HW Homecare received an overall rating of Requires Improvement following a focused inspection in May–June 2023, with four regulatory breaches identified covering risk management, staff recruitment, training, and governance, plus a warning notice issued for Regulation 17. Significant concerns included absent registered management for 13 months, widespread lack of auditing, unsafe medicines administration, poor safeguarding awareness, and an unprofessional culture that deterred people from raising concerns.
Concerns (16)
criticalMedication management: “One person's medicines were being given irregularly but not recorded on a medicine administration record (MAR).”
critical
Safeguarding
: “We identified several incidents that could potentially involve safeguarding, but this had not been recognised by staff.”
criticalGovernance: “The provider did not provide evidence of auditing since our previous inspection. Areas such as training, complaints, medicines management or safeguarding had not been reviewed.”
criticalLeadership: “There had not been a registered manager at the service for 13 months. The provider had a leave of absence due to ill health for 3 months prior.”
criticalIncident learning: “The provider had not reported all notifiable incidents to CQC.”
moderateCare planning: “People's records did not always identify or assess risks...we found little improvements had been made.”
moderateInfection control: “One person said, 'Staff wear a uniform, never seen them with gloves on.' Relatives fed back that staff did not always wear full PPE.”
moderateStaff training: “One relative said, 'One staff member didn't even know what dementia was. They do have 1 or 2 nice carers who just don't have the experience.'”
moderateStaff competency: “There was no evidence of competency checks to check staff understanding of their roles and responsibilities, such as with medicines management.”
moderateSupervision / appraisal: “Staff told us they had not received regular support in their roles in the form of supervisions and appraisals.”
moderateComplaints handling: “Allegations from people of staff bullying had been discussed in a staff meeting. There was no other evidence to show that this had been managed.”
moderateConsent / capacity: “Staff lacked confidence and understanding regarding their responsibilities under the mental capacity act, including need for legal documentation for power of attorney.”
moderatePerson-centred care: “People's care documentation was not person-centred nor reflective of their current support needs.”
moderateRecord keeping: “We were unable to view 2 out of 3 staff training records as we were informed records had been accidently deleted.”
minorStaffing levels: “One staff member said 'We work long hours with not much help. There is a shortage of staff to cover calls so taking time off is difficult.'”
minorCommunication with families: “A person and relatives told us they had not been asked for their views on care, nor had they been involved with regular reviews.”
Strengths
· People received support from the same staff every day, providing consistency of care.
· A professional gave positive feedback about staff responsiveness, willingness to attend meetings, and communication regarding people's needs.
· The provider demonstrated willingness to improve and responded immediately to some areas of concern during the inspection.
· Staff had been involved in best interest meetings and worked collaboratively with other professionals.
· People and relatives felt people were safe and described staff as trustworthy.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
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
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Working in partnership with others; Continuous learning and improving careRequires improvement
HW Homecare, a newly registered domiciliary care agency, received an overall rating of Requires Improvement at its first inspection, driven by incomplete risk assessments, absent contingency planning, missing recruitment and supervision records, and an audit process not yet established. Despite these governance and record-keeping shortfalls, staff were praised as highly caring and knowledgeable, and the service was rated Good for effective, caring and responsive care.
Concerns (6)
moderateCare planning: “People's records did not always identify or assess risks, for example with moving and handling, falls, choking, and specific health conditions.”
moderateCare planning: “Care plans lacked personalised information about how people liked to be supported, what they could do independently and where they needed support.”
moderateGovernance: “The registered manager and care coordinator were responsible for completing a variety of audits...however, due to only being registered for six months, this process had not been started yet.”
moderateRecord keeping: “Staff records were also missing some information regarding recruitment...Staff told us they had been to staff meetings, however none of these had been recorded.”
moderateOther: “We found that the service did not have a contingency plan to manage emergencies, such as adverse weather conditions or staff sickness.”
minorSupervision / appraisal: “Because the service was new, the registered manager had not yet introduced regular supervision or annual appraisals.”
Strengths
· People, relatives and a professional unanimously described staff as kind, caring and respectful, with privacy and dignity always upheld.
· Staff received a robust induction including four days of training, shadowing, and competency checks covering medicines, moving and handling and infection control.
· Staff knew people exceptionally well, enabling personalised, person-centred support that mitigated gaps in formal documentation.
· The registered manager demonstrated openness to feedback and began implementing improvements during the inspection itself.
· Strong multi-agency working and positive relationships with the local authority and professionals were evidenced.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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
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: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlGood
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: 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 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 staffRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersGood