Hartwig Care Ltd received an overall Good rating following a focused inspection of Safe and Well-Led domains, with Safe deteriorating to Requires Improvement due to inadequate guidance for high-risk medicines and shortfalls in care visit scheduling and monitoring in the Hackney borough. Well-Led remained Good, with managers demonstrating awareness of issues and active work on improvements, supported by positive feedback from people, relatives and external professionals.
Concerns (4)
moderateMedication management: “three people who were prescribed anticoagulants. These people's care plans did not have guidance for staff to help staff monitor and manage the side effects of these medicines.”
moderateMissed or late visits: “Six out of seven people...reported frequent staff changes, poor staff punctuality, and shorter visits than planned. Four people said there were some occasions when staff did not turn up at all.”
moderateRecord keeping: “Some staff were not logging in and out of their visits, making it difficult for us to ascertain if calls took place.”
minorCare planning: “some care plans needed more information on specific aspects of care for individual people...some risk assessments needed more personalisation to reflect specific risks for specific individuals.”
Strengths
· Safe recruitment procedures in place with required checks including DBS, references and employment history for all reviewed staff files.
· Infection control processes were sufficient; staff received COVID-19 training and PPE was generally used correctly.
· Staff felt supported by managers during the COVID-19 pandemic with training, PPE supply and management availability.
· Effective multi-agency working praised by external health and care professionals.
· Quality assurance audits identified most shortfalls including medicine administration and care visit monitoring.
Hartwig Care Ltd improved from Requires Improvement to Good across all five key questions at this December 2018 inspection, having successfully remediated the previous Regulation 12 medicines management breach through new systems, training, and audits. Minor shortfalls remained around risk assessment detail, supervision recording, care plan personalisation, and communication with people about late or changed calls, all of which the proactive management team had already begun to address.
Concerns (7)
moderateSupervision / appraisal: “We saw in staff files that these activities had not always been recorded to show that they had taken place and what was discussed/agreed.”
minorMedication management: “We found that not all senior staff were up to date with their auditing of medicines. We discussed this with the senior management team who assured us this would be addressed.”
minorCare planning: “Some care plans would benefit from more detailed information on people's background and how exactly they would like to receive support.”
minorRecord keeping: “monitoring systems around staff training mostly included manual checks and cross-referencing of staff training records. This was time consuming and could cause monitoring errors.”
minorCommunication with families: “Some people using the service and their families raised concerns around communication about staff lateness and changes to staff.”
minorMissed or late visits: “between August and November 2018 there were on average 11 low risk missed calls a month because the agency did not manage to secure a replacement staff at the short notice.”
minorConsent / capacity: “one person had consent given by their next of kin without evidence to support that this had been appropriate and in their best interests.”
Strengths
· Previous breach of Regulation 12 regarding medicines management had been fully addressed with new systems, training, and regular audits introduced.
· Sufficient staffing levels deployed; reports showed the vast majority of calls took place as planned with missed calls constituting less than 1% of care delivered.
· Robust safeguarding procedures in place; all staff demonstrated good understanding of how to protect people from harm or abuse.
· Safe recruitment procedures followed, including DBS checks and verified references for all new staff.
· Staff received comprehensive mandatory and specialist training including annual refresher courses; approximately 78% had completed or were completing the Care Certificate.
Quality-Statement breakdown (21)
safe: Using medicines safelyGood
safe: Supporting people to stay safe from harm and abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Learning lessons when things go wrongGood
safe: Recruitment and staffing levelsGood
safe: Preventing and controlling infectionGood
effective: Staff skills, knowledge and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
Hartwig Care Ltd was rated Requires Improvement overall following a September 2017 inspection, with a regulatory breach identified under Regulation 12 for unsafe medicines management including widespread discrepancies across MAR charts and MAF forms and unclear responsibility for administration. While staff were caring, well-trained, and received positive feedback from people and professionals, significant gaps in governance, risk documentation, MCA recording, and care plan detail for complex needs undermined the safety and leadership of the service.
Concerns (7)
criticalMedication management: “there were discrepancies in information recorded in all 10 cases...the agency did not have formal procedures and policies on transferring information about people's medicines”
criticalMedication management: “it was not always clear if a person self-medicated or if administration was shared between the agency's staff and a person's family”
moderateGovernance: “there were no overall managerial auditing systems and procedures...the agency did not have effective tools to monitor and assess the quality of the care”
moderateRecord keeping: “medicine audits for one person for July and August 2017 had not identified that MAR charts did not have recorded medicines details, known allergies and other information”
moderateConsent / capacity: “there were not always clear records stating if those family members who were making decisions on their behalf had a Lasting Power of Attorney”
moderateCare planning: “for a person with epilepsy...there was no direction or advice on how to manage or respond to a seizure if necessary”
minorMissed or late visits: “Two people reported that they had recently experienced a missed care visit...issues around time keeping during weekends and when their regular care staff were absent”
Strengths
· People spoke positively about staff who supported them, describing them as kind, caring, and compassionate.
· Staff were well trained with thorough induction, Care Certificate completion, shadowing, and annual refresher training.
· Robust and values-based recruitment process with thorough pre-employment checks.
· Continuity of care maintained by allocating the same care staff to individuals, supporting long-term relationships.
· Safeguarding concerns were dealt with promptly and appropriate external bodies were notified as required.
Quality-Statement breakdown (20)
safe: Medicines managementRequires improvement
safe: Risk assessment and managementRequires improvement
safe: Safeguarding people from abuse and harmGood
safe: Staffing levels and emergency coverRequires improvement
safe: Recruitment practicesGood
effective: Mental Capacity Act compliance and documentationRequires improvement
Hartwig Care Limited, a domiciliary care agency serving nearly 600 people across five London boroughs, received a Good rating across all five key questions at its May 2015 inspection. The service demonstrated strong person-centred care, robust governance, consistent staffing, and high levels of satisfaction among people using the service and their relatives.
Strengths
· People and relatives were highly satisfied with the service and felt safe with care workers
· Robust staff recruitment procedures including DBS checks and reference verification
· Comprehensive mandatory and refresher training programme aligned to Skills for Care Common Induction standards
· Care plans reflected individual needs, preferences, cultural identity and first language
· Consistent allocation of the same care workers to individuals, supporting continuity and relationship-building
effective: Supporting people to eat and drink enough with choice in a balanced dietGood
effective: Healthcare supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supportedGood
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: Personalised careGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Leadership and managementGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood
well-led: Working in partnership with othersGood
effective: Staff supervision and appraisalGood
effective: Access to healthcare professionalsGood
caring: Compassion and dignity in care deliveryGood
caring: Continuity of care and staff matchingGood
caring: Involvement in decision-making and care choicesGood
responsive: Person-centred care planningGood
responsive: Detail in care plans for complex health needsRequires improvement
responsive: Complaints handlingGood
responsive: Involvement in care reviews and satisfaction monitoringGood
well-led: Governance and quality auditing systemsRequires improvement
well-led: Leadership, accountability and staff supportGood
well-led: External stakeholder feedback and relationshipsGood