Date of Assessment: 20 November 2025 to 27 November 2025 with site visit on 20 November 2025. Third Hand Healthcare Ltd is a domiciliary care agency that provides personal care to people living in their own homes. At the time of this inspection 120 people were using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. People told us their care needs were met, and they liked the staff who supported them. They said the staff were kind and caring and treated them with respect. However, they raised concerns in a number of areas in relation to communication, timeliness and consistency of care workers. There was oversight in place to monitor missed, late and cancelled calls. People were treated with kindness and compassion. The provider supported staff wellbeing and staff were encouraged to give feedback. Staff were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. Leaders were visible and supportive, helping staff develop in their roles. People received care and support from staff who were trained and qualified to meet their needs. Appropriate recruitment checks were in place to help ensure staff employed were suitable to care for people safely. There were governance systems in place to monitor the quality of the service, and these were mostly effective. This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. At the time of our inspection a manager was in post and registered with the Care Quality Commission.
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Third Hand Healthcare Ltd improved from Requires Improvement to Good across all inspected key questions, having successfully embedded changes following a previous breach of Regulation 11 relating to consent. The service demonstrated safe recruitment, effective medicines management, person-centred care planning and strong governance oversight.
Strengths
· People felt safe with staff and reported staff arrived on time and did not rush them
· Robust electronic medicines management system with alerts for missed medications and no gaps in administration records
· Staff recruited through robust procedures including DBS checks, right to work and reference checks
· Strong consent and Mental Capacity Act compliance following previous breach of Regulation 11
· Comprehensive audit programme covering medicines, care plans, call times and incidents
Third Hand Healthcare Ltd improved significantly from its previous Inadequate rating, exiting Special Measures, but remained Requires Improvement overall due to a continued breach of Regulation 11 regarding Mental Capacity Act assessments that were not decision-specific and reached contradictory outcomes. Caring was rated Good, reflecting compassionate, dignified and person-centred care, while safe, effective, responsive and well-led all required further embedding of new policies and practices.
Concerns (3)
criticalConsent / capacity: “Mental capacity assessments were not decision specific...the outcome opposed the findings of the assessment of capacity.”
moderateCare planning: “Care plans did not include specific care plans around people's health conditions. For example one person had a diagnosis of Parkinson's disease, but there was no care plan around this.”
minorIncident learning: “The provider had not implemented a monthly analysis of accidents and incidents.”
Strengths
· Medicines management and infection control practices were safe, with electronic MARs completed and regular spot checks on staff.
· Staff treated people with dignity, respect and compassion; people described staff as 'friends' who knew them well.
· Safe recruitment practices now in place including full employment histories, references and DBS checks.
· Sufficient staffing levels with consistent staff allocation and effective call monitoring systems.
· Complaints handled appropriately and in line with the provider's policy.
Quality-Statement breakdown (22)
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
Third Hand Healthcare Ltd received an overall Inadequate rating at its first CQC inspection in May 2019, with seven breaches of the Health and Social Care Act 2008 Regulations covering safeguarding, safe care and treatment, consent, staffing, recruitment, person-centred care and good governance. The service was placed in special measures due to widespread failures including unreported safeguarding concerns, unsafe medication management, absent quality audits, undertrained staff, and non-personalised care plans.
Concerns (15)
criticalSafeguarding: “Safeguarding concerns had been reported to the local authority by a relative regarding possible neglect from the service. The nominated individual had not fulfilled their regulatory responsibility by notifying us.”
criticalMedication management: “MAR charts stated that medicine was to be given 'twice a day'. There were no protocols in place for 'as and when' medicine (PRN) meaning that staff would not be aware of the safe correct dosage.”
criticalCare planning: “People's care records did not contain health care plans. One person was diagnosed with Parkinson's and another person had a diagnosed heart issue. There were no care plans around this.”
criticalStaff training: “No staff members had completed dementia awareness, stroke awareness, personal care, or risk assessment mandatory training.”
criticalGovernance: “No audits had been completed. The nominated individual told us, 'I haven't started doing any audits. At the moment I'm doing more care than I should be.'”
criticalConsent / capacity: “People who required assistance with medicines due to either lacking or fluctuating capacity did not have decision specific mental capacity assessments or best interest decisions.”
criticalRecord keeping: “Risks to people were not always appropriately recorded and managed. One person was at risk of pressure sores. However, there was no risk assessment around this.”
criticalIncident learning: “Staff did not respond appropriately to somebody who had suffered a stroke. 'They're still pending stroke training apart from one person. There's no reason why it's taken so long.'”
criticalLeadership: “It was unclear when the registered manager would be returning to the service, and the nominated individual had not made us aware of notifiable incidents in line with their regulatory requirement.”
moderateSupervision / appraisal: “Staff were not formerly supervised in their role. 'They haven't been very often, but we've done quite a number. [The registered manager] would go in and write that she had been there... They haven't been recorded otherwise.'”
moderateStaff competency: “Regular competency checks were not being completed which would have identified the shortfalls identified earlier in this section.”
moderateComplaints handling: “The nominated individual told us that they had received no complaints. There were no complaints recorded. However, people and staff told us about complaints that had not been recorded.”
moderatePerson-centred care: “People and relatives told us they were not involved in decisions around their care. Other people's care plans did not contain any personalised information at all.”
minorEnd-of-life care: “People's end of life wishes had not been discussed or recorded. 'We haven't really approached end of life care plans. There was no reason to as such.'”
minorInfection control: “Infection control practices were not checked by the nominated individual to ensure that they were safe. Spot checks had not been recorded.”
Strengths
· Staff were described as kind and caring by people and relatives, with one person stating 'They are very cheerful, we get on perfectly well. They are very caring.'
· There were a sufficient number of staff to meet people's needs and no missed care calls were reported.
· Staff supported and encouraged people to be independent where possible.
· Staff respected people's dignity during personal care.
· A business continuity plan was in place to ensure people continued to receive safe care in emergencies.
Quality-Statement breakdown (20)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
effective: Staff support: induction, training, skills and experienceInadequate
effective: Staff support: induction, training, skills and experienceGood
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
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
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
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 candour; regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; working in partnership with othersGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careInadequate
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesInadequate
responsive: End of life care and supportRequires improvement
responsive: Improving care quality in response to complaints or concernsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Continuous learning and improving care; Working in partnership with othersInadequate