We carried out a review of the data available to us about Hartwig Care (Camden) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hartwig Care (Camden), you can give feedback on this service.
Hartwig Care Limited is a domiciliary care agency that provides personal care to people in their own homes. The people who used the service had a variety of care needs and included elderly and frail people and those with learning disabilities. At the time of the inspection, the agency provided care to approximately 480 people across three London boroughs. 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
Before this inspection, we received concerns about allocating and monitoring care visits for people who used the service. We were also told that there was limited support for care and office staff, and that the service was not always following guidelines on COVID-19 safety. During this inspection, we identified that the service had been experiencing some shortfalls in how care visits were scheduled and monitored. We made a recommendation about it.
Overall, the care and office staff told us they felt supported by their managers during the COVID-19 pandemic. This included appropriate training, supply of personal protective equipment (PPE) and the managers always being available to guide and support. Overall, both the care and the office staff thought the service supported them when they had to self-isolate due to the COVID-19 risks. A few staff said this support was not sufficient. We fed this back to the members of the senior management team.
We reviewed infection control processes and procedures at the service. Overall, we were assured that these were sufficient to protect people and staff during the coronavirus pandemic. When people, relatives, or the staff identified shortfalls in infection prevention and control, the managers addressed this.
At this visit, we identified the service needed to make improvements in relation to the management of high-risk medicines. We made a recommendation about this. The service managed other aspects of medicines management well, and people received their medicines as prescribed.
The service had appropriate safeguarding procedures in place to protect people from abuse. The service recruited staff safely, and staff received safeguarding training to help them recognise different types of abuse. The service assessed risks to people’s health and well-being. We highlighted to the senior management team that some risk assessments needed more personalisation to reflect specific risks for specific individuals. When an accident or incident happened, staff notified the service about it, and respective managers acted to ensure people were safe.
Overall, people and their relatives spoke positively about the care staff and the managers at the service. They thought care staff were kind and caring, and people felt comfortable in their presence. People had care plans describing their care needs and preferences. We noted that some care plans needed more information on specific aspects of care for individual people. People and relatives told us that some staff, who did not visit people regularly, would benefit from more information about people before visiting for the first time. We fed this back to the managers at the service.
People, relatives and care staff said that overall, it was easy to contact the service when they needed support and advice.
The managers undertook a range of quality checks to ensure people were supported as agreed. We noted that the senior management team knew about most shortfalls highlighted by us during this inspection and acted on improvements.
External health and care professionals said Hartwig provided effective care to people, and when they identified issues with care, the managers acted on improvements to ensure people received safe care.
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 01 February 2019).
Why we inspected
We received information of concern about following COVID-19 safety guidelines, scheduling and monitoring of care visits and care and support provided for staff at the service. A decision was made for us to undertake a focused inspection to examine these concerns by reviewing the key questions of safe and Well-led.
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 these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make some improvements. We made two recommendations about management of high risk medicines and care visits planning and staff allocation. Please see the safe sections of this full report.
The overall rating for the service has remained 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 Hartwig Care Ltd - 5 Ella Mews on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Risks to people’s health and wellbeing had been assessed and reflected in peoples’ care files. We found that some risk assessment documentation would benefit from more detailed information on risk management strategies for identified risks. We saw that the agency had already identified this and action had been taken to improve the quality and detail of information about risks to people.
There were other arrangements in place to help to provide safe care. Safeguarding procedures were established and staff knew what to do if they thought somebody was at risk from others. Recruitment procedures were appropriate and people were protected from unsuitable staff. There were procedures in in place for recording, monitoring and reducing of accidents and incidents. Infection control measures were used by staff when supporting people. There were sufficient staffing deployed to support people and to ensure scheduled calls took place as planned.
People were supported by staff who were trained in a range of mandatory and specialist subjects. The training was regularly updated. New staff had undergone an induction to the agency and their care role. They also received a series of four support meetings with a care worker liaison officer to ensure they were comfortable and competent to support people.
Staff told us they had received regular supervision and appraisal of their skills. They felt supported by their managers who were accessible when staff needed them. We found that the monitoring and recording systems around staff supervision and the spot checks of staff’s direct work with people could be improved to reflect all formal support provided. During our visit the senior management commenced making improvements to these records.
People’s needs and preferences had been assessed and the information gathered had been then used to formulate individual care plans. People were involved in the planning and reviewing of their care. Staff were provided with sufficient information on how to meet people’s needs. Some care plans would benefit from more detailed information on people’s background and how exactly they would like to receive support. We found that the agency had already commenced improvement work on person centred care planning. This included the provision of additional training for staff in person centred care and introduction of a new online care planning system, which helped reflect people’s changing needs as the changes happened.
People were supported to lead a healthy life and have access to health professionals. Staff helped people have enough food and drink and have a balanced diet that met people’s personal preferences and dietary requirements. Staff supported people to have access to appropriate health services for health checks, when their needs changed or if people’s health suddenly deteriorated.
The agency had worked within the principles of the Mental Capacity Act 2005. People were asked for their consent before receiving support and they were encouraged to make decisions about their everyday care. Where people did not have capacity to make a decision, the agency had liaised with their legally appointed representatives and respective external professionals to ensure care was provided in people’s best interest.
People said staff who supported them were kind and caring. Staff we spoke with understood their role in ensuring people received dignified care and that people’s unique characteristics, for example cultural and religious needs, were recognised and valued. Staff respected people’s dignity and privacy when providing care.
There was an effective system in place to deal with people’s complaints and we saw complaints had been dealt with promptly and action had been taken to address issues.
Staff spoke positively about their managers. There was a clear management structure in place. Individual job roles had been clearly defined across the agency therefore staff knew what they were responsible and accountable for.
The senior management team was proactive in addressing issues and carrying out ongoing development of the service provision. Monitoring systems were effective in identifying shortfalls in the service delivery. Where shortfalls were identified by the inspection team, the management team was responsive to the feedback received and introduced improvements as a result of it. There was a clear vision for development of the service. New systems, tools and technologies were being introduced to improve the care provided and its monitoring.
People, staff and external health professionals had been encouraged to give feedback about the service provided by the agency. This was done through a range of feedback mechanisms, such us, care reviews, surveys, staff team meetings and forums, the complaints system and through ongoing partnership work with respective external services.
More information is in the full report
Rating at last inspection: Requires Improvement (22 December 2017)
About the service: Hartwig Care Limited is a domiciliary care agency that provides personal care to people in their own homes. The people who used the service had a variety of care needs and included elderly and frail people, as well as those with learning disabilities. At the time of the inspection, the agency provided around 11000 hours of care a week to approximately 470 people across three London boroughs.
Why we inspected: It was a scheduled inspection based on previous rating.
Follow up: We will continue to monitor the service and we will revisit it in the future to check if they continue to provide good quality of care to people who use it.
Hartwig Care Limited is a domiciliary care agency that provides personal care to people in their own homes. The people who used the service had a variety of care needs and included elderly and frail people, as well as those with learning disabilities. At the time of the inspection, the agency provided care to almost 600 people across four London boroughs.
At the time of our visit the agency had two registered managers who were each responsible for different geographical areas of the service delivery. 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. Both registered managers were supported by the operations manager, a team of care managers, field supervisors, care planners, care coordinators and monitors and care staff who were all responsible for ensuring care was provided as planned. The agency had also had a dedicated finance, recruitment and training team.
During our inspection, we found positive aspects to the care provided by Hartwig Care Limited. However, we also identified some areas that required improvement. The agency had not always fully assessed and managed all of the risks to care and treatment of people who used the service. We also found issues relating to clear recording of medicines that were prescribed to people and clarity of who was responsible for medicines management for respective individuals.
There were staffing issues identified in relation to time keeping and continuity of care during the weekends and finding emergency staff cover in some geographical areas and the agency was working towards addressing these issues.
Where people lacked capacity to make decisions, staff had not always had full information on what decisions people could have made and how to support them to do so. It was not always clearly documented if family members who consented to care and treatment on behalf of their relatives had been officially authorised to act on their behalf.
The majority of people received appropriate care in relation to their dietary and nutritional needs, however, where needs relating to food were more complex the support had not always been documented clearly.
People’s care plans were person centred. They indicated people’s strengths and abilities with regard to their level of dependency, along with the actions and support required by the care worker. However, in some cases care plans had limited information on how to provide care to people with specific health care needs or where risks had been identified relating to specific medical conditions.
The quality monitoring systems, such as care file and medicines audits, related to individual care files. There were no overall managerial auditing systems and procedures. Consequently, the agency did not have effective tools to monitor and assess the quality of the care and support provided to identify any patterns for gaps in performance and to take appropriate action to address these gaps.
There were a number of positive aspects about this provider. People spoke positively about the staff who supported them and the service they provided. Staff were well trained and they knew their professional duties and responsibilities. The management team was responsive in addressing identified issues related to keeping people happy with the service they received. External health and care professionals commented positively about the agency and they had not raised any serious concerns with the Commission about the quality of the service provided to people who used it.
The agency helped to protect people from harm and abuse and any safeguarding concerns were promptly dealt with by the management team and appropriate external bodies were notified as required by regulations. Thorough recruitment checks carried out by the agency ensured only appropriate staff were supporting people.
Staff ensured people had access to appropriate external health care support if needed and external health professionals confirmed staff took appropriate action when the person required additional support.
People were usually allocated the same care staff ensuring continuity of care was maintained and people were able to form friendly, long-term professional and caring relationships with care staff. Staff treated people with care and compassion and people spoke positively about staff who supported them. Staff sought people’s consent before providing any care intervention and people felt their dignity and privacy was respected at all time.
People were involved in the planning and reviewing of their care and the agency frequently asked people and their family members if they were satisfied with the support provided. Any complaints had been regularly reviewed, analysed and actions had been taken to improve the service provided.
People using the service, their family members and external health and social care professionals had all given us positive feedback about the agency and how it was managed.
Staff understood their professional duties and responsibilities, they felt supported and they thought there was a good communication between staff and all levels of the management team who worked with them and supported them to provide good quality care.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we made one recommendation related to following the principles of the Mental Capacity Act (MCA) 2005.
Hartwig Care Limited is a domiciliary care agency based in Hampstead, North London. The agency provides personal care to people in their own homes. The people who used the service had a variety of care needs and included elderly and frail people, as well as those with learning disabilities. At the time of the inspection the agency provided care to almost 600 people across five London boroughs.
The provider was given 48 hours’ notice because the location provides a domiciliary care service. At the last inspection on 27 February 2014 the provider met all of the requirements we looked at.
At the time of our inspection 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 2008 and associated Regulations about how the service is run.
From telephone discussions we had with people using the service and relatives we found that people were highly satisfied with the way the service worked with them. People were confident about contacting staff at the agency to discuss anything they wished to and people believed that care workers knew how to care for people.
The care plans we looked at showed that risks associated with the care to be delivered were identified and responded to. The agency had effective staff recruitment procedures in place which showed that diligent checks were undertaken to ensure that care staff were suitable to provide care. T he service had access to the organisational policy and procedure for the protection of vulnerable adults from abuse. We asked staff about how they would recognise any potential signs of abuse. The care workers and other staff we spoke with told us that they received training about protecting adults from abuse and were able to describe the action they would take if a concern arose. It was the policy of the provider to ensure that staff had initial training which was then followed up with periodic refresher training. When we looked at staff training records we found that this had happened.
We spoke with the registered manager, training manager and provider who explained the system used for both mandatory and optional training courses. We found the mandatory training covered core skills and knowledge for staff and induction training was in line with the Skills for Care Common Induction standards. Staff supervision records showed that a system for consistent supervision for all staff was in place.
The agency had detailed policies, procedures and information in relation to the Mental Capacity Act 2005 (MCA). It should be noted that the agency does not have responsibility for making applications under this legislation; however, they have a responsibility for ensuring that any decision on the MCA 2005 were complied with. Care staff we spoke with demonstrated a good understanding of this area.
People we spoke with were very satisfied with the care provided by staff. This was the overwhelming feeling of the people we spoke with as they all echoed the same sentiments and said they or their relatives were treated as individuals and with dignity The care plans we looked at drew attention to individual needs such as how people communicate, their cultural identify and first language. The care plan format contained a portrait of the person as part of the information available to care staff. This helped to provide information which assisted care staff to form a good rapport with the people they cared for.
We looked at the complaints record and found that when complaints had been made these had been responded to openly and the agency had taken the necessary steps to both resolve complaints and learn from them.
The care provided by staff was clearly set out in all the care plans that we looked at. This included information about people's preferences and individual needs. For example the times when carers were to visit people’s homes to deliver care was stated along with the numbers of care staff required.
There was a clear management structure in place and staff were aware of their roles and responsibilities. From our discussion with the registered manager during our inspection we were told about, and shown, the monitoring systems for the day to day operation of the service. Staff had specific roles and responsibilities for different areas and were required to report to the registered manager about the way the service was operating and any challenges or risks to effective operation that arose.
The registered manager told us that they sought people’s views at least annually and we saw examples of feedback that had been obtained. This feedback was highly positive and showed that people felt they were listened to and their views about the quality of the service were respected.
We spoke with 17 people who use the service or their relatives. We received 22 questionnaires, out of the 61 which were sent out to people who use the service. People commented mostly positively of their experiences with the agency. They told us that 'carers are always friendly and polite' and that 'they have become like a family.' Some of the negative comments related to staff being occasionally late or not being able to deal with all tasks, such as cooking or cleaning effectively. A relative of a person who used the service told us that 'carer had made enormous effort.' Another one said 'the agency is efficient and deals promptly with any problems.'
We noted that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.
People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
People were cared for, or supported by, suitably qualified, skilled and experienced staff. There were enough staff to meet people's needs.
The provider had an effective system to regularly assess and monitor the quality of service that people receive.
There was an effective complaints system available. Comments and complaints people made were responded to appropriately.
We spoke with the registered manager, as well as senior staff and care workers. We contacted fifteen people who use the service by telephone. Where they were not able to tell us their experiences, we spoke with relatives and carers or with healthcare professionals involved in their support.
People were involved in the regular assessment and review of their care and support needs. The care and support was person-centred and individualised. Mostly, people using the service spoke highly of the regular carer workers or care teams who knew their care needs well. One person said they were 'generally very satisfied' with the service. Another said their care workers were 'marvellous.' A few people said that when new care workers were sent to cover absences, they were sometimes unfamiliar with their needs and the tasks to be performed. Almost all the people said the care workers were polite and respectful and that the visits were usually made on time.
The provider had an effective system for monitoring the visits made by care workers. Workers were given appropriate induction training and assessment before beginning work and received ongoing training and support.