Heart to Heart Care NW Limited

Heart to Heart NW Ltd is a domiciliary care agency that provides support and personal care to adults in their own homes. At the time of our inspection 112 people received support from the service. Not everyone who used the service received personal care. The Care Quality Commission 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

Effective quality assurance and governance measures had not been fully embedded at the service. We were not always assured that quality performance or risk management measures were assessing the quality and safety of care people received.

Safety monitoring and management of risk had improved. The majority of care records contained relevant and up to date care needs and risk management information. However, we identified that additional oversight and assurance measures need to be implemented as a way of ensuring that all areas of risk were appropriately recorded and monitored.

Improved medicine management processes had been implemented. Care records contained essential information for staff to follow, improved medication administration processes had been implemented, PRN (as and when needed) medicines and topical cream processes had been strengthened and there was a greater level of oversight in relation to compliance.

Infection prevention and control (IPC) measures and arrangements had improved. Staff were engaged in COVID-19 testing regimes, staff had completed IPC training, PPE was readily available, and people had relevant COVID-19 risk assessments in place.

People were protected from abuse and avoidable harm; systems and processes were in place to ensure safeguarding incidents were recorded and reported, staff knew how to escalate any safeguarding concerns and there was a greater level of oversight in relation to call monitoring and completion of daily tasks.

The introduction of an 'electronic call monitoring' (ECM) system meant that there was greater oversight in relation to staffing levels and call times. The provider ensured that call times were analysed in conjunction with the packages of care that needed to be delivered. We did receive some feedback to suggest that staff continued to run late from time to time.

Recruitment procedures and pre-employment recruitment checks need to be strengthened. We have made a recommendation regarding recruitment practices.

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 last rating for this service was ‘inadequate’ (published 29 November 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Although improvements had been identified during this inspection, the provider was still in breach of regulation 17 (Good Governance).

This service has been in special measures since November 2021. 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

We undertook this focused inspection to check whether the breaches of regulations and warning notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met.

The focused inspection reviewed the key questions of safe, and well-led only. 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.

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

The overall rating for the service has improved 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 Heart to Heart Care NW Ltd 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 have identified a breach in relation to ‘good governance’.

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.

Heart to Heart NW Ltd is a domiciliary care service that provides support and personal care to adults in their own homes. At the time of our inspection 155 people received support from 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

This was a focused inspection looking at the domains of safe and well-led only. At the last inspection, the provider was rated good in the safe domain, and requires improvement in well-led. At this inspection, both of these domains had deteriorated to inadequate.

Medication management was not safe. There were no adequate systems in place to check that people’s medicines were administered as prescribed. Medication administration records contained gaps indicating that some people had not received the medicines they needed to keep them safe and well.

People’s needs and risks had not been adequately assessed. Staff lacked sufficient guidance and information on what these needs and risks were. Some people had specific dietary requirements that needed to be followed to protect them harm. Records showed these people had not received safe and appropriate care at all times.

The visit times people had agreed with the service, were not always respected. Visits were sometimes much later or earlier than agreed. There was no effective system in place to ensure staff attended when they should.

Incidents of a safeguarding natures such as unexplained bruising or inappropriate care had not been identified by the manager or provider. This meant they had not been properly investigated and reported to the local authority or CQC.

The provider’s policies and procedures for COVID-19 were too brief and failed to clearly identify how risks associated with the virus would be mitigated against. The risks of COVID-19 had not been assessed or planned for, in respect of, the welfare of people using the service and staff. This was not good practice and did not adhere to government guidelines.

There were limited systems in place to monitor and audit the quality and safety of the service. The audit systems in place had not identified the concerns we identified during the inspection. The systems were poor and did not ensure risks to people’s health, safety and welfare were managed and safe care provided.

Staff were recruited safely. Staff told us they felt supported by the manager and able to raise any concerns. The manager and assistant manager told us the service had experienced staff shortages as a result of COVID-19 which had placed extra pressure on the service.

People and their relatives said staff were kind, caring and supportive. They told us staff wore appropriate PPE to prevent the spread of infection during their visits.

During the inspection, the manager and assistant manager were open and approachable, but were unable to explain concerns identified during the inspection. They did not demonstrate they had a clear understanding of the management requirements of the service in order to ensure people’s care was safe and the service well-led.

Rating at last inspection and update

The last rating for this service was good (published 10 October 2019). At the last inspection the domain of safe was rated good and the domain of well led was rated requires improvement. At this inspection, these domains had deteriorated to inadequate. A breach of regulation 12 (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment) and regulation 17 (Good Governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified.

Why we inspected

We received concerns in relation to the quality and safety of the service both from people or, relatives of people using the service and the Local Authority. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Heart to Heart NW Ltd 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.

Please see the action we have told 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.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work with the local authority to monitor progress.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service has been placed 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.

Smart Care Services NW Limited is a domiciliary care agency, providing personal care to people in their own houses or flats. At the time of inspection, the service supported 192 in Warrington and surrounding areas.

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’s experience of using the service was overall positive. We found, some improvements were needed with regards to meeting regulatory requirements, however the provider addressed these immediately. Smart Care Services NW Limited is an independent provider and we recognised they had significantly invested into developing their quality assurance systems following our last inspection. This had led to improvements, but some newer aspects of governance still needed to embed and develop to be effective at ensuring consistently high-quality care.

We have made a recommendation about staffing. When we assessed the service, we considered the individual experience of people, relatives and staff and looked at these in proportion to the size of the service. For example, the large majority of people received their care calls on time or mostly on time. Some people felt call times and consistency of staff were not always reliable. However, we also heard this had improved and the registered manager was reviewing all care call routes to provide greater consistency. We made a recommendation regarding effectively supporting people to take their medicines at the right time.

Overall, we heard positive comments from people and relatives about care staff. Although some people noted variation in standards and room for improvement, others praised staff highly, for the way in which they engaged with people and supported their independence. All of the staff we spoke with praised the positive culture of the service, its leadership and the support provided. This was evident in the fact that several staff had left to go to a different provider but chose to return. The service worked in partnership with different professionals to promote people’s health and wellbeing. Stakeholder feedback noted continued improvement, with some areas of inconsistencies to address.

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 last rating for this service was requires improvement (published 8 August 2018).

At the last inspection we found the provider was in breach of regulations, as governance systems had not always been effective. 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

This was a planned inspection based on the previous rating.

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.

Smart Care Services NW Limited is a domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the registered provider was providing support to 147 people.

Not everyone being supported by Smart Care Services NW Limited received personal care. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, help with tasks relating to personal hygiene and eating. 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 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.

This was the first comprehensive inspection of Smart Care Services NW Limited since their registration with the Care Quality Commission in April 2017.

Quality assurance and governance systems were not effectively in place. Audits and checks were not assessing, monitoring or identifying areas of improvement that were needed. We found care plan and risk assessment audits to be ineffective, records and documentation were not appropriately completed and processes to gauge feedback needed to be developed.

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

Medication management procedures were in place and staff were familiar with the importance of complying with medication policies. Staff were trained in the administration of medication and ‘spot checks’ were completed to monitor and assess the competency levels of staff. Topical (medicated) creams were safely applied and people were administered the medication they required. We did identify that PRN (‘as and when’ needed medication) protocols needed to be reviewed.

We recommend that the registered provider reviews their PRN policies and procedures, ensuring people receive PRN medication in the safest way.

Care plans and risk assessments were in place and staff were familiar with the support needs of people they were supporting. We received positive feedback from people, relatives and healthcare professionals about the level of safe care that was provided and how risks were managed.

Recruitment processes were safely in place. The registered provider ensured that staff who were employed were suitable to work with vulnerable adults. Disclosure Barring and System (DBS) checks were conducted prior to employment commencing.

Staffing levels were safely managed and people received the level of care and support expected. We were informed that all scheduled support visits took place and staff ‘generally’ arrived on time. Relatives and people who received support said that staff would always inform them if they were going to arrive later than expected.

‘Accident and Incident’ reporting procedures were in place. There was an up to date ‘Accident Reporting’ policy and staff were familiar with the necessary reporting procedures. The registered provider ensured that all incidents involving people who were supported, medication and safeguarding were routinely recorded and trends were established accordingly.

Staff were knowledgeable in the area of safeguarding and whistleblowing procedures. Staff had received the necessary safeguarding training which meant that people were protected from harm and abuse. Staff knew how to report any concerns and who to report their concerns to.

Health and safety policies and procedures were in place. Staff were provided with personal protective equipment (PPE) and they were aware of the different infection prevention control procedures that they needed to follow. The registered provider ensured that staff were provided with uniforms, aprons and gloves.

During the inspection we checked to see if the registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. People’s ability to make decisions about the care they received was considered in line with principles of the MCA. However, we identified that ‘consent’ to care documentation needed to be reviewed and updated.

Staff received regular supervision and told us that they were thoroughly supported in their roles. All new staff had to complete a five-day induction where both mandatory and specialist training was provided.

Support was provided by external healthcare professionals such as GP, social workers, district nurses and dieticians. People received a holistic level of care which supported their overall health and well-being. We also received positive feedback from the healthcare professionals we spoke with during the inspection.

People’s nutrition and hydration needs were supported. Staff were aware of people’s preference with regards to eating and drinking, as well as any associated risks. The appropriate referrals were made to external healthcare professionals and the relevant guidance was followed.

We received positive feedback across the course of the inspection from everyone we spoke with. People, relatives and healthcare professionals all confirmed that the care provided by Smart Care staff was kind, caring and respectful. People felt that they received dignified care and they were able to build positive relationships with regular staff who supported them.

The registered provider had a complaints policy in place. We reviewed how complaints were reviewed and if these were responded to in line with the registered providers policy. We found that complaints were effectively managed and responded to in accordance with policy. People and relatives explained that if they did have any complaints or concerns they could confidently speak to staff or managers.

‘End of life’ support was provided to people who were at the end stages of life. At the time of the inspection there was nobody who was supported with this level of specialised care. However, staff received ‘end of life’ training as part of the five-day induction.

The registered manager ensured that team meetings regularly took place and effective communication systems were in operation. People told us that they were always updated with significant information and there was a collaborative approach to care that people received.

The registered provider had a variety of different policies and procedures in place. Policies contained relevant information and guidance for staff to follow. Some of the policies we reviewed included health and safety, safeguarding, lone working, whistleblowing, equality and diversity, medication administration and manual handling.

Staff expressed that they felt supported by the registered provider and the registered manager. Staff said that there was an ‘open door’ policy and they could access support whenever they needed it.

The registered manager was aware of their regulatory responsibilities and understood that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures.