HFH Healthcare Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.
At our last inspection we rated this key question good. At this inspection, the rating has remained good. This meant people continued to be safe and protected from avoidable harm.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People were encouraged and supported to raise concerns with the provider. Managers and staff understood the importance of reporting safety concerns and learning lessons when things went wrong.

Systems were in place to support staff to report and record safety concerns and events when they arose. Managers investigated safety concerns and incidents and used the learning from these to support staff to continually improve their practice, reduce risk and keep people safe. For example, following a hot water scalding incident the provider took immediate and appropriate action to reassess the risks posed from the use of hot water bottles. Risk management plans and policies were developed and shared with staff to minimise the likelihood of similar incidents reoccurring.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Information was obtained from people, and others involved in their care and treatment, about people’s individual health and personal care needs and risks they might face. This was used to develop individualised care and risk management plans to ensure people received safe and appropriate care and treatment from the moment they started receiving a home care service from this provider.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Managers and staff understood how to safeguard people. They knew how to recognise and report abuse and neglect, were able to articulate how they would spot signs if people were at risk of abuse or harm. A member of staff told us, “Abuse can be physical, emotional, sexual, psychological and financial. To safeguard people I support, I stay alert to any signs of abuse and follow my organisation’s safeguarding policy. This means I would report any concerns I might have immediately to my line manager or safeguarding lead, and if needed, escalate it to the local authority.” Another member of staff added, “As a health care assistant, it is my responsibility to safeguard people from abuse and neglect. I know I must immediately inform my care coordinator about any safeguarding issues that come to my attention.”

Managers and staff had received up to date child protection and safeguarding adults training which was routinely refreshed.

People told us they felt safe receiving a home care service from their regular carers who delivered it. A person said, “I am kept safe by my regular carers”. A relative added, “Our carers know how to keep my [family member] safe.”

Managers worked proactively with the relevant external health and social care professionals and bodies when a concern was raised and took appropriate action to safeguard people from further risk, when this was required.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The risks people might face were assessed and staff had easy access to paper and electronic risk management plans that detailed what action they needed to take to prevent or safely manage any identified risks. A member of staff told us, “I identify risks through peoples’ individual care plan, risk assessments, and daily observations. Common risks include falls, pressure ulcers, choking, or cross-infection, especially in those with mobility issues or certain medical conditions.” Another member of staff added, “Every client has risk assessments and management plans in place which we are trained to follow.”

If people needed to use specialist medical equipment such as, PEG (Percutaneous Endoscopic Gastrostomy) feeding, catheters, ventilators and oral suction, staff had access to sufficiently detailed and up to date guidance about how to safely use them. Staff were clear what action they needed to take to safely use the medical equipment they were required to. For example, staff demonstrated good awareness of how to safely manage the supply of oxygen a person they regularly supported needed. This included: constantly monitoring its flow, knowing what action they needed to take immediately if they identified any issues with the medical equipment and who to contact for additional support.

The service detected and controlled potential risks in the care environment. They made sure equipment and facilities supported the delivery of safe care.

There were effective arrangements in place to maintain and monitor the health and safety of people’s home environment. Health and safety risk assessments, including those relating to fire safety and the number of spare bedrooms people had for those who needed live-in care staff had all been conducted before a person could start receiving a home care service from this provider. Specialist medical equipment staff used to support people, including mobile hoists, ventilation machines, tracheostomy and oral suctioning devices, cannulas, catheters, and adjustable beds, were all routinely checked and serviced in accordance with the manufacturer's guidelines. Nurses regularly visited people at home which ensured they were able to identify and mitigate any potential environmental health and safety risks people living and working in a particular home environment might face. Staff told us they had clear guidelines available to help them deal with emergencies. In relation to fire safety, emergency evacuation plans were in place to guide staff about what to do in the event of a fire happening in a person’s home.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

People received continuity of care from the same group of health care staff who were familiar with their complex health and personal care needs, wishes and daily routines. Staff were punctual and had enough time to complete all the care and treatment tasks they were expected to during each of their call visits and/or shifts. Typical feedback we received included, “I have a regular team of cares who always turn up on time,” “Staff are usually punctual, and if they are going to be late for whatever reason, they are quick to let me know as soon as possible. My care coordinator is also good at planning my call visits and always manages to find and send the same staff who know what I need and like” and “We have a steady team of carers who know my [family member] well, including how to communicate with him and keep him safe. The staff are usually on time and let the office know if they’re running late”. The provider operated a 24 hour on-call service. This meant managers and nurses were always available to offer advice to staff or to cover a call visit or shift at short notice in the absence of staff. The service had a dedicated member of staff based in their offices who was responsible for arranging emergency staff cover when staff were unable to attend their scheduled call visit or shift.

Care staff were equally complimentary about how their call visits/shifts were coordinated by the office-based managers and staff. A member of staff told us, “I often support the same clients, which promotes continuity of care. This helps us build trust and a good rapport with these people, so we can have a better understanding of their needs and preferences.” Another member of staff added, “My home visits and shifts are usually well-coordinated. The staff rota allows me sufficient time to travel between my clients, and I am able to complete the required tasks without rushing. We have appropriate breaks in-between, allowing me to rest and maintain good physical and mental health. This ensures I provide safe and effective care.”

Staff were well-trained to meet people’s individual needs, in line with their choices and preferences and encouraged to continually improve in their role. Staff received a mixture of e-learning and in-person practical and theoretical training, which was routinely refreshed and included, ongoing competency-based assessments. A member of staff told us, “We get all the training we need to keep the people we support safe. Its constantly being refreshed and if you don’t keep your knowledge and skills up to date the care coordinators in the office will not let you work anymore. HFH are very strict about this because of the complex health care conditions of the people we look after.” A relative added, “Our regular carers are well-trained and know what they’re doing. They can tell straight away if my [family member] is in any discomfort and what to do if any of the medical equipment is playing up.”

The complexity of people's health and personal care needs and conditions, preferences and geographical location were all considered in the matching process, so only the right staff who were suitably trained, knowledgeable and skilled would be assigned to support specific individuals. For example, where people required complex medical interventions, such as tracheostomy or catheter care, they were matched with a team of health care staff who had the right levels of knowledge, skills and experience to meet these people’s health care needs. Staff received additional and ongoing clinical training relating to the specific health care needs of the people they supported such as, tracheostomy, spinal cord injury, enteral nutrition and catheter care, oral suctioning, mechanical and non-invasive ventilation and autonomic dysreflexia awareness.

People told us staff were competent and compassionate. A person said, “My regular carers seem well-trained and supported by the nurses who often come and visit me at home to check how I am and how my carers are doing. They [staff] are familiar with the specialist equipment I need and between myself, my regular carers and the nurses we can spot any potential problems and resolve them.”

Staff were equally complimentary about the training they received. A member of staff told us, “I receive ongoing training that is relevant to my role, including updates on safeguarding, infection control, medicines administration, and condition-specific care, like dementia. This helps me maintain high standards in my practice.”

New staff had to complete a thorough induction training programme which was mapped to the Care Certificate. The Care Certificate is a nationally recognised set of standards which provides new staff with the expected level of knowledge to be able to do their jobs well. The induction was followed by a period of shadowing experienced nursing and care staff during their call visits and shifts and a probationary review. This was confirmed by a relative who told us, “It’s good that any new staff have to visit us at home and do several shifts shadowing experienced members of our existing carers before they are allowed to become part our regular support team.”

The service had an in-house team of qualified and experienced nurse practice trainers/educators who were responsible for delivering inductions and on-going training for all staff. The provider had well-equipped training rooms located in their main offices where all staff received their theoretical and practical learning. These training rooms contained all the medical equipment and resources staff might need to learn how to use safely including, various mobile hoists, ventilation machines, tracheostomy and oral suctioning devices, cannulas, catheters and adjustable beds. There were also mannequin dummies for staff to safely practice their newly acquired knowledge and skills on.

Staff had ongoing opportunities to reflect on their working practices and to identify any further training, learning or support they might need. Staff had regular individual and group meetings with their line managers and co-workers. A member of staff said, “I have regular supervision meetings with my line manager where I can discuss my work performance and training needs, as well as any concerns I may have. I also have bi-annual work performance appraisal meetings with my line manager to formally review my professional development, set goals, and reflect on my achievements at work.” Another member of staff added, “The team is supportive, training is ongoing, and the people we support are well-matched with suitably qualified and experienced staff. There is good communication and a strong focus on professional development and providing high standards of care.”

The provider continued to operate safe recruitment practices and only suitably fit and proper staff were employed to work for this provider. The provider maintained a recruitment tracker to monitor staff recruitment and completed Disclosure and Barring Service (DBS) checks. A DBS check helps employers make safer recruitment decisions by processing requests for criminal record checks of individuals applying for certain jobs, particularly those involving children or vulnerable adults.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had received relevant infection control and food hygiene training and had access to resources and equipment to help them reduce the risk of infections spreading. Staff used personal protective equipment [PPE] when meeting the intimate personal care needs of people they supported. A member of staff told us, “I always have access to sufficient PPE such as gloves, masks, and aprons. PPE stocks are regularly checked and replenished, and we’re trained in its correct usage to ensure safety for both the people we support and ourselves.” A relative added, “The staff always have ample supplies of PPE which is sent directly to our home, so it’s there when they need to provide my [family member] with any personal care.” Staffs working practices in relation to infection control and their safe use of PPE were routinely checked and observed by nursing staff as part of their routine quality monitoring home visits.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

A person told us, “I receive all my medicines as I should and my carers make sure that new supplies are ordered on time.” A member of staff added, “I always follow my employees safe management of medicines policies and procedures. This includes routine checking of MAR (Medication Administration Record) charts and diligently adhering to the 5 ‘Rights’ of safe medicines administration (Right person, Right drug, Right dose, Right time, Right route). In addition, I always record any medicines I have administered and report any refusals or medicines issues I might encounter.”

The provider had policies in place relating to the safe storage and administration of medicines. Staff were able to demonstrate how to correctly store medicines as per their policy.

Staff received relevant training and their competency to continue managing medicines safely was routinely assessed. This meant they were clear about their roles and responsibilities in relation to the safe management and administration of medicines.