added to reports after any representations and appeals have been concluded.

Following receipt of the draft inspection report the provider sent us evidence of more detailed care plans and assessments for some people and these had more information to enable the staff to know how to care for them.

People who used the service, their relatives and the local authority representatives felt the service met their needs. They said that care workers were kind, caring and polite. The care workers arrived on time and carried out all the tasks they expected. People told us that they were given choices and the care workers respected these.

The staff told us they were well supported and were happy working with the agency. They told us they had all the training they needed.

The registered manager had a good knowledge of the individual people who used the service and their needs. Stakeholders told us the registered manager was responsive and addressed any issues of concern.

The inspection took place on 5 July 2016 and was announced. We gave the provider 48 hours' notice because we wanted to make sure someone would be available to assist with the inspection.

This was the first inspection of the service since it was registered in November 2014. The service started providing care to people in 2016.

Humble Healthcare Limited is a domiciliary care agency providing personal care and support to people who live in their own homes. The agency is privately owned and this is the only registered location run by the provider. At the time of our inspection five people were receiving a service. Some people paid for their own care and some people were funded by the London Borough of Hounslow. The agency provided care and support to some older people and also younger adults with long term health conditions and mental health needs.

The registered manager had left the organisation. The provider was in the process of registering himself as the manager of the service. He had submitted an application to do this. 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 and associated Regulations about how the service is run.

The way in which new staff were recruited did not include sufficient checks on their suitability to work with vulnerable people. For example, the provider had not obtained a full employment history or references from previous employers for some members of staff. Information on staff job application forms was incomplete and the provider had not sought further information. Therefore the provider could not be sure that the staff who they employed were suitable.

The assessments of the risks people were exposed to did not include information for the staff about how they could support people and reduce the likelihood of harm.

Some of the records at the service were incomplete and not sufficiently detailed. In addition some information, such as staff supervision and quality monitoring had not been recorded.

You can see what action we told the provider to take at the back of the full version of the report.

People who used the service were happy with the care they received they found the care staff kind and helpful. They told us care workers arrived on time and met their needs. They found the provider responsive when they had a query or needed information. They had agreed to the way in which their care was delivered.

The staff felt supported and told us they had the information they needed to care for people. They had received training and information relevant to their role. They told us they were able to speak with the manager for extra information, support and training whenever they needed.

The provider was responsible for the daily management of the service. They knew the needs of the people who they cared for well and regularly checked that people were receiving good quality care.