HW Homecare

Updated 11 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The service was conducted by an Inspector and an Assistant Inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

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 was not a registered manager in post. The nominated individual was the responsible person with support from the branch manager to manage day to day running of the service.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. We also needed to gain consent from people to call them for feedback.

Inspection activity started on 30 May 2023 and finished on 23 June 2023. We visited the office on the 30 May 2023. We spoke with people and their relatives, staff, and the branch manager up until 23 June 2023 and had a conversation and email exchanges with the provider.

What we did before the 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

We spoke with 1 person who was receiving care. We spoke with 4 relatives and 1 health and social care professional about their experience of the care provided. We also spoke with 4 members of staff including the nominated individual, the branch manager and 2 care staff.

We reviewed a range of records. This included 7 people's care records and 1 person’s medicine records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, policies and procedures were reviewed.

Updated 11 August 2023

About the service

HW Homecare is a domiciliary care agency. At the time of our inspection, they provided personal care to 9 people living in their own homes. It provided a service to older adults, some who required moving and handling support or to manage health conditions.

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

Although a person and relatives told us they felt people were safe, we found risks to people were not always identified or recorded to ensure people’s safety. Staff did not always demonstrate knowledge of how to recognise concerns or report them to appropriate others. We received mixed feedback about the use of personal protective equipment (PPE) used by staff and staff competency had not been assessed in this area. Medicines had not always been given safely and there were no contingency plans for an emergency event. Staff recruitment checks were not consistently made before employment.

We found areas for improvement regarding staff knowledge and training. Staff were not adequately supported in their roles. There was minimal staff supervision and checks to ensure training had been effective.

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. However, we found staff did not always understand their legal responsibilities regarding documentation under the mental capacity act.

People's care documentation was not person-centred nor reflective of their current support needs. Where risks had been identified to people's health and wellbeing, assessments had not consistently been completed to detail support needs or when to seek further professional advice. There was a lack of oversight on incidents, complaints, training, medicines and safeguarding which meant the provider had not reflected on themes and trends. We also found that the provider had not always reported incidents to us that they were legally required to do.

The culture of the service was not always open and positive. Some feedback included unprofessional behaviour from staff, with reluctance to raise concerns or confusion on who to complain to. People, their relatives and staff had not been asked to provide feedback about their experiences of care.

People had assessments of need completed before they received support and involvement from professionals when required. A professional gave positive feedback about how staff worked with them to support a person.

Despite the concerns we found, a person and relatives were happy they received support from the same staff every day. The provider demonstrated a willingness to work with others and improve the service. The branch manager responded immediately to some areas of improvement during the inspection.

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 requires improvement (published 24 February 2022). The service remains rated requires improvement.

Why we inspected

We received concerns in relation to poor governance and minimal improvements from the previous inspection. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led.

We inspected and found there was a concern with staff training and understanding of mental capacity, so we widened the scope of the inspection to become a focused inspection which included the key question of Effective.

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 remained Requires Improvement. However, the key question of effective has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this report.

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

Enforcement

We have 4 identified breaches of regulations in relation to risk management, staff recruitment, staff training and leadership at this inspection.

We identified concerns about staff knowledge of mental capacity. We have made a recommendation regarding this.

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