Honor Care Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating is requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment.
 

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness. Lessons were not always learnt to continually identify and embed good practice.

The oversight and management of safety events was not always effective. Where accident and incidents had occurred and documented, these did not always detail post-incident information, such as the actions taken by staff and whether external healthcare professionals had been involved. Safety events had also not always been reviewed and analysed by the provider for understanding and learning. Following feedback, the provider acknowledged the need for improvement in this area. This meant people were at risk of accidents and incidents not being appropriately managed.

There was also a lack of an effective learning culture in other areas, such as a lack of regular staff meetings by the provider. This meant staff did not have the opportunity to share learning to improve service delivery.
 

The provider did not always ensure safe systems of care. They did not always manage or monitor people’s safety.

The provider did not have effective systems of monitoring and managing safety in the service. For example, concerns regarding the management of safety events, safeguarding and awareness of the principles of the Mental Capacity Act 2005 (MCA), had not been identified or acted upon to ensure people were consistently safe. This meant people were exposed to avoidable risk.

People and relatives told us they had been involved and had no concerns regarding the transition process for people before they moved to the service. The provider was able to describe this process, which included obtaining information regarding people’s care and support needs so this information could be reflected in their care records.
 

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on protecting their right to live in safety, free from avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

The provider failed to understand, manage and report safety incidents that had occurred which had affected people’s health, safety and welfare. There was an increased risk of recurrence of safety events due to incidents not always being adequately managed, which exposed people to avoidable harm. These events had not been appropriately reported to external partners, such as the local authority safeguarding team and CQC. This meant we could not be assured people were appropriately safeguarded.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). Where the provider judged that a person lacked capacity to be able to consent to their care arrangements, a mental capacity assessment had been carried out. However, these assessments were not decision-specific regarding key aspects of people’s care, and instead solely referred to people’s ability to be able to consent to receiving a package of care from the provider.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In homecare services, where a person is suspected as lacking mental capacity in relevant areas, this can be done through an application to the Court of Protection, which is part of the MCA. We checked whether the service was working within the principles of the MCA and how they sought authorisation regarding the use of restrictive practices and found, where this was applicable, people did not have a court order issued by the Court of Protection which legally authorised instances in which people were subjected to deprivations of liberty. For example, while the provider and a family member stated staff did not use physical restraint with a person, care records showed a person had been subjected to physical restraint by staff following them having displayed heightened emotional behaviours towards staff. Some staff also told us physical restraint was an intervention they used on occasions with this person. However, a court order had not been requested by the provider to authorise this deprivation of liberty. This meant we could not be assured people were being deprived of their liberty with the legal authority to do so.
 

The provider did not always work well with people to understand and manage risks.

People’s care plans did not always provide information which accurately reflected people’s needs and risks. For example, care plans did not always provide information which adequately detailed people’s emotional, behavioural, physical health, mobility and safety needs. Where people displayed heightened emotional behaviours, guidance was not available to staff, meaning staff unfamiliar with these people’s needs might not be able to support them effectively. This exposed people and staff to the risk of harm. There was some evidence of referrals having been made to healthcare professionals. However, there were missed opportunities where referrals to healthcare professionals may have been beneficial to people.

Staff mostly demonstrated a good awareness of the risks associated with people and how they could be supported.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment and facilities supported the delivery of safe care.

Staff received health and safety training and demonstrated a good awareness of how to ensure people’s home environments and mobility equipment were maintained to mitigate potential risks.

The provider completed spot-checks of staff practice within the environments of people they helped to maintain. No concerns were identified from these checks.

The provider did not make sure there were enough suitable and skilled staff.

The provider had not obtained written references from previous employers of the international sponsored staff they employed. The provider stated they had instead received verbal references from previous employers regarding these staff. However, there were no records which detailed what these conversations consisted of. This meant there were limited assurances around staff suitability to support vulnerable people.

Staff had not received training which was relevant to aspects of people’s needs. For example, staff had not received medicines and moving and handling competency assessments, which was relevant to some people’s needs. This meant people were at risk of their needs not always being provided by competent staff.

Staff received inductions and received regular supervisions with leaders. People and relatives were satisfied staff demonstrated the skills they needed to provide safe care.

The provider assessed and managed the risk of infection.

Most staff had received training in infection prevention and control (IPC). Supplies of personal protective equipment (PPE) were observed in the office, which staff told us they had access to when they needed it, and people and relatives said staff used PPE when providing care. The service had an IPC policy which set out the provider’s IPC expectations.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff received training in safe medicines management. However, they had not received medicine competency assessments to ensure they administered medication competently and safely.

The provider did not always have a clear and consistent awareness of people’s medicines needs. For example, 1 person’s care plan stated they self-medicated. However, the plan also stated staff were to administer the person’s medicines and needed to be aware of the dose and timing of their medicines. This meant people’s medicines arrangements were not always clear and support was not always provided by competent staff in accordance with best practice guidance.

A medicines policy was in place, and staff we spoke with demonstrated a good awareness of medicines processes and people’s individual medicine needs.