Healthvision - Hounslow

Healthvison Hounslow is a domiciliary care agency. It provides personal care to people living in

their own houses and flats in the community. At the time of our inspection 89 people were using the service. 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

The provider had procedures for managing incidents, accidents, safeguarding alerts and complaints, and quality monitoring processes in place, to help monitor and improve service delivery. However, we identified a care plan that had not ben updated with the most recent information.

We have made a recommendation that the provider review best practice regarding quality assurance processes to help ensure records are always up to date.

People and their relatives felt people received safe care. The provider had risk assessments and risk mitigation plans in place to help reduce risks and keep people safe. The provider followed safe recruitment practices to help ensure suitable people were employed. Staff received appropriate training to meet people’s care needs.

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.

Care plans were person centred and included information about individual care needs and people’s preferences. People were mostly supported by the same staff who were kind and caring. People using the service, their relatives and staff told us they knew how to raise concerns with the provider.

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 requires improvement (published 22 Sept 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Healthvision Hounslow provides a range of services to people in their own home including personal care. Most of the people who used the service were older people, some of whom were living with the experience of dementia. The majority of people were funded by the local authority.

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, 109 people were receiving personal care.

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

During the inspection we found the management of risks was not always effective as risk management plans were not always developed to provide care workers with guidance on mitigating the identified risks. Medicines were not always managed appropriately to help ensure people received their medicines safely. Care workers were not always appropriately deployed so that care visits were carried out at the planned time and for the length of time allocated. Robust COVID-19 risk assessments were not completed.

We found a few shortfalls around the arrangements relating to infection prevention and control and we have recommended the provider follow the government guidance in relation to risk assessments.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans were not always person centred or updated appropriately to meet people’s current needs. Communication and end of life care plans were not robust enough to meet people’s individual needs.

Safe recruitment procedures were not always followed. The provider had systems in place to monitor, manage and improve service delivery, however these were not always effective.

The provider had procedures to safeguard people from the risk of abuse and systems in place to record safeguarding alerts, complaints, and incidents appropriately.

Staff followed appropriate infection prevention and control practices. Care workers were supported in their roles through training and supervision, but we have made a recommendation about reviewing the training of staff, including new staff so they all have the skills and knowledge to care for staff safely.

Most people and relatives reported senior staff or managers were available and responsive when they contacted the office or when they needed support.

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 requires improvement (published 22 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, the need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed.

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.

Healthvision Hounslow provides a range of services to people in their own home including personal care. Most of the people who used the service were older people, some of whom were living with the experience of dementia. At the time of our inspection, 128 people were receiving personal care, and the majority of people were funded by the local authority.

Not everyone using Health vision Hounslow 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 consider any wider social care provided.

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

People's medicines were not always administered or managed correctly. Risk management plans were not detailed and did not always give staff clear guidance to mitigate risks. Accidents and incidents were not always investigated in line with the providers policies and procedures.

The provider did not have effective quality assurance systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people.

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.

Staff understood the provider's safeguarding policies and were familiar with the reporting procedures. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection.

People spoke highly of the staff and the management. People felt the staff would go out of their way to help them.

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 requires improvement (report published 22 July 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvements had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this announced targeted inspection to check if the provider had made improvements to meet regulations 12 (Safe care and treatment), 11(consent) 17 (Good governance), of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which they were in breach of at our last inspection in July 2019. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices, breaches of regulations or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm. Please see the safe, effective and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Healthvision Hounslow on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, consent and good governance. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Healthvision - Hounslow provides a range of services to people in their own home including personal care. Most of the people who used the service were older people, some of whom were living with the experience of dementia. Two people who used the service had a learning disability. At the time of our inspection, 84 people were receiving personal care, and all were funded by the local authority.

Not everyone using Healthvision - Hounslow 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 consider any wider social care provided.

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

We made a recommendation in relation to the deployment of staff.

People’s medicines were not always managed safely. Although there were regular audits which identified errors and discrepancies, there had not been any improvements. Therefore, we could not be sure people were receiving their medicines as prescribed.

There were risk assessments in place. However, where an area of risk has been identified, there were not always guidelines about how to mitigate this and support the person to remain safe. Body maps were in place but not always completed.

Accidents and incidents were recorded and appropriate action was taken. However, there was no evidence of lessons learned and guidelines about how to reduce the risk of reoccurrence.

The provider did not always follow the principles of the Mental Capacity Act 2005 (MCA). There was no evidence that people's mental capacity was assessed prior to using the service and records were not always signed by the person even when they were able to do so.

Although there were regular audits, these were not always effective. Where areas of concerns had been identified, actions taken had not resulted in improvements.

Although most people reported they felt safe with the care workers who supported them, they did not always receive their visits on time and were not always informed when staff were running late or had been replaced.

There was a safeguarding policy and procedure and staff were aware of these. They knew how to keep people safe and received training in safeguarding adults.

Staff were recruited safely and underwent all the necessary checks. There were enough staff employed to meet the needs of people. Staff received sufficient training to meet the needs of people who used the service.

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; the policies and systems in the service did not always support this practice.

People were supported to remain healthy and staff liaised with healthcare professionals to ensure their needs were met. People were supported to eat their meals according to their preferences.

Staff spoke about people they supported with respect and care. People's religious and cultural needs were recorded in their care plans and met.

The provider had an end of life policy, however, people's end of life wishes were not recorded in their care plans. Staff received basic training in this subject during their induction.

Care plans were clear and contained information about each person, their background, likes and dislikes. However, where people had specific health needs, there were no detailed support plans for staff to follow to ensure they met these.

Complaints were logged and there was evidence these were responded to appropriately and in line with the provider’s complaints policy.

There were regular meetings where information was shared and concerns were discussed. The registered manager liaised with other professionals to share ideas and increase their knowledge.

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 19/6/2018 and this was the first inspection.

Why we inspected

This was a planned inspection based on when the service was registered.

Enforcement

We have identified breaches in relation to the management of medicines, mental capacity and consent to care, person-centred care and leadership at this inspection.

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 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.