HFH Healthcare Limited

People’s experience of using this service and what we found

At this inspection we have continued to rate the service ‘good’ overall. The majority of people using the service and their relatives were satisfied with the quality of care and support provided. They felt the quality of care had improved since the new registered manager took over the management of the agency. The provider had made progress since the previous inspection in ensuring people received continuity of care and support from staff who understood their complex health care needs.

Staff knew how to manage risks people might face and protect them from avoidable harm. The majority of the staff felt well supported and valued. New staff underwent pre-employment checks which ensured their suitability and fitness for the role. There was ongoing recruitment of care assistants to ensure staffing levels were sufficient to meet the needs of people receiving care. People were supported to manage and receive their medicines safely. People received support from staff who assessed and responded to risks regarding infection prevention and control, including those associated with Covid-19 pandemic.

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. Staff had access to training to maintain people's safety and meet their specific needs.

People, their relatives, health and social care professionals and staff commended the way the agency was now being run. The provider and registered manager had systems in place which they used to regularly monitor and assess the quality and safety of care provided to people. People, their relatives and staff were given opportunities to provide feedback about the service. They said the registered manager was approachable and welcomed feedback to enable them to learn and improve the care people received. People felt able to raise their concerns and were confident any issues raised would be addressed. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver safe care and treatment to people using 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 and update.

The last rating for this service was good (published 22 May 2019). This report only covers our findings in relation to the key questions; Is the service safe, effective and well-led?

Why we inspected

We received concerns in relation to the ability of staff to perform in their roles and the way the service was managed. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We found evidence during this inspection that the provider had taken action to mitigate risks to people receiving unsafe care. Please see the safe, effective and well-led sections of this full report.

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 the key questions of Caring and Responsive were used in calculating the overall rating at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection strategy. If we receive any concerning information we may inspect sooner.

HFH Healthcare Limited is a home care agency. It provides nurse-led personal care and treatment to children and adults living in their own home who have spinal or brain injuries, neurological conditions or genetic diseases. Some people may also be living with dementia, a learning disability or autism, mental health needs and/or sensory impairments.

At the time of our inspection approximately 50 children or young people and 100 adults received a nurse-led home care service from this agency. Around 30 people using the service received 24-hour care from live-in staff.

People’s experience of using this service:

¿ At this inspection we have continued to rate the service ‘Good’ overall.

¿ However, the service’s rating for the key question, ‘Is the service well-led?’ remains ‘Requires Improvement’.

¿ Although most people using the service, their relatives and external health care professionals told us the quality of the care they were provided with by this agency remained either ‘good’ or had improved in the last six months; we continued to receive mixed feedback from people about constantly changing care staff and the negative impact this had on the continuity of care they received.

¿ We discussed this on-going issue with the newly registered manager who acknowledged the action they had already taken to improve continuity of care would take more time to be fully implemented and for everyone to feel the benefit. This included employing more nurses and having core groups of care staff working together in one area with the same service users. Progress made by the provider to ensure people consistently received good quality care from staff who were familiar with their needs will be assessed at their next inspection.

¿ This issue notwithstanding, people and their relatives told us staff were always polite and kind towards them. Staff also respected people’s dignity and privacy. They listened to people and supported their independence where possible.

¿ People were kept safe from the risk of harm. Potential risks to people and staff were assessed and managed appropriately. Staff had a clear understanding of how to recognise and report abuse and neglect.

¿ Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met.

¿ Staff were safely recruited to ensure they were suitable to work in a care service. People received support from trained and supervised staff who had the right skills and knowledge.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ People’s needs and individual preferences were documented in their care plan, which were personalised and routinely reviewed to ensure they remained up to date and accurate.

¿ People had been consulted about their support needs and involved in helping staff develop their care plan.

¿ People, their relatives, professional representatives and staff all said they could approach the registered manager if they had any issues or concerns. There was a procedure in place which explained how people could raise concerns or complaints.

¿ The provider had effective systems in place to assess and monitor the quality and safety of the service people received. This helped the service continuously improve it's practice and to learn lessons when things went wrong.

¿ The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver a safe, effective service.

Rating at the last inspection

At the last inspection the service was rated ‘Good’ overall (Report was published on 27 December 2017).

Why we inspected

This inspection was brought forward by approximately a year due in part to concerning information we received about the higher than expected number of safeguarding alerts and complaints raised in relation to this service in the past 18 months. The ongoing information shared with Care Quality Commission (CQC) about these safeguarding incidents and complaints indicated potential concerns about the way the service was managed, which we examined as part of our inspection.

Follow up

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates in keeping with our inspection methodology (See above).

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service had a registered manager in post who was also the Chief Executive Officer (CEO) of the company. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last CQC inspection of this service in February 2016 we rated them ‘Good’ for the five key questions ‘is the service safe’, ‘effective’, ‘caring’, ‘responsive’ and ‘well-led?’ At this inspection we found the service remained rated ‘Good’ overall.

However, we have changed the rating for the key question is the service well-led from ‘Good’ to 'Requires Improvement’. Although people said they were happy with the care they received from their ‘regular’ care staff, we received mixed feedback from people, their relatives and professional representatives concerned about the high rates of staff turnover the agency had experienced in the last 12 months and new care staff not being so familiar with peoples complex health care needs, daily routines and preferences. This point notwithstanding most people felt staff retention had improved recently and their new care staff had begun to familiarise themselves with people’s needs, routines and wishes. In addition, we received some mixed comments from people and their relatives and professional representatives concerned about poor communication from the agency. For example, people told us they were not always notified in a timely way about changes to care staff rotas and therefore they did not always know who their care staff would be and what knowledge, skills and experience they had.

We discussed the aforementioned issues with the registered manager who acknowledged the agency had faced a challenge in the last 12 months dealing with higher than average rates of staff turnover and a significant increase in the number and complexity of the health care needs of people they now supported. The registered manager told us they planned to improve the way the agency was managed by introducing new fixed hour contracts for all staff to increase staff retention and senior coordinator posts to oversee smaller teams of specialist care staff working in specific geographical areas. Progress made by the provider to introduce new staff contracts and senior coordinator positions will be assessed at the services next inspection.

The negative points described above notwithstanding most people felt safe using the agency and with their ‘regular’ care staff. There continued to be robust procedures in place to safeguard people from harm and abuse. Care staff were still familiar with how to recognise and report abuse. The provider had assessments and management plans in place to minimise possible risks to people, which included infection control and safe food handling measures. There was a 24 hours on call system in operation that ensured management and nurse support and advice was available for care staff when they needed it. Staff recruitment procedures continued to prevent people from being cared for by unsuitable care workers. Medicines were managed safely and people received them as prescribed.

Care staff received appropriate training and support to ensure they had the right knowledge and skills to effectively meet the complex health care needs of people they regularly supported. Managers and care staff adhered to the Mental Capacity Act 2005 code of practice. People were supported to eat healthily, where the agency was responsible for this. Care staff also took account of people’s food and drink preferences when they prepared meals. People received the support they needed to stay healthy and to access healthcare services.

People and their relatives told us they were happy with the care and support provided by their ‘regular’ care staff. Care staff continued to treat people with dignity and respect. They ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. People were involved in planning the care and support they received. Each person continued to have an up to date support plan. People felt comfortable raising any issues they had about the provider. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

The provider had an open and transparent culture. They routinely gathered feedback from people using the service, their relatives and care staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided. Care staff felt supported by managers and senior nurses.

HFH Healthcare Limited is a domiciliary care agency that provides nursing and personal care to people living in their own homes. The agency specialises in providing 24 hour nursing and/or personal care to children, younger adults and older people with complex health care needs who are not in hospital, but have been assessed as having a primary health need. The agency works closely with local NHS continuing care teams to provide packages of care. Most people receiving a service from HFH Healthcare live in and around London and are funded by the NHS. There were 18 children, 86 younger adults and six older people received nursing and/or personal care and support from this agency at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The agency was well managed. The agency had a clear management structure in place. The management team demonstrated strong leadership and a good understanding of their roles and responsibilities. They also communicated a strong ethos focusing on person centred care and ensuring people received a good quality service from the agency. Managers regularly met with staff and checked they were clear about their duties and responsibilities to the people they cared for. Staff told us they felt valued and appreciated for the work they did by the agency’s management team.

Furthermore, the agency had established effective governance systems to routinely assess and monitor the quality of service provided by the agency. Regular audits were carried out and, for areas where issues were identified, appropriate and timely action was taken to ensure people’s welfare and safety. The service also used external scrutiny and challenge to ensure people received appropriate care and support from the agency.

People told us they were happy with the standard of care and support they received from the agency and that staff were kind and caring. People’s rights to privacy and dignity were also respected. Our discussions with people using the service, their relatives and community health and social care professionals supported this.

People told us they felt safe when staff from the agency visited them at home. Managers and staff knew how and when to report abuse or neglect if they suspected people were at risk. They had all received up to date training in protecting children and safeguarding adults at risk. Staff had access to appropriate guidance to ensure identified risks to people were minimised. Regular maintenance and service checks were carried out on equipment used by staff in people’s homes, such as mobile hoists.

People were supported to keep healthy and well. Staff ensured people were able to access community health and social care services whenever they needed them. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration. People received their medicines as prescribed and staff knew how to manage medicines safely.

People agreed to the level of support they needed and how they wished to be supported. People had care plans in place which reflected their specific needs and preferences for how they were cared for and supported. These gave staff guidance and instructions on how people’s needs should be met. People were appropriately supported by staff to make decisions about their care and support needs. Staff supported people to be as independent as they could and wanted to be. When people's needs changed, managers and staff responded promptly by immediately reviewing the person’s care plan. Managers and staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and acted according to this legislation.

The views and ideas of people using the service, their relatives, community professional and staff were routinely sought by the provider and used to improve the service they provided. People told us that they felt able to raise any issues or concerns and these were dealt with promptly and satisfactorily. There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these.

There were enough suitably competent staff to care and support people. Staffing levels were planned to ensure there was a good mix of suitably competent staff on every shift to meet people’s needs. Staff received relevant training to help them in their roles. Staff had a good understanding of people’s needs and how these should be met. Staff felt supported by their managers and senior staff and were given regular opportunities to share their views about how people's experiences could be improved. The provider carried out appropriate checks to ensure staff were ‘fit’ to work with people receiving services from the agency.

We looked at the care records for four people using the service. People received a client household guide when they first started using HFH Healthcare. This gave detailed information about the service and what people could expect in terms of their care and support. We saw how assessments had been used to develop a plan of care and support. People told us they had been involved in their initial assessments of care and felt their on-going care and support had been explained to them and met their individual needs. All the people we spoke with told us they were happy with their or their relative's assessment of care.

People told us their carers were introduced to them before they started working with them. One person told us 'I have been involved in choosing the carers that assist me, now I have a team I am happy with' another told us 'HFH introduced the carers to us, we had a few changes but now we have good relationships with all our carers.'

We spoke with the registered manager, the director of healthcare, head of clinical governance, a member of staff from the clinical team, two care co-ordinators and three care workers. We found there were effective recruitment procedures in place for new staff and existing staff told us they felt properly supported to provide care to people using the services. People we spoke with felt their carers were skilled enough and had been adequately trained to give them the support they needed.

We saw there were effective systems in place to monitor the quality of care provided to people who use the service.