Humble Healthcare Limited improved from an overall Inadequate rating (March 2023) to Good across all five key questions following focused regulatory action, with all breaches of Regulations 9, 12, 17, 18, and 19 remediated. The service demonstrated strong person-centred care, effective governance, consistent staffing, and culturally competent practice supported by external consultants.
Strengths
· Provider demonstrated significant improvement since previous inadequate rating, addressing all regulatory breaches across Regulations 9, 12, 17, 18, and 19.
· Consistent staffing with same regular care workers; people and families reported timely visits and good communication about any changes.
· Staff undertook refreshed and additional training including medicines management, learning disabilities, moving and handling, and communication techniques such as basic sign language and pictorial signs.
· Care plans were reassessed and personalised for all people using the service, incorporating risk management, communication needs, cultural preferences and positive risk-taking.
· Strong person-centred culture with people and families expressing high satisfaction; provider respected equality, diversity, religion, and LGBT+ identities.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: End of life care and supportGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Continuous learning and improving care; Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
Humble Healthcare Limited was rated Inadequate overall following a February 2023 focused inspection, with continuing breaches of Regulations 9, 12, 17, 18 and 19 across safe care, staffing, recruitment and governance, placing the service in special measures. Despite positive feedback from people about individual care workers, the provider failed to make sufficient improvements since the previous inspection, with persistent failures in risk assessment, medicines management, staff training and quality governance spanning the majority of its 9 inspections since registration in 2014.
Concerns (13)
criticalCare planning: “There was not enough information about some risks people were exposed to or how these should be managed. For example, one person regularly became physically aggressive causing harm to themselves, staff and others.”
criticalMedication management: “Not all staff who supported people with their medicines were trained to do so. The medicines assessments were incomplete and did not give enough detail about risks.”
criticalStaff competency: “Staff had not been trained to understand these. For example, some people had epilepsy...The staff had not had the training to understand how to support people in the event they had a seizure.”
criticalStaff training: “Since July 2022, all health and social care providers have been required to ensure staff received training on learning disabilities and autism. This training had not taken place.”
criticalStaffing levels: “Failure to ensure there were sufficient numbers of suitably qualified and experienced staff to meet people's needs was a breach of Regulation 18 (staffing).”
criticalGovernance: “The provider has been in breach of legal requirements at 8 of the 9 inspections we have undertaken since they were registered in 2014.”
criticalIncident learning: “They recorded some incidents, but not all of these and did not record when staff used restraint or restrictive practices. Failure to record these meant the incidents were not investigated.”
criticalSafeguarding: “Staff sometimes restrained people but there were no plans for this, the staff had not been trained to do so safely and the provider did not investigate, reflect on or analyse these incidents.”
moderateSupervision / appraisal: “Staff were not always given the supervision they needed to discuss their work and to ensure they had the knowledge and skills to care for people safely.”
moderateRecord keeping: “Some monitoring records were inaccurate and therefore could not be relied upon. Records of spot checks on staff recorded their compliance with tasks they were not assigned to carry out.”
moderatePerson-centred care: “Care plans were not always detailed enough about people's individual needs or how they should be cared for. Some people had complex care packages...There was not enough information.”
moderateConsent / capacity: “Records did not always clearly show how decisions had been made or consent obtained.”
moderateCommunication with families: “People were not always supported with their communication needs. Some people could not use speech. The staff had not been trained to understand how to communicate effectively.”
Strengths
· People using the service and their relatives liked their individual care workers and felt their needs were being met.
· The provider had worked with the local authority to investigate safeguarding concerns and staff had basic safeguarding training.
· Staff supported people to access other health and social care services when needed, acting appropriately when people became unwell.
· The provider employed staff who spoke different languages and could usually match staff who could communicate with people in their first languages.
· The provider had a suitable complaints system and people who had made complaints felt these had been resolved to their satisfaction.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement