About the service 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.