Herts at Home

Updated 5 January 2023

The inspection

We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and care workers.

Inspection team

This performance review and assessment was undertaken by one inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care [and support] service.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were two registered managers in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 28 November 2022 and ended on 14 December 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

This performance review and assessment was carried out without a visit to the location’s office. We used technology such as video calls to enable us to engage with people using the service and care workers, and electronic file sharing to enable us to review documentation.

We received feedback from nine people who used the service and five relatives about their experience of the care provided. We received feedback from 38 care workers, and we had a video call with the nominated individual on 08 December 2022 and also with the registered managers on 14 December 2022. We reviewed a range of records relating to the management of the service, including care plans and risk assessments, care workers training records, evidence of monitoring care workers practice and medication competencies.

Updated 5 January 2023

Herts at Home Limited is a domiciliary care service; it is owned by Hertfordshire County Council and is operated from an office located at County Hall, Hertford. At the time of our inspection 353 people received personal care and support. Support was provided for people living in nine sheltered housing schemes and in their own houses and flats in the community.

Not everyone using Herts at Home receives the 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.

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

External agency staff deployed to cover for staff shortages did not always provide consistent care appropriate to meet people’s needs.

People had not experienced any missed care visits however, people said they were not informed when care workers were running late.

Care workers ‘slept in’ at the housing schemes however, there was no ‘out of hours’ support available during the night in the event of an emergency.

Care worker’s training matrix did not include fire safety training and care workers confirmed they had not received this training. This meant care workers may not understand about fire prevention and people may not be protected in the event of a fire.

Care workers reported good support from their local managers and were comfortable to approach them and felt well supported. However, feedback indicated the management culture was not always open and transparent, senior management were not always approachable and did not always support the team to do their roles.

People said they received good care and support however, people and relatives across all areas this service operated told us some care workers were not happy, demoralised and demotivated.

The provider had undertaken an organisational re-structure which left some care workers feeling undervalued. A divide had been created within the staff team as a result of the re-structure, this had contributed to the dip in morale and wellbeing.

People, their relatives, care workers and external professionals were encouraged to complete quality assurance questionnaires forms. However, feedback indicated the staff team were not assured their anonymity or confidentiality would be protected either through quality assurance surveys or the provider’s whistleblowing processes.

Safe and effective recruitment practices were followed to help ensure recruits were of good character and sufficiently experienced, skilled and qualified. Care workers were trained and had their competencies to safely administer medicines checked by senior staff. Care workers had received infection control training, their performance in this area was assessed at local management spot checks.

People were supported and encouraged to be as independent as possible with a risk assessment process. Care workers were knowledgeable about potential risks to people’s health, well-being or safety. These needs were assessed and reviewed to take account of people’s changing needs and circumstances.

People said they felt safe. People’s relatives were confident people were safe and protected from abuse and avoidable harm. People were supported by care workers who had been trained how to safeguard people from harm. Care workers understood the risks and potential signs of abuse and knew how to raise concerns.

Incidents and accidents were recorded, investigated by local managers and reviewed by the senior management team to help ensure appropriate steps were taken to improve people’s safety and wellbeing.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The two registered managers had regular contact with managers for each extra care housing scheme and the community team. Regular checks and audits were undertaken across a wide range of areas including the management of medicines, health and safety, complaints, safeguarding, accidents and incidents, care workers’ performance and people’s support plans.

Health and social care professionals told us the management team were always responsive to any comments and suggestions and demonstrated commitment to working collaboratively with people, their families, specialists and professionals as needed.

The management team and care workers were clear about the provider’s values and the purpose of the services provided. The management notified us of certain events that occurred. This meant we could ensure appropriate and effective actions had been taken.

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

Rating at last inspection

The last rating for this service was good (published 18 December 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. 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 good to requires improvement based on the findings of this inspection. We have found the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

Follow up

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