3HA Care Services

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

At the last inspection, the provider was in breach of the regulations. They had failed to ensure clear guidance was available to staff about the risks to people’s health needs, medicines management and the safe recruitment of staff. At this assessment, we found a comprehensive recruitment process and clearer risk assessments and care planning to ensure people received safe care. Improvements had been made and the provider was no longer in breach of the regulations relating to the question of Safe. People received safe care from staff who understood their personal and health care needs and followed healthcare guidance from professionals. Staff knew how to safely support people around their individual risks, which protected their rights, and safeguarded them from abuse and neglect. Medicines administration was managed well by safely recruited, competent and trained staff.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and staff were encouraged and supported to raise concerns, they felt confident that they will be treated with compassion and understanding, and would not be blamed, or treated negatively if they did so. Staff told us they had the training available to do their job. They felt supported by the management team and were clear about their responsibilities. Staff knew how to speak up and could describe how to do this and the actions that would be taken. A staff member told us, “I feel respected and supported by my colleagues and managers. They value my input, and dedication to my work, and encourage open communication. I can call them at any time for support if I need too.”

The registered manager had processes in place to learn from accident, incidents, safeguarding and complaints at the service. Staff had received training in how to report any issues and had the systems available to them to raise alerts directly with senior staff. The registered manager investigated any issues and lessons were learned and changes implemented to improve the service. Information was shared with staff through memo’s, emails, supervisions, and staff meetings.

People were supported to access services and enable them to return home from hospital. This included admissions and discharge from hospital, and referrals to professionals, where people needed specific support. Managers and staff knew how to access health and social care services when people needed them. We saw evidence of how they had liaised effectively with professionals on behalf of people they cared for.

There was positive feedback from professionals about the support offered by the service. A professional told us, “I have found communication is easier, faster and staff are happy to provide care notes and access to the person via their telephone when it was not possible to get hold of the person directly. Senior staff are cooperative and complete visits to see how care is delivered first hand and complete a review as needed.” Another said, “Information given by people indicates that staff (both carers and the office) go above and beyond the care plan to support the person and work together to correct issues as soon as they arise. I have found that staff are proactive in ensuring all professionals are informed of concerns or make referrals to various agencies based on the needs at the time. This is done in a timely manner.”

There was a system in place to assess and ensure the service could meet people’s needs. People’s changing physical and mental health needs were discussed with them and recorded to ensure continuity of care. A professional told us, “Given the care they provide, especially as reablement is short term and at the time people are discharged from hospital, often not in the best of physical and mental wellbeing, they [3HA] do an excellent job to support people and address issues positively.” Referrals for professional support were made such as to the GP, district nurse teams, or social services for additional help and advice when needed. The area team managers communicated effectively with relevant services, assessed, and reviewed people’s needs and ensured smooth transitions between healthcare services. A person said, “The care plan was done by the hospital, and I had minimal input, but they seemed to know what was needed and it works very well for us.”

People were protected from the risk of abuse and told us they felt safe using the service. A person said, “I am happy with the service. Of course, I feel safe with them, they are very caring.” Another person told us, “They do their best and they are really kind, which makes me feel protected.” A family member said, “I told the person who came from the agency. We are happy with the service. [Name of person] is safe, and the care workers are trustworthy.” Another told us, “Generally, [relative] is happy and satisfied with the service and feels very safe. The reason is I think they [staff] are skilful.”

Staff had received training in how to safeguard people and knew how to raise any concerns with management or external agencies. A staff member said, “I know I am to report to my manager immediately of any safeguarding concerns or issues following the organisation’s safeguarding policies. Another told us “I feel I know enough about safeguarding. I am confident the management team would act appropriately but I would also contact the local authority safeguarding team myself if needed.”

The registered manager evidenced they had safeguarding policies and procedures in place including ‘whistle blowing’. These were in the process of being reviewed to ensure they were up to date. They told us staff knew how to report abuse and had done so to protect people. The registered manager had raised safeguarding concerns and notifications appropriately and worked with a number of local authorities to investigate these to ensure people were being safeguarded.

People told us they had been involved in discussing their plan of care when they first started using the service. Care plans and risk assessments were person centred and aimed to provide positive outcomes for people whilst maintaining their choice and independence. People had a choice of the gender of staff to provide their care. A person told us, “I was fully involved with planning what I needed from my care.” A family member said, “We are involved in the care plan of [relative] and satisfied with the service.” Staff supported people to remain safe and well and were aware of potential risks to their health and wellbeing. A family member told us, “We feel [relative] is safe. Staff use hoist transfers from chair to bed and bed to chair.” Another said, “Right from the beginning I have been impressed how the staff have made my [relative] comfortable when moving them, and using the hoist as they are very nervous of it.”

Care plans provided clear information to staff in how to protect people whilst giving choice and control over their lives. This included how people were moved, positioned and used equipment; their skin and personal care routine; and protocols for specific conditions such as epilepsy, diabetes and autonomic dysreflexia. A staff member said, “I access information about people through our electronic App. This App is user-friendly and allows me to quickly find updates and changes in people’s care and any relevant notes from other team members.”

The system for assessing and monitoring risks had been improved. Area managers had a clear remit to ensure all assessment information was recorded, reviewed and updated when people’s needs changed. Care plan audits were undertaken to ensure information remained accurate and up to date, reducing the risks to people’s safety. The provider sought consent to people’s plan of care, and we saw these had been signed by them or their representatives. A person told us, “I signed a form to say I was happy with what we discussed in my care plan.”

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were mostly satisfied with the times they received their calls, and the staff involved in delivering their care. People said that if staff were going to be late, they usually received a phone call to inform them. A person told us, “I feel safe and most of the staff are on time and stay for the agreed time.” Another said, “My staff do everything they can to stick to as near the same time each day for me.” A third person said, “I am never rushed, and all of the care staff are extremely respectful to me. They arrive together and on time. They appear well-trained and used the hoist carefully.” A minority of people commented on the timing of their calls. A person told us, “I am happy with the care, but I never really know what time the staff will arrive which can be quite unsettling.” A family member told us, “The only issue we have is that the time of the calls differ greatly day to day, for example, the staff can come at 7.30am on one morning and then it can be 11.00am the next day. It doesn’t make sense.”

Staff told us there were enough staff with the right skills and experience to care for people. They received support, supervision and training in their role. They had enough time to get to their calls and were not rushed. They worked together effectively to provide safe care that met people’s individual needs and would step in for others if needed on the rota. A staff member said, “I communicate with my manager well as they always emphasise on how, ‘good teamwork always makes the dream work’.” There were appropriate staffing levels, and a consistent staff team. The service was organised into 4 teams with management support in each team to provide consistency with rota arrangements and support systems to better meet the needs of people in specific areas. A staff member told us, “I feel like there is equal opportunity amongst staff as we rotate the areas in which we cover. That way, we have a chance to familiarise ourselves with the different people we care for and the different colleagues we work with.”

Processes were in place to manage and monitor call visits, their duration and any late or missed calls. The electronic system provided information and alerts to the area manager if a staff member did not arrive at the required time so it could be investigated which reduced the risk of a person not receiving a visit. Where late visits had occurred, this was due mostly to traffic. We raised the concerns regarding the timing of calls with the registered manager for them to investigate. There was an induction programme for new staff including face to face training, shadowing more experienced staff and regular reviews of performance. Staff were supported to complete nationally recognized training to develop their career. Staff had regular supervision and staff meetings to share learning and review performance. A staff member said, “I feel positive about the support system in place. The regular check-ins not only help me stay on track but also show the organisation care about my development. I also appreciate that I can reach out for assistance whenever I am faced with challenges or need clarification. The resources provided make me feel supported and empowered to succeed as a healthcare assistant.” Improvements had been made to the recruitment process. The application form had been updated to request all gaps in employment history, checks on overseas sponsorship and right to work in the UK, taking up references and requesting a Disclosure and Barring Service (DBS) check before starting employment. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. All information and identification were verified, and interviews recorded to ensure staff were employed properly and safely.

People told us staff were aware of controlling the risks of infection when entering their home and providing personal care. A person said, “I feel safe because my staff member is always careful and uses PPE.” Another told us, “The staff are very caring and always use gloves and an apron.”

Staff confirmed they had enough supplies of personal protective equipment [PPE] such as face masks, aprons and gloves when providing care to people in their own homes. A staff member said, “There is enough PPE available. I use it after washing and drying my hands immediately I get into any person’s house, during personal care, dispensing and administration of medicines or when interacting with individuals who may have infections or other health risks to ensure safety and prevent contamination.” Another told us, “Having access to PPE in different sizes is important because it ensures that all staff members, regardless of their physical build, can wear protective gear that fits them properly and provides maximum protection.”

People were protected from the risk of infection as staff had received infection, prevention, and control training. They knew what process to follow to keep people safe. The provider had policy and procedures in place for infection prevention and control including COVID-19.

People were supported to take their medicines as prescribed. A person told us, “The care staff give me my medicines which are stored in a locked cupboard.” Another said, “The care staff are lovely no complaints at all. They manage my medicines nicely.”

Staff told us they had received training in medicine management and had regular competency checks to support them with medicines. A staff member said, “We get training on how to administer and handle the type of medicines before we go out in the field.” Another told us, “Care plans include information about the medicine, such as the dose, when to take it, and what to look out for. It also includes any alternative support or interventions that can be used.”

Improvements had been made to the management of medicines. Care plans provided clear information as to the medicines people were taking, how they wished to take them and any ordering and collection of medicines. There were clear lines of accountability, so staff knew their role and responsibilities about administration, recording and safety. The Medication Administration Records [MAR] we saw were completed correctly with no errors recorded. The area managers audit the MAR to ensure they are completed correctly and follow up any issues with staff to check their competence and confidence in giving medicines. Any refresher training needed was organised before the staff member could continue administering medicines. A staff member said, “I did the medicine administration e learning and had my checks done. There are clear MAR sheets for each person so l know exactly what to give to them, when and how.” Audits were completed monthly, and any trends or regular occurrences evaluated and addressed. The providers policy and procedures were being updated with relevant up to date guidance including the risks of paraffin-based emollients used in people’s homes.