During the previous inspection in September 2017, we identified a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It was related to the safe management of medicines. At this inspection we found that this had been addressed and the requirements of the Regulation had been met. The agency had introduced new medicines management systems to ensure medicines were managed and administered safely. Staff had received additional medicines training and their competencies to administer medicines safely had been checked. The management team had carried out regular medicines audits to ensure new medicines management procedures had been followed.

Risks to people’s health and wellbeing had been assessed and reflected in peoples’ care files. We found that some risk assessment documentation would benefit from more detailed information on risk management strategies for identified risks. We saw that the agency had already identified this and action had been taken to improve the quality and detail of information about risks to people.

There were other arrangements in place to help to provide safe care. Safeguarding procedures were established and staff knew what to do if they thought somebody was at risk from others. Recruitment procedures were appropriate and people were protected from unsuitable staff. There were procedures in in place for recording, monitoring and reducing of accidents and incidents. Infection control measures were used by staff when supporting people. There were sufficient staffing deployed to support people and to ensure scheduled calls took place as planned.

People were supported by staff who were trained in a range of mandatory and specialist subjects. The training was regularly updated. New staff had undergone an induction to the agency and their care role. They also received a series of four support meetings with a care worker liaison officer to ensure they were comfortable and competent to support people.

Staff told us they had received regular supervision and appraisal of their skills. They felt supported by their managers who were accessible when staff needed them. We found that the monitoring and recording systems around staff supervision and the spot checks of staff’s direct work with people could be improved to reflect all formal support provided. During our visit the senior management commenced making improvements to these records.

People’s needs and preferences had been assessed and the information gathered had been then used to formulate individual care plans. People were involved in the planning and reviewing of their care. Staff were provided with sufficient information on how to meet people’s needs. Some care plans would benefit from more detailed information on people’s background and how exactly they would like to receive support. We found that the agency had already commenced improvement work on person centred care planning. This included the provision of additional training for staff in person centred care and introduction of a new online care planning system, which helped reflect people’s changing needs as the changes happened.

People were supported to lead a healthy life and have access to health professionals. Staff helped people have enough food and drink and have a balanced diet that met people’s personal preferences and dietary requirements. Staff supported people to have access to appropriate health services for health checks, when their needs changed or if people’s health suddenly deteriorated.

The agency had worked within the principles of the Mental Capacity Act 2005. People were asked for their consent before receiving support and they were encouraged to make decisions about their everyday care. Where people did not have capacity to make a decision, the agency had liaised with their legally appointed representatives and respective external professionals to ensure care was provided in people’s best interest.

People said staff who supp

This inspection took place on 18, 19, 20 September 2017 and was announced.

Hartwig Care Limited is a domiciliary care agency that provides personal care to people in their own homes. The people who used the service had a variety of care needs and included elderly and frail people, as well as those with learning disabilities. At the time of the inspection, the agency provided care to almost 600 people across four London boroughs.

At the time of our visit the agency had two registered managers who were each responsible for different geographical areas of the service delivery. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. Both registered managers were supported by the operations manager, a team of care managers, field supervisors, care planners, care coordinators and monitors and care staff who were all responsible for ensuring care was provided as planned. The agency had also had a dedicated finance, recruitment and training team.

During our inspection, we found positive aspects to the care provided by Hartwig Care Limited. However, we also identified some areas that required improvement. The agency had not always fully assessed and managed all of the risks to care and treatment of people who used the service. We also found issues relating to clear recording of medicines that were prescribed to people and clarity of who was responsible for medicines management for respective individuals.

There were staffing issues identified in relation to time keeping and continuity of care during the weekends and finding emergency staff cover in some geographical areas and the agency was working towards addressing these issues.

Where people lacked capacity to make decisions, staff had not always had full information on what decisions people could have made and how to support them to do so. It was not always clearly documented if family members who consented to care and treatment on behalf of their relatives had been officially authorised to act on their behalf.

The majority of people received appropriate care in relation to their dietary and nutritional needs, however, where needs relating to food were more complex the support had not always been documented clearly.

People’s care plans were person centred. They indicated people’s strengths and abilities with regard to their level of dependency, along with the actions and support required by the care worker. However, in some cases care plans had limited information on how to provide care to people with specific health care needs or where risks had been identified relating to specific medical conditions.

The quality monitoring systems, such as care file and medicines audits, related to individual care files. There were no overall managerial auditing systems and procedures. Consequently, the agency did not have effective tools to monitor and assess the quality of the care and support provided to identify any patterns for gaps in performance and to take appropriate action to address these gaps.

There were a number of positive aspects about this provider. People spoke positively about the staff who supported them and the service they provided. Staff were well trained and they knew their professional duties and responsibilities. The management team was responsive in addressing identified issues related to keeping people happy with the service they received. External health and care professionals commented positively about the agency and they had not raised any serious concerns with the Commission about the quality of the service provided to people who used it.

The agency helped to protect people from harm and abuse and any safeguarding concerns were promptly dealt with by the management team and appropriat

At the time of inspection the agency employed 289 care workers who provided approximately 410,000 hours of care per year. The agency supported people who lived in seven London boroughs.

We spoke with 17 people who use the service or their relatives. We received 22 questionnaires, out of the 61 which were sent out to people who use the service. People commented mostly positively of their experiences with the agency. They told us that “carers are always friendly and polite” and that “they have become like a family.” Some of the negative comments related to staff being occasionally late or not being able to deal with all tasks, such as cooking or cleaning effectively. A relative of a person who used the service told us that “carer had made enormous effort.” Another one said “the agency is efficient and deals promptly with any problems.”

We noted that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. There were enough staff to meet people’s needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

Hartwig Care Limited is a domiciliary care agency based in Hampstead, North London. The agency provides personal care to people in their own homes. The people who used the service had a variety of care needs and included elderly and frail people, as well as those with learning disabilities. At the time of the inspection the agency provided care to almost 600 people across five London boroughs.

The provider was given 48 hours’ notice because the location provides a domiciliary care service. At the last inspection on 27 February 2014 the provider met all of the requirements we looked at.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. 

From telephone discussions we had with people using the service and relatives we found that people were highly satisfied with the way the service worked with them. People were confident about contacting staff at the agency to discuss anything they wished to and people believed that care workers knew how to care for people.

The care plans we looked at showed that risks associated with the care to be delivered were identified and responded to. The agency had effective staff recruitment procedures in place which showed that diligent checks were undertaken to ensure that care staff were suitable to provide care.

T

he service had access to the organisational policy and procedure for the protection of vulnerable adults from abuse. We asked staff about how they would recognise any potential signs of abuse. The care workers and other staff we spoke with told us that they received training about protecting adults from abuse and were able to describe the action they would take if a concern arose. It was the policy of the provider to ensure that staff had initial training which was then followed up with periodic refresher training. When we looked at staff training records we found that this had happened.

We spoke with the registered manager, training manager and provider who explained the system used for both mandatory and optional training courses. We found the mandatory training covered core skills and knowledge for staff and induction training was in line with the Skills for Care Common Induction standards. Staff supervision records showed that a system for consistent supervision for all staff was in place.

The agency had detailed policies, procedures and information in relation to the Mental Capacity Act 2005 (MCA). It should be noted that the agency does  not have responsibility for making applications under this legislation; however, they have a responsibility for ensuring that any decision on the MCA 2005 were complied with. Care staff we spoke with demonstrated a good understanding of this area.

People we spoke with were very satisfied with the care provided by staff. This was the overwhelming feeling of the people we spoke with as they all echoed the same sentiments and said they or their relatives were treated as individuals and with dignity

The care plans we looked at drew attention to individual needs such as how people communicate, their cultural identify and first language. The care plan format contained a portrait of the person as part of the information available to care staff. This helped to provide information which assisted care staff to form a good rapport with the people they cared for.

We looked at the complaints record and found that when complaints had been made these had been responded to openly and the agency had taken the necessary steps to both resolve complaints and learn from them.

The care provided by staff was clearly set out in all the care plans that we looked at. This included information about people's preferences and individual needs. For example the times when carers were to visit people’s homes to deliver care was stated along with the numbers of care staff required.

There was a clear management structure in place and staff were aware of their roles and responsibilities. From our discussion with the registered manager during our inspection we were told about, and shown, the monitoring systems for the day to day operation of the service. Staff had specific roles and responsibilities for different areas and were required to report to the registered manager about the way the service was operating and any challenges or risks to effective operation that arose.

The registered manager told us that they sought people’s views at least annually and we saw examples of feedback that had been obtained. This feedback was highly positive and showed that people felt they were listened to and their views about the quality of the service were respected.