Background to this inspection
Updated
18 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspection team
The inspection was carried out by two inspectors and an ‘Expert by Experience’. An ‘Expert by Experience’ is a person who has personal experience of using or caring for someone who uses this type of care service
Service and service type
Heart to Heart Care NW Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection; we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 3 March 2022 and ended on 8 March 2022. We visited the office location on 3 March 2022.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We also sought feedback from the local authority who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with the five people who were receiving support, five relatives about their experiences of care their loved ones received, the registered manager, deputy manager, and six members of staff.
We reviewed a range of records including six people’s care records, multiple medication administration records, and four staff personnel files in relation to recruitment. We also reviewed a variety of records relating to the management and governance of the service, including policies and procedures.
After the inspection
Due to the impact of the COVID-19 pandemic we limited the amount of time we spent on site. A variety of records and documentation was sent to us electronically, these were reviewed remotely following the inspection visit. We looked at policies and procedures, quality monitoring and staff training records.
We continued to seek clarification from the provider to validate evidence found.
Updated
18 March 2022
About the service
Heart to Heart NW Ltd is a domiciliary care agency that provides support and personal care to adults in their own homes. At the time of our inspection 112 people received support from the service. Not everyone who used the service received personal care. The Care Quality Commission 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
Effective quality assurance and governance measures had not been fully embedded at the service. We were not always assured that quality performance or risk management measures were assessing the quality and safety of care people received.
Safety monitoring and management of risk had improved. The majority of care records contained relevant and up to date care needs and risk management information. However, we identified that additional oversight and assurance measures need to be implemented as a way of ensuring that all areas of risk were appropriately recorded and monitored.
Improved medicine management processes had been implemented. Care records contained essential information for staff to follow, improved medication administration processes had been implemented, PRN (as and when needed) medicines and topical cream processes had been strengthened and there was a greater level of oversight in relation to compliance.
Infection prevention and control (IPC) measures and arrangements had improved. Staff were engaged in COVID-19 testing regimes, staff had completed IPC training, PPE was readily available, and people had relevant COVID-19 risk assessments in place.
People were protected from abuse and avoidable harm; systems and processes were in place to ensure safeguarding incidents were recorded and reported, staff knew how to escalate any safeguarding concerns and there was a greater level of oversight in relation to call monitoring and completion of daily tasks.
The introduction of an 'electronic call monitoring' (ECM) system meant that there was greater oversight in relation to staffing levels and call times. The provider ensured that call times were analysed in conjunction with the packages of care that needed to be delivered. We did receive some feedback to suggest that staff continued to run late from time to time.
Recruitment procedures and pre-employment recruitment checks need to be strengthened. We have made a recommendation regarding recruitment practices.
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 29 November 2021) 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. Although improvements had been identified during this inspection, the provider was still in breach of regulation 17 (Good Governance).
This service has been in special measures since November 2021. 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
We undertook this focused inspection to check whether the breaches of regulations and warning notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met.
The focused inspection reviewed the key questions of safe, and well-led only. 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 them. 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 improvements. Please see the safe and well-led sections of this full report.
The overall rating for the service has improved to ‘requires improvement’. 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 Heart to Heart Care NW Ltd 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 have identified a breach in relation to ‘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 for 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.