Precious Hope Health and Home Care

Precious Hope Health and Home Care provides care and support to older people and people with a learning disability living in their own homes. At the time of our inspection the service was supporting 28 people.

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

Improvements were required to the monitoring of the safety and quality of the service. Day to day oversight was in place, however, monitoring of themes and trends to drive improvement were not in place.

People knew who to speak with if they had any complaint or concern. There was a complaints procedure in place so any complaint would be dealt with appropriately. However, relatives told us they regularly had to raise concerns with the manager about some aspects of care and support; but felt it was addressed appropriately.

People received care from a regular team of staff who had received the training and support required to carry out their roles. Staff knew how to keep people safe from abuse or harm. Safe recruitment practices were in place.

People received their prescribed medicines safely and there were effective practices to protect people from infection.

People's needs were assessed before they used the service. Risks to people's health were assessed and plans were in place to reduce any risks identified; these were reviewed regularly to ensure staff knew how to

meet their needs.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 November 2021).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Precious Hope Health and Home Care 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.

Precious Hope Health and Home Care provides care and support to older people and people with a learning disability living in their own homes. At the time of our inspection the service was supporting 23 people, however, only 19 people were 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

The provider failed to ensure their recruitment policies were followed. This meant staff had been employed without all the suitable checks being carried out.

People were at risk of not receiving their calls as planned. The provider failed to use their systems to check people had received their care at the planned times placing people at risk of not receiving their meals, personal care and medicines as planned. The provider did not have an adequate system to ensure staff who required supervision and close monitoring received this.

The provider did not have a robust system to ensure staff had accurate information about how to provide care as not all the care plans reflected people’s current needs.

Whilst the provider continued to recruit enough staff to meet people’s needs, the registered manager and office staff were providing care to ensure people received their care.

People and their relatives were asked for feedback about their care through telephone surveys. Staff meetings enabled staff and managers to discuss how they planned to improve the service.

People were protected from the risk of abuse by staff who understood how to recognise and report abuse. The registered manager had raised safeguarding concerns appropriately.

Staff had received training in infection prevention and control and had access to personal protective equipment which they used during people’s care.

The registered manager reviewed accidents, incidents, near misses and complaints; information from lessons learned were shared with staff to reduce further risk.

The registered manager referred people to other organisations and health professionals for assessments to improve people’s housing, medicines and fire risks.

The provider had implemented an electronic medicines system which had improved the managerial oversight of recording of people’s medicines.

The provider and registered manager were working with commissioners and a consultant to improve their governance systems.

Rating at last inspection

The last rating for this service was requires improvement (published 20 October 2020).

Why we inspected

We received concerns in relation to recruitment and governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to recruitment and a continued breach in relation to managerial oversight and governance at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Precious Hope Health and Home Care is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 19 people were receiving support with 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

There was a lack of oversight and governance systems to ensure people received a safe service. Systems that were in place were not implemented effectively and audits had not effectively identified concerns with the service. Systems in place to safeguard people from abuse had not been followed in a timely way.

Records relating to people's risks and care needs were incomplete and contained misleading information. As a result, staff did not receive all the information and guidance they required to provide care that met people's needs. Medicine records were incomplete, and the administration of people’s medicines was not consistently recorded.

Improvements were required to the timing of people’s care visits. Recruitment records required review to ensure the provider had the information needed to provide assurance that staff were suitable to work in the service.

People provided positive feedback about the regular staff who provided their care. They told us they received the care they required.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People felt listened to and their views were acted upon.

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.

Staff understood infection control requirements and worked in a safe way to limit the spread of infection.

The provider was aware that improvements were required to the service. They were implementing new systems and were working with commissioners to make the improvements needed.

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

Rating at the last inspection

The last rating for this service was good (published 2 December 2017).

Why we inspected

We received concerns in relation to the quality, safety and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have identified breaches in relation to safe care and treatment and good governance at this inspection. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in September 2016 the service was rated ‘Requires Improvement’ under ‘Safe’ and ‘Well-Led’ and the overall rating was ‘Requires Improvement’. We saw the provider had displayed the ratings, on their website and it was also on display within the agency office. At this inspection we found the provider had made the necessary improvements as identified at the last inspection, namely to the call monitoring system and the overall monitoring of the service. The service is now rated as Good.

The service had a registered manager. 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 2008 and associated Regulations about how the service is run.

Staff understood their responsibilities to keep people safe and systems were in place to respond to any concerns of abuse. Individual risks to people’s health and welfare were assessed and appropriate measures were in place to effectively manage risks.

Recruitment procedures were sufficiently robust to protect people from receiving unsafe care from staff unsuitable to work at the service. There was sufficient staff available to meet people’s support needs. Where the service took on the responsibility for peoples’ medicines these were managed safely.

People were involved in decisions about their care and support needs as much as they were able. Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA 2005) and applied their knowledge appropriately.

Staff knew the people who used the service well. People were given choices about their day to day routines and about how they wanted their care to be delivered. People’s privacy and dignity was maintained at all times. People were involved in planning their care, the care plans were personalised and regularly reviewed.

People received care from staff that had the appropriate skills and knowledge to meet their needs. All staff received on-going training to refresh their knowledge and skills.

The service was open and transparent, systems were in place to receive and respond to complaints. Notifications were submitted to the Care Quality Commission (CQC) as required and the provider worked with other healthcare providers and commissioners.

Systems were in place for the provider to effectively monitor all aspects of the service to continually drive improvement.

The service provides support with personal care to people in their own homes. At the time of our inspection there were 18 people using the service.

The service did not have a registered manager in post at the time of our inspection. 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 2008 and associated Regulations about how the service is run.

The registered manager for the service had resigned in July 2016 however they had yet to cancel their registration to manage the service with the Care Quality Commission (CQC). The provider told us that they had appointed a new manager for the service and that they had submitted the relevant documents to CQC to begin the registered manager application process.

People did not always have the correct information regarding the staff that would be attending their support call and could not always be assured that the visit would take place at the agreed time. The provider was aware of this and was currently working to improve the consistency and timing of care visits.

The provider did not have all appropriate measures in place to assure themselves of the quality and safety of the service. The system in place to monitor care staff attendance at care visits was not sufficiently robust. The provider was aware of this and was taking action to implement a new system of call monitoring.

There were systems in place to manage medicines safely. Staff were trained in the safe administration of medicines and people had specific care plans relating to the provision of their medicines.

People were protected from harm arising from poor practice or abuse as there were clear safeguarding procedures in place for care staff to follow if they were concerned about people’s safety. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

Recruitment procedures were sufficiently robust to protect people from receiving unsafe care from support staff that were unsuitable to work at the service.

People were actively involved in decisions about their care and support needs as much as they were able. Staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA2005) and applied their knowledge appropriately. There was a Mental Capacity policy and procedure for staff to follow to assess whether people had the capacity to make decisions for themselves.

People received care from staff that were kind and friendly. People had meaningful interactions with staff and looked forward to seeing the staff. People received care at their own pace and were treated with dignity and respect.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. Care plans were written in a person centred approach and detailed how people wished to be supported and where possible people were involved in making decisions about their care.

People received care from staff who had the appropriate skills and knowledge to meet their needs. All staff had undergone the provider’s induction and the provider had a plan in place for on going training.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.