We carried out a review of the data available to us about Third Hand Healthcare Ltd 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 Third Hand Healthcare Ltd, you can give feedback on this service.
Third Hand Healthcare is a service providing care to people in their own homes. 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. At the time of our inspection, the agency was caring for 43 people, of which 35 received personal care.
People’s experience of using this service and what we found
People told us they felt safe with staff and that staff helped ensure any risks to their health or well-being were reduced. People said staff arrived on time and stayed the time they expected. They told us they did not feel staff rushed them. People confirmed staff were following national guidance around COVID-19 in that they always wore masks and gloves when providing care. In addition, people confirmed staff supported them with their medicines. We found staff were recruited safely and the agency reviewed and analysed incidents and accidents and learnt from them.
Where people were supported with their nutrition and hydration, they reported staff provided the support they needed. People were involved in developing their own care plans, which ensured they were enabled to make their own choices and decisions. People’s consent was sought before care was carried out and they told us they felt staff were competent in their role. 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.
People’s care plans contained sufficient information to guide staff in relation to the care people required. There was evidence that staff also had social calls with people to reduce the risk of isolation, particularly during the COVID-19 pandemic. People told us they would have no hesitation contacting the agency if they had any concerns.
Management oversight of the agency was good. Improvements introduced at our last inspection had been embedded and sustained and there was a robust office team structure in place which helped ensure that people received a good service and staff felt supported. Management regularly reviewed the care people received and worked with external agencies to provide a holistic service.
Rating at last inspection and update
The last rating for this service was Requires Improvement (report published 25 January 2020).
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an announced comprehensive inspection of this service on 16 December 2019 when a breach of legal requirements was found in ‘Need for Consent’. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
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, Effective, Responsive and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement 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 Third Hand Healthcare 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.
People’s experience of using this service and what we found
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Risks to people were appropriately recorded and managed. Staff were aware of their responsibility to safeguard people from abuse and how to report concerns. Medicines management and infection control practices were safe. There were a sufficient number of staff to meet people’s needs and people told us staff called them if they were running late. Any accidents and incidents were recorded and actions taken to mitigate any further occurrences.
People and relatives told us they felt staff were competent at their job and were well trained. Staff confirmed this and said they had received a thorough induction after a safe recruitment process. Staff supported people with their nutritional and hydration needs and referred people to healthcare professionals where needed. Communication between staff was effective and had led to good outcomes for people.
People and relatives told us staff were kind and compassionate towards them, often referring to them as ‘friends’. People felt that staff new them well and treated the with dignity and respect. People were encouraged to maintain their independence and make day to day decisions around their care where safe to do so.
Care plans included information around people’s backgrounds and end of life wishes so staff could deliver personalised care. People received care that was flexible to their needs. Complaints were dealt with appropriately and in line with the provider’s policy.
A large amount of improvement had been made since our last inspection, and staff and the manager were keen to ensure the new policies and practices were fully embedded in to the service. People, relatives and staff members felt the management team were approachable and honest and were often asked for their feedback so further improvements to the service could be made. Quality audits were also completed to identify any issues and ensure they were resolved in a timely manner. The manager was aware of their regulatory responsibility and had informed the CQC and other relevant authorities of notifiable incidents.
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 Inadequate (published 6 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in most areas and the provider was in breach of one regulation. We have given recommendations to the provider health care plans for people.
This service has been in Special Measures since May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating.
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.
Third Hand Healthcare Ltd) is a domiciliary care agency. At the time of our inspection, it was providing personal care to 15 people living in their own houses and flats. It provides a service to older adults, some of whom are living with dementia. Not everyone using Third hand Healthcare Ltd receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
People’s experience of using this service and what we found
Although staff said they were aware of their role in safeguarding people from abuse, safeguarding concerns had not been appropriately reported. Risks to people were not appropriately recorded, and the recording and auditing of medicines was also inadequate. There were a sufficient number of safely recruited staff to meet people’s needs. However, recruitment checks were not thorough. Accidents and incidents were recorded but steps were not always taken to reduce reoccurrence.
People’s rights were not always protected in line with the principles of the Mental Capacity Act 2005. Staff had not received all the appropriate training and staff supervisions had not been recorded and were not effective. Staff told us there was an effective communication system in place, but referrals to healthcare professionals were not made where required. The service did not follow national guidance and best practice.
People and relatives told us that staff were kind and caring. However, we observed that staff did not always respect people’s privacy and did not speak respectfully about them. People and relatives told us they were not involved in decisions around their care. Staff encouraged people to be independent where possible and respected their dignity.
Care plans were not personalised to reflect people’s needs and did not include information on how to support people with their medical conditions. At the time of our inspection, no one was receiving end of life care. However, care plans did not include people’s end of life wishes. Complaints were not dealt in line with the provider’s policy.
People and relatives gave varied feedback on the running of the service. It was unclear when the registered manager would be returning to the service, and the nominated individual had not made us aware of notifiable incidents in line with their regulatory requirement. Internal quality audits had not been completed, and the nominated individual had not resolved issues identified in a quality assurance visit completed by the local authority. People were not always asked for feedback on the quality of the service. There were links to local organisations where knowledge and training resources could be used, but these were not being utilised. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection
This service was registered with us on 4 July 2018 and this is the first inspection.
Why we inspected
This was a planned inspection based on our inspection schedule for new providers.
Follow up
We will follow up on recommendations made and any improvements required at our next inspection.
Enforcement
We have identified seven breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, safeguarding, staffing competency and recruitment, need for consent, delivering personalised care and good governance. We also found one breach of The Health and Social Care Act 2008 (Registration) Regulations 2009 in relation to not making us aware of notifiable events.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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 monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.