You are here

Humble Healthcare Limited Inadequate

Reports


Inspection carried out on 11 May 2018

During a routine inspection

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 carried out on 7 November 2017

During a routine inspection

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 carried out on 12 July 2017

During a routine inspection

The inspection took place on 12 July 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.

The last inspection took place 5 July 2016 when we rated the service Requires Improvement. We made breaches in respect of safe care and treatment, fit and proper persons employed and good governance. At the inspection of 12 July 2017we found that there had not been enough improvements in any of these areas. In addition we found other areas of concern which included the management of medicines, supervision of staff and the assessment of people's needs.

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 28 people were using the service. People using the service lived in the London Boroughs of Southwark and Hounslow. The majority were older people (over the age of 65 years). Four people had been using the service since 2016. The other 24 people started using the service between March and June 2017. There were 16 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.

The owner of the company was also the 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 and associated Regulations about how the service is run.

The risks to people's safety and wellbeing had not been assessed and there was no guidance to ensure the staff minimised these risks.

Medicines were not managed safely so people were at risk of harm.

The provider had not undertaken all the required checks on the staff employed. Therefore people were at risk of receiving care from staff who were not suitable. The provider did not ensure that staff were suitably supervised to make sure they were competent.

The provider had not assessed or planned for people's needs. Therefore there was a risk that they would receive care which was not suitable.

Records were not accurately maintained. Therefore staff did not have clear information about how they should meet people's needs.

The provider's systems for monitoring the quality of the service, mitigating risks and making improvements were insufficient and this meant people were at risk of receiving care which was not safe and did not meet their needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For the breaches of Regulations in relation to person centred care and staff support you can see what action we have asked the provider to take at the back of the report. We are taking further action against the provider for breaches of Regulations in relation to safe care and treatment, good governance and fit and proper persons employed. Full information about CQC’s regulatory response to the concerns found during this inspection is added to reports after any representations and appeals have been concluded.

Following receipt of the draft inspection report the provider sent us evidence of more detailed care plans and assessments for some people and these had more information to enable the staff to know how to care for them.

People who used the service, their relatives and the local authority representatives felt the service met their needs. They said that care workers were kind, caring and polite. The care workers arrived on time and carried out all the tasks they expected. People told us that they were given choices and the care workers respected these.

The staff told us they were well supported and were happy working with the agency. They told us they had all the training they needed.

The registered manager had a good knowledge of the individual people who used the service and their needs. Stakeholders told us the registered manager was responsive and addressed any issues of concern.

Inspection carried out on 5 July 2016

During a routine inspection

The inspection took place on 5 July 2016 and was announced. We gave the provider 48 hours' notice because we wanted to make sure someone would be available to assist with the inspection.

This was the first inspection of the service since it was registered in November 2014. The service started providing care to people in 2016.

Humble Healthcare Limited is a domiciliary care agency providing personal care and support to people who live in their own homes. The agency is privately owned and this is the only registered location run by the provider. At the time of our inspection five people were receiving a service. Some people paid for their own care and some people were funded by the London Borough of Hounslow. The agency provided care and support to some older people and also younger adults with long term health conditions and mental health needs.

The registered manager had left the organisation. The provider was in the process of registering himself as the manager of the service. He had submitted an application to do this. 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 way in which new staff were recruited did not include sufficient checks on their suitability to work with vulnerable people. For example, the provider had not obtained a full employment history or references from previous employers for some members of staff. Information on staff job application forms was incomplete and the provider had not sought further information. Therefore the provider could not be sure that the staff who they employed were suitable.

The assessments of the risks people were exposed to did not include information for the staff about how they could support people and reduce the likelihood of harm.

Some of the records at the service were incomplete and not sufficiently detailed. In addition some information, such as staff supervision and quality monitoring had not been recorded.

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 were happy with the care they received they found the care staff kind and helpful. They told us care workers arrived on time and met their needs. They found the provider responsive when they had a query or needed information. They had agreed to the way in which their care was delivered.

The staff felt supported and told us they had the information they needed to care for people. They had received training and information relevant to their role. They told us they were able to speak with the manager for extra information, support and training whenever they needed.

The provider was responsible for the daily management of the service. They knew the needs of the people who they cared for well and regularly checked that people were receiving good quality care.