Heart to Heart Care NW Limited received an Inadequate overall rating following a focused inspection of the safe and well-led domains, with breaches of Regulations 12, 13, and 17 identified across medication management, safeguarding, missed visits, risk assessment, and governance. The service was placed in special measures due to widespread and significant failings that put people at risk of avoidable harm.
Concerns (11)
criticalMedication management: “Medication administration records contained gaps indicating that some people had not received the medicines they needed to keep them safe and well.”
criticalSafeguarding: “One person had unexplained bruising that had not been reported to the local safeguarding authority or CQC as required by the manager.”
critical
Missed or late visits
: “They failed to turn up on three occasions... Nobody rang to let me know. I just managed myself. I felt upset.”
criticalCare planning: “Some people required a specialised diet to prevent them from choking, but they were given meals by staff that were unsafe for them to eat.”
criticalGovernance: “The governance arrangements in place to audit the quality and safety of the service were not sufficient. The systems were poor and ineffective.”
criticalIncident learning: “Safeguarding, accidents and other incidents that had occurred were not always properly recorded, investigated and reported.”
criticalLeadership: “They were however, unable to explain the failings of the service and why they had not been picked up and addressed.”
moderateInfection control: “The provider's policies and procedures relating to infection control and COVID 19 were brief and did not provide sufficient guidance on how the risk of COVID-19 would be managed.”
moderateRecord keeping: “The systems were poor and ineffective. They failed to identify the serious concerns with risk management, medication management, safeguarding, record keeping and governance.”
moderatePerson-centred care: “I used to have regular carers to shower wash me till they got whisked away... I'm a woman of 76, being washed by a girl of 18 and it's very unpleasant.”
minorCommunication with families: “I haven't spoken to anyone for a long time and not had a general review with Heart to Heart.”
Strengths
· Staff were recruited safely with appropriate recruitment checks in place.
· Staff were described by people and relatives as kind, caring, patient and approachable.
· Staff wore appropriate PPE during visits to prevent the spread of infection.
· The manager and assistant manager were open and approachable during the inspection.
· Staffing levels were generally considered sufficient by staff and most people using the service.
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careInadequate
well-led: Provider plans and promotes person-centred, high-quality care and understands and acts on duty of candour responsibility when things go wrongInadequate
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristics; Working in partnership with othersInadequate
Heart to Heart Care NW Ltd improved from Inadequate to Requires Improvement following a focused inspection of safe and well-led, exiting special measures with progress in medicines, IPC, safeguarding and call monitoring. However, the provider remained in breach of Regulation 17 (Good Governance) due to inconsistently embedded quality assurance, risk management and feedback response processes.
Concerns (8)
criticalGovernance: “Effective quality assurance and governance measures had not been fully embedded at the service.”
criticalGovernance: “Not enough improvement had been made at this inspection and the provider was still in breach of regulation 17.”
moderateCare planning: “some risk assessments did not always contain all the relevant control measures staff needed to provide the most effective level of care.”
moderateRecord keeping: “medical health and mental health support needs were missing from risk assessments we reviewed.”
moderateStaff competency: “Pre-employment recruitment checks were completed. However, we did highlight that some measures needed strengthening.”
moderateMissed or late visits: “The carer is often late and changes the time”
moderateCommunication with families: “there was no evidence to suggest that the feedback in relation to duration of calls and continuity of care was addressed / responded to.”
minorLeadership: “some office staff were not always approachable or listened to the concerns raised by care staff.”
Strengths
· Improved medicine administration procedures and policies in place, with medication champions deployed and improved compliance audits.
· Improved infection prevention and control arrangements, with all staff trained and engaged in COVID-19 testing.
· Improved safeguarding systems; staff completed comprehensive safeguarding training and knew how to escalate concerns.
· Introduction of an electronic call monitoring (ECM) system gave greater oversight of call times and staffing.
· Service no longer in special measures; improved from Inadequate to Requires Improvement.
Quality-Statement breakdown (9)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staff