We carried out a review of the data available to us about H & H Healthcare Limited 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 H & H Healthcare Limited, you can give feedback on this service.
H & H Healthcare Limited is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides care and support to people which include personal care and medicine support. At the time of this inspection, the provider informed us that they were providing personal care to 35 people who used the service.
Not everyone using H & H Healthcare Limited received a regulated activity. CQC only inspects the service 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 received personalised care that met their needs from care staff who knew them well.
Assessments of people's care and support needs were carried out before they started using the service and people and their relatives told us they were involved in planning their care.
People and relatives had confidence in the ability of staff to deliver care effectively. Since the last inspection in September 2019, the service’s induction and training arrangements for staff had been improved and staff told us they were provided with relevant training which gave them the skills and knowledge to support people effectively.
Staff told us they felt supported by their managers and felt able to speak with them. However, staff supervisions were not being completed for all staff regularly. We made a recommendation about this.
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 nutritional needs were met, and the management team and staff worked in partnership with health and social care professionals to ensure people received effective care.
Systems were in place to manage and respond to complaints. People and relatives spoke positively about how the service was run. However, people told us engagement and communication could be improved. We made a recommendation about this.
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 5 November 2019).
On 9 February 2021 we conducted a focused inspection of the Safe and Well Led key lines of enquiry based on risk. This inspection was not rated. We found improvements in both areas and the service was no longer in breach of regulations in these areas.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 9 September 2019. Breaches of legal requirements were found.
The provider completed an action plan after the last inspection to show what they would do and by when to improve, in relation to mental capacity, staff training and support, person centred care and quality assurance and governance systems.
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 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 H & H Healthcare Limited 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.
H & H Healthcare Limited is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides care and support to people which include personal care, food preparation and medication support. At the time of this inspection, the provider informed us that they were providing personal care to 51 people who used the service.
Not everyone using H & H Healthcare Limited received a regulated activity. CQC only inspects the service 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 and relatives were happy with the care workers who supported them. Comments included, “I get on well with them all” and “Really cheerful staff, makes you feel so much better”.
People felt safe and comfortable when staff were in their home. People were kept safe as potential risks had been assessed and managed. Staff recruitment practices were safe.
People felt staff were trained and experienced to meet their needs. One person said, “They are very careful when helping me and they are well trained”. However, one person and one relative told us some staff were not meeting their needs as well as others. We raised this with the registered manager who assured us they would follow this up.
People's medicines were managed safely. Medicines Administration Records (MARs) contained all of the required information and were fully completed. Regular medicines audits were carried out to ensure people received their medicines safely.
People and their relatives confirmed staff followed good infection control practice in their homes. Staff had completed infection control training and additional training specifically relating to COVID-19. Some staff were unsure of the order they should put on and take off Personal Protective Equipment (PPE). During the inspection, the provider sent further information out to staff, so they understood their responsibilities in relation to this.
People told us the service was well managed and there was good communication. Comments included, “I feel the company is well managed, very happy”, “The service does everything well, I wouldn’t want to change anything”. A healthcare professional told us, “Communication is good and I have found this has improved over the last 12 months.”
Since the previous inspection, the registered manager had restructured the leadership of the service. This had led to the development of new processes to monitor the service, drive improvement and provide oversight. An electronic system had been introduced to monitor people’s visits and ensure people and staff were safe. Following the previous inspection, the management team had worked hard to make the required improvements and had plans to further develop the service.
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 Requires Improvement (published 1 November 2019).
The service was rated as Requires Improvement because we found the registered provider to be in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve and by when. During this focused inspection, we were given assurances that improvements had been made in relation to the assessment of people's mental capacity, the delivery of person-centred care, and staff training. However, as this was a focussed inspection based on risk, we did not look in detail at these areas of care, therefore the rating remained the same.
Why we inspected
This was a planned inspection based on the previous rating.
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the key questions of safe and well-led. There will be no overall rating given for the service as this was not a comprehensive inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for H & H Healthcare Limited 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.
H&H Healthcare provides a domiciliary care service for older people living in their own homes in the community. At the time of our inspection, there were forty-four people receiving personal care.
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
Leadership and monitoring of the service was not effective in ensuring people received good quality care which kept up to date with legislation and best practice. Systems to monitor the quality and safety of the service were either not in place or had been ineffective in driving the necessary improvements. However, during the inspection the provider understood the issues and how they came about. The provider acknowledged and understood what they needed to do to address the issues and immediate action was taken. The provider employed additional support and was receiving support from commissioners and the local authority quality improvement team, to achieve the improvements required.
Risks to people's health, safety and welfare had not always been adequately assessed. Governance and oversight systems had failed to ensure risk assessments provided sufficient guidance to staff to ensure people received safe care. Specific risks were not always recorded, meaning people were not protected as much as possible from harm.
People did not have personalised care plans in place. People's records were not written in a person-centred way and contained insufficient guidance for staff about how to meet people’s needs and preferences.
The management of medicines was not always managed safely or effectively which meant people were at risk of harm. Medicine records were not filled out correctly and therefore we could not be assured that people had received their medication as prescribed. The provider had not ensured care workers had been properly assessed and observed before they were permitted to handle people's medicines, to ensure this was done safely.
Care was not being provided in line with the Mental Capacity Act (2005). Mental capacity assessments for people who were considered to lack the capacity to make decisions about their care and support, were not in place. Therefore, we could not be certain people were supported to have maximum choice and control of their lives and were supported by staff in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
The provider did not have sufficient oversight of training to ensure staff had sufficient training to support people's individual needs. Training records did not demonstrate that all staff had been trained in mandatory subjects considered necessary to meet people’s needs.
Robust recruitment practice was not always followed. Complete work history including explanation for gaps in employment history and references, had not always been obtained. This potentially placed people at risk of harm.
People told us they felt safe due to the caring approach of staff and spoke positively about the support they received. People told us staff were kind and caring and treated them with respect. People felt staff upheld their dignity and supported them to keep their independence where possible. People told us they were involved in reviews of their care.
People told us they felt there were sufficient staff employed to meet their needs. Most people told us staff mainly arrived on time and stayed for the allocated time. However, the provider did not record, monitor and review late or missed visits to identify how to reduce these occurring.
The service was responsive to people's changing needs. We saw examples where people had been referred to other agencies, so their needs could be re-assessed. There was also liaison with family members. People's complaints were investigated by the service and responded to promptly and an apology given.
We made a recommendation with regards to infection control auditing .
Rating at last inspection
The last rating for this service was good (published 28 March 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
At this inspection we rated the service as requires improvement. We identified six breaches of regulations, in relation to safe care and treatment, fit and proper persons employed, staffing, need for consent, person-centred care and good governance. Please refer to the end of the report for action we have told the provider to take.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At the last inspection, the service was rated Good.
At this inspection we found the service remained Good.
This inspection took place on 8 and 9 March 2017. 72 hours’ notice was given as the service is small and we needed to be sure the registered manager would be available when we visited the agency offices. This time also enabled the registered manager (who was also the provider) to arrange home visits. This allowed us to hear about people’s experiences of the service.
At the time of the inspection, the domiciliary care service was providing personal care to 51 people. People were either funded through their local authority, NHS funded or through private arrangements.
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.
People and their relatives told us staff were caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. People’s privacy and dignity was promoted. People were actively involved in making choices and decisions about how they wanted to live their life. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.
People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process, to attend care reviews where possible or via telephone conference facilities. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were personalised and guided staff to help people in the way they liked.
Risks associated with people’s care were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. The registered manager / provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were managed safely.
People received care from staff who had undertaken training to be able to meet their unique needs. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.
The service was well led by a registered manager / provider and supported by a small administration team. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which required improvement. The registered manager promoted the ethos of honesty, learned from mistakes and admitted when things had gone wrong. The service was constantly striving to improve.
H & H Healthcare Limited is a domiciliary care service that provides care and support to adults of all ages, in their own homes. The service provides help with people’s personal care needs in the Plymouth, Ivybridge and surrounding areas. This includes people with physical disabilities, mental health problems and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.
At the time of our inspection 19 people were receiving a personal care service. These services were funded either privately, through Devon and Plymouth Councils or NHS funding.
There was a registered manager in post who was responsible for the day-to-day running of the home. 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.
We carried out this announced inspection on 7, 12 & 13 January 2015; we told the provider the day before that we would be coming. This was to ensure the registered manager was available when we visited the agency’s office and so we could arrange to visit some people in their own homes to hear about their experiences of the service. This was the first inspection since the service was registered.
People we spoke with told us they felt safe using the service. People told us, “I can rely on them {staff}” and “overall very good”. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.
There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. Staff supported people to attend healthcare appointments and liaised with other healthcare professionals as required if they had concerns about a person’s health.
People received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke well of staff, comments included, “good attention to detail” and “they {staff} do a brilliant job”. Health and social care professionals told us managers kept in contact with them and informed them of any concerns about the people using the service. They told us staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.
Health and social care professionals told us staff really understood people’s needs, were flexible and willing to provide a service for people with complex needs. One professional told us, “they are an outstanding service; they don’t treat people as ‘difficult’ seeing beyond people’s behaviour and supporting them to become independent. They take our most complex cases and have achieved amazing results with people”.
The registered manager and staff had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.
There was a positive culture in the service, the management team provided strong leadership and led by example. The provider/registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way that they cared for people. Care staff told us, “you have time to give people the help they need and deserve” and “clients get a good service and have the care that’s right for them”.
People and their families told us the management team was very approachable and they were included in decisions about the running of the service. People told us someone from the office rang and visited them regularly to ask about their views of the service and review the care and support provided. Staff were encouraged to challenge and question practice and were supported to try new approaches with people.
The service worked in partnership with other health and social care professionals to seek their advice about current practices and monitor the quality of the service provided. Health and social care professionals were all very positive about working with the service and how the service sought different ways to improve the quality of the service provided.