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Humble Healthcare Limited Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 7 July 2018

that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

At the last inspection of 8 November 2017 we rated the service Requires Improvement overall and in the key questions of Safe and Well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-Led to at least ‘good’.

At this inspection of 11 May 2018 we found they had not made the required improvements and have rated the service Inadequate overall and in the key questions of Safe and Well-led. We have rated the key questions of Effective, Caring and Responsive as Requires Improvement.

Humble Healthcare Limited is 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 people and younger adults with physical disabilities, learning disabilities and mental health needs. At the time of our inspection 24 people were using the service. All the people lived within the London Borough of Southwark and their care was commissioned by this local authority. Humble Healthcare Limited is the only location for this provider.

There was a registered manager in post; they were also the owner of the company. 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 had not made suitable arrangements to ensure that people received their medicines as prescribed and in a safe way.

The provider's governance arrangements had failed to identify when things had gone wrong and take action to put this right. For example, we found medicines administration records which had errors. These had been audited by the registered manager, although the errors had not been identified or investigated.

Some people were supported by staff who undertook shopping for them. There was no system to ensure that people were not financially abused because the staff did not keep records of expenditure and the provider did not carry out checks on this.

Records about people were not always accurate or complete. The provider had used the same information in a number of different people's care plans and this was not relevant to them and did not describe their needs. Therefore, there was a risk that people would receive care and treatment which was not appropriate and did not meet their needs.

Where risks had been identified by the local authority, the provider had not ensured that these were recorded within risk assessments or care plans and there was no guidance for the staff on how to minimise these risks.

The provider was unable to evidence that staff had been suitably trained and supervised to provide care and support to people who used the service.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The provider had procedures for recruiting staff but was not always able to evidence they had made the necessary checks on staff suitability.

Following the inspection visit the provider updated some of the care plans and risk assessments as a result of our feedback and sent us evidence of this.

Most people using the service were happy with the service they received. One person raised significant concerns but the provider spoke with this person to resolve these and they reported that they were satisfied with this. Some other people felt that the service did not meet their needs, whilst others were very satisfied and felt the provider did a good job. People told us that care workers did not always arrive on time but most people did not mind this and they said the care workers stayed for the agreed time. Most people explained that they usually had the same care workers, who they had a good relationship with and liked. A few people felt the attitude of some care workers needed to be improved but most people told us that care workers were kind, caring and compassionate.

The majority of people told us that their needs were being met. The relatives of some people explained how they felt the agency offered peace of mind and that they had seen improvements in people's health and wellbeing since they started receiving support from the agency. The provider was able to meet people's requirements about visits at certain times of the day. At the previous inspection we spoke with a representative from the local authority and they told us that this flexibility regarding visit times was something other agencies did not offer. The feedback from people using the service and their representatives at this inspection confirmed this was still the case.

A small number of people felt that communication from the agency needed to improve but most people using the service, their relatives and staff told us that the registered manager was available when they were needed. Some people said that they had called the registered manager to request something, such as a change in the time of visits, and this had been arranged. The care worker we spoke with said that they could ''Ring [the manager] at any time, even two in the morning, and he answered the phone.'' They told us they felt supported by this. The provider also obtained regular feedback from people about the service they received, through telephone monitoring and asking them to complete surveys about their experiences.

The registered manager had recognised that they needed support and guidance to make sure the governance at the service was suitable. They had employed a consultant who had started to offer them advice and support. The consultant explained that they would continue to work with the provider to make improvements.

Inspection areas

Safe

Inadequate

Updated 7 July 2018

The service was not safe.

People were placed at risk because the procedures for managing medicines were not always followed.

The risks for individual people had not always been assessed or planned for.

There were insufficient safeguards to protect people from the risk of financial abuse.

The provider was not able to evidence that the recruitment of staff included all the necessary checks on their suitability.

Effective

Requires improvement

Updated 7 July 2018

Some aspects of the service were not effective.

The staff did not always have the training, supervision and support they needed to make sure they provided effective care.

People's needs were assessed, although the records of these were not always complete or accurate.

People consented to their care and treatment.

People who received support at mealtimes were happy with this support.

Caring

Requires improvement

Updated 7 July 2018

Some aspects of the service were not caring.

Some people did not feel the care workers or the provider provided a caring service.

Most people felt they were involved in making decisions.

Most people felt that care workers were kind, caring and polite.

Responsive

Requires improvement

Updated 7 July 2018

Some aspects of the service were not responsive.

Most people felt their needs were being met, but plans of care were not always accurate, complete or relevant. Therefore there was a risk that people's needs would not be met.

People knew how to discuss a concern and the provider had a system for dealing with this.

Well-led

Inadequate

Updated 7 July 2018

The service was not well-led.

The provider's systems for monitoring and improving the quality of the service were not effective.

Records were not clearly or accurately maintained.

The provider had not taken sufficient action to address the breach of Regulations identified at the last inspection.