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Humble Healthcare Limited Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 December 2017

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.

Inspection areas

Safe

Requires improvement

Updated 6 December 2017

Some aspects of the service were not safe.

There were procedures for the safe administration of medicines but the staff did not always follow these because they did not record medicines administration accurately.

The risks to people's safety and wellbeing were assessed and planned for.

There were enough staff to meet people's needs and the provider had carried out checks on their recruitment.

There were procedures designed to keep people safe and the staff were aware of these.

Effective

Good

Updated 6 December 2017

The service was effective.

People's needs and choices were assessed and care was provided to reflect these assessments.

People were cared for by staff who were well trained, supported and supervised.

The provider was acting within the principles of the Mental Capacity Act 2005.

People received the support they needed at mealtimes.

The staff monitored people's healthcare needs.

Caring

Good

Updated 6 December 2017

The service was caring.

People were treated with kindness, respect and compassion.

People were actively involved in making decisions about their care and expressing their views.

People's privacy, dignity and independence were respected and promoted.

Responsive

Good

Updated 6 December 2017

The service was responsive.

People were cared for in a way which met their needs and reflected their preferences.

People were cared for by the same familiar staff who knew their needs.

People felt able to make a complaint and raise concerns with the provider.

Well-led

Requires improvement

Updated 6 December 2017

Some aspects of the service were not well-led.

The provider's audits did not always identify when something had gone wrong or action was needed.

Records were not always accurately maintained.

There had been improvements to the service and the provider had demonstrated a commitment to making changes. They had identified and mitigated risks and had developed systems to carry out audits and checks.

There was an open and inclusive culture where people using the service and staff felt able to express their views, felt listened to and felt that the provider responded appropriately.