About the service H&H Healthcare provides a domiciliary care service for older people living in their own homes in the community. At the time of our inspection, there were forty-four people receiving personal care.
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
Leadership and monitoring of the service was not effective in ensuring people received good quality care which kept up to date with legislation and best practice. Systems to monitor the quality and safety of the service were either not in place or had been ineffective in driving the necessary improvements. However, during the inspection the provider understood the issues and how they came about. The provider acknowledged and understood what they needed to do to address the issues and immediate action was taken. The provider employed additional support and was receiving support from commissioners and the local authority quality improvement team, to achieve the improvements required.
Risks to people's health, safety and welfare had not always been adequately assessed. Governance and oversight systems had failed to ensure risk assessments provided sufficient guidance to staff to ensure people received safe care. Specific risks were not always recorded, meaning people were not protected as much as possible from harm.
People did not have personalised care plans in place. People's records were not written in a person-centred way and contained insufficient guidance for staff about how to meet people’s needs and preferences.
The management of medicines was not always managed safely or effectively which meant people were at risk of harm. Medicine records were not filled out correctly and therefore we could not be assured that people had received their medication as prescribed. The provider had not ensured care workers had been properly assessed and observed before they were permitted to handle people's medicines, to ensure this was done safely.
Care was not being provided in line with the Mental Capacity Act (2005). Mental capacity assessments for people who were considered to lack the capacity to make decisions about their care and support, were not in place. Therefore, we could not be certain people were supported to have maximum choice and control of their lives and were supported by staff in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
The provider did not have sufficient oversight of training to ensure staff had sufficient training to support people's individual needs. Training records did not demonstrate that all staff had been trained in mandatory subjects considered necessary to meet people’s needs.
Robust recruitment practice was not always followed. Complete work history including explanation for gaps in employment history and references, had not always been obtained. This potentially placed people at risk of harm.
People told us they felt safe due to the caring approach of staff and spoke positively about the support they received. People told us staff were kind and caring and treated them with respect. People felt staff upheld their dignity and supported them to keep their independence where possible. People told us they were involved in reviews of their care.
People told us they felt there were sufficient staff employed to meet their needs. Most people told us staff mainly arrived on time and stayed for the allocated time. However, the provider did not record, monitor and review late or missed visits to identify how to reduce these occurring.
The service was responsive to people's changing needs. We saw examples where people had been referred to other agencies, so their needs could be re-assessed. There was also liaison with family members. People's complaints were investigated by the service and responded to promptly and an apology given.
We made a recommendation with regards to infection control auditing .
Rating at last inspection
The last rating for this service was good (published 28 March 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
At this inspection we rated the service as requires improvement. We identified six breaches of regulations, in relation to safe care and treatment, fit and proper persons employed, staffing, need for consent, person-centred care and good governance. Please refer to the end of the report for action we have told the provider to take.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk