Hannah's Homecare Ltd

Hannah's Homecare is a domiciliary care agency, providing personal care to people in their own homes. At the time of the inspection there were 37 people receiving support.

People’s experience of using this service and what we found

Risks to people were not always assessed and managed robustly. Although some risk assessments were in place, they were not all accurate or consistent and some risks had not been assessed for all people. Care plans were not always updated when people’s needs changed. This meant staff may not have up to date information on how to meet people’s needs safely.

Medicines were administered by trained staff; however, people did not always receive their medicines as they were prescribed. For instance, the required four hours between doses of one medicine was not always adhered to. Records regarding the administration of medicines were not always clearly and robustly maintained.

Systems were in place to monitor the service and monitor quality and safety but were not always fully effective as they did not cover all aspects of the service and did not highlight all of the issues we raised during the inspection.

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; but the policies and systems in the service did not always support this practice. Records showed people signed to show their consent to planned care when able, but when mental capacity assessments were required to be completed, they were not always decision specific and best interest decisions were not clearly documented.

People and their relatives told us they felt safe with the support provided by Hannah’s Homecare. Staff were aware how to raise any safeguarding concerns and there were sufficient numbers of safely recruited staff available to meet people’s needs. People told us staff arrived on time and stayed for the planned amount of time and they usually received support from the same group of staff that knew them well.

People told us staff were well trained and knew their needs and how to support them. Staff were knowledgeable about actions they should take if people were unwell, and referrals were made to other professionals if there were concerns about people’s health and wellbeing. Staff told us they felt well supported in their jobs and records showed they received regular training and supervision and the provider had policies in place to help guide staff practice.

Feedback regarding the service provided to people was positive and the culture of the service helped ensure good outcomes for people. People, relatives and staff told us they felt the service was well managed. Systems were in place to gather people’s feedback regarding the service, such as surveys and a complaints procedure.

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 good (published 8 April 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led, and this was expanded onsite to include 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 changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to the management of risk and medicines at this inspection. We also made recommendations about the recording of people’s consent and governance systems. 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.

People’s experience of using this service:

People received support from staff that were kind, caring and compassionate. People’s needs had been fully assessed prior to them being supported by the service. Care plans had been developed and reflected people’s individual needs and preferences. They had been regularly reviewed to ensure the most up-to-date information and guidance was available for staff. People were supported by regular staff with whom they had developed positive relationships with.

Recruitment practices were safe and people were supported by staff that had undertaken a thorough induction and had completed training that was relevant to their role. Enough staff were employed to meet the needs of the people supported.

Risk assessments were in place giving guidance to staff to ensure that risks were minimised. These were regularly reviewed and held the most up-to-date information for staff. People were protected from the risk of harm and abuse. Staff had undertaken safeguarding training and felt confident to raise any concerns they had.

Staff had undertaken medication training and had their competency regularly assessed. Medication policies and procedures, along with best practice guidance was available for staff to follow. Medication administration records (MARs) were fully completed and regularly reviewed to ensure people received their medicines safely. Staff had completed infection control training and had access to personal protective equipment (PPE). An infection control policy and procedure was in place.

People spoke positively about the staff that supported them and the management team. People told us their privacy and dignity was respected and their independence was promoted. People told us their views were regularly sought regarding the staff and the care they received.

The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. Staff understood and respected people’s right to make their own decisions where possible, and encouraged people to make decisions about the care they received. Consent had been sought before any care had been delivered in line with legal requirements.

Rating at last inspection: Requires Improvement (Report published March 2018).

Why we inspected: This was a planned inspection based on the rating of the last inspection.

Follow up: We will continue to monitor all intelligence we receive about the service until we return to visit as per inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at

www.cqc.org.uk

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the service was supporting 16 people.

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.

At this inspection we found a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not ensure that they sourced adequate information about the people whom they employed prior to them commencing work.

You can see what action we have asked the provider to take at the end of this report.

We spoke with three people who used the service and two relatives who all gave positive feedback about the service and the staff who worked in it.

Staff spoken with and records seen confirmed training had been provided to enable them to support people with their specific needs. We found staff were knowledgeable about the support needs of the people that used the service. The registered manager needed to improve how the training information was recorded.

The staff understood the requirements of the Mental Capacity Act 2005 (MCA). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected. However, we did note that improvements were needed as to how this information was recorded.

Care plans were person centred and developed with the people who used the service. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.