About the service:

HFH Healthcare Limited is a home care agency. It provides nurse-led personal care and treatment to children and adults living in their own home who have spinal or brain injuries, neurological conditions or genetic diseases. Some people may also be living with dementia, a learning disability or autism, mental health needs and/or sensory impairments.

At the time of our inspection approximately 50 children or young people and 100 adults received a nurse-led home care service from this agency. Around 30 people using the service received 24-hour care from live-in staff.

People’s experience of using this service:

¿ At this inspection we have continued to rate the service ‘Good’ overall.

¿ However, the service’s rating for the key question, ‘Is the service well-led?’ remains ‘Requires Improvement’.

¿ Although most people using the service, their relatives and external health care professionals told us the quality of the care they were provided with by this agency remained either ‘good’ or had improved in the last six months; we continued to receive mixed feedback from people about constantly changing care staff and the negative impact this had on the continuity of care they received.

¿ We discussed this on-going issue with the newly registered manager who acknowledged the action they had already taken to improve continuity of care would take more time to be fully implemented and for everyone to feel the benefit. This included employing more nurses and having core groups of care staff working together in one area with the same service users. Progress made by the provider to ensure people consistently received good quality care from staff who were familiar with their needs will be assessed at their next inspection.

¿ This issue notwithstanding, people and their relatives told us staff were always polite and kind towards them. Staff also respected people’s dignity and privacy. They listened to people and supported their independence where possible.

¿ People were kept safe from the risk of harm. Potential risks to people and staff were assessed and managed appropriately. Staff had a clear understanding of how to recognise and report abuse and neglect.

¿ Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met.

¿ Staff were safely recruited to ensure they were suitable to work in a care service. People received support from trained and supervised staff who had the right skills and knowledge.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ People’s needs and individual preferences were documented in their care plan, which were personalised and routinely reviewed to ensure they remained up to date and accurate.

¿ People had been consulted about their support needs and involved in helping staff develop their care plan.

¿ People, their relatives, professional representatives and staff all said they could approach the registered manager if they had any issues or concerns. There was a procedure in place which explained how people could raise concerns or complaints.

¿ The provider had effective systems in place to assess and monitor the quality and safety of the service people received. This helped the service continuously improve it's practice and to learn lessons when things went wrong.

¿ The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver a safe, effective service.

Rating at the last inspection

At the last inspection the service was rated ‘Good’ overall (Report was published on 27 December 2017).

Why we inspected

This inspection was brought forward by approximately a year due in part to concerning information we received about the higher than expected number of safeguarding alerts and complaints raised in relation to this service

This service is a domiciliary care agency. It provides nursing, personal care and treatment for children and adults living in the community with complex health conditions, disabilities and injuries. At the time of our inspection 40 children and 110 younger and older adults living in or around London received a home care service from HFH Healthcare. This agency specialises in supporting children and adults with spinal and brain injuries or neurological disorders, some of whom may also be living with dementia, have learning and physical disabilities, sensory impairments or mental health needs.

The service had a registered manager in post who was also the Chief Executive Officer (CEO) of the company. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the last CQC inspection of this service in February 2016 we rated them ‘Good’ for the five key questions ‘is the service safe’, ‘effective’, ‘caring’, ‘responsive’ and ‘well-led?’ At this inspection we found the service remained rated ‘Good’ overall.

However, we have changed the rating for the key question is the service well-led from ‘Good’ to 'Requires Improvement’. Although people said they were happy with the care they received from their ‘regular’ care staff, we received mixed feedback from people, their relatives and professional representatives concerned about the high rates of staff turnover the agency had experienced in the last 12 months and new care staff not being so familiar with peoples complex health care needs, daily routines and preferences. This point notwithstanding most people felt staff retention had improved recently and their new care staff had begun to familiarise themselves with people’s needs, routines and wishes. In addition, we received some mixed comments from people and their relatives and professional representatives concerned about poor communication from the agency. For example, people told us they were not always notified in a timely way about changes to care staff rotas and therefore they did not always know who their care staff would be and what knowledge, skills and experience they had.

We discussed the aforementioned issues with the registered manager who acknowledged the agency had faced a challenge in the last 12 months dealing with higher than average rates of staff turnover and a significant increase in the number and complexity of the health care needs of people they now supported. The registered manager told us they planned to improve the way the agency was managed by introducing new fixed hour contracts for all staff to increase staff retention and senior coordinator posts to oversee smaller teams of specialist care staff working in specific geographical areas. Progress made by the provider to introduce new staff contracts and senior coordinator positions will be assessed at the services next inspection.

The negative points described above notwithstanding most people felt safe using the agency and with their ‘regular’ care staff. There continued to be robust procedures in place to safeguard people from harm and abuse. Care staff were still familiar with how to recognise and report abuse. The provider had assessments and management plans in place to minimise possible risks to people, which included infection control and safe food handling measures. There was a 24 hours on call system in operation that ensured management and nurse support and advice was available for care staff when they needed it. Staff recruitment procedures continued to prevent people from being cared for by unsuitable care workers. Medicines were managed safely and people received them as prescribed.

Care staff received appropriate training and support to ensure the

This inspection took place on 16 February 2016 and was announced. The provider was given 48 hours’ notice because the location provides domiciliary nursing care we needed to be sure that someone would be available in the office so we could look at certain documentation. The last Care Quality Commission (CQC) inspection of the agency was carried out on 07 January 2014, where we found the service was meeting all the regulations we assessed.

HFH Healthcare Limited is a domiciliary care agency that provides nursing and personal care to people living in their own homes. The agency specialises in providing 24 hour nursing and/or personal care to children, younger adults and older people with complex health care needs who are not in hospital, but have been assessed as having a primary health need. The agency works closely with local NHS continuing care teams to provide packages of care. Most people receiving a service from HFH Healthcare live in and around London and are funded by the NHS. There were 18 children, 86 younger adults and six older people received nursing and/or personal care and support from this agency at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The agency was well managed. The agency had a clear management structure in place. The management team demonstrated strong leadership and a good understanding of their roles and responsibilities. They also communicated a strong ethos focusing on person centred care and ensuring people received a good quality service from the agency. Managers regularly met with staff and checked they were clear about their duties and responsibilities to the people they cared for. Staff told us they felt valued and appreciated for the work they did by the agency’s management team.

Furthermore, the agency had established effective governance systems to routinely assess and monitor the quality of service provided by the agency. Regular audits were carried out and, for areas where issues were identified, appropriate and timely action was taken to ensure people’s welfare and safety. The service also used external scrutiny and challenge to ensure people received appropriate care and support from the agency.

People told us they were happy with the standard of care and support they received from the agency and that staff were kind and caring. People’s rights to privacy and dignity were also respected. Our discussions with people using the service, their relatives and community health and social care professionals supported this.

People told us they felt safe when staff from the agency visited them at home. Managers and staff knew how and when to report abuse or neglect if they suspected people were at risk. They had all received up to date training in protecting children and safeguarding adults at risk. Staff had access to appropriate guidance to ensure identified risks to people were minimised. Regular maintenance and service checks were carried out on equipment used by staff in people’s homes, such as mobile hoists.

People were supported to keep healthy and well. Staff ensured people were able to access community health and social care services whenever they needed them. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration. People received their medicines as prescribed and staff knew how to manage medicines safely.

People agreed to the level of support they needed and how they wished to be supported. People had care plans in place which reflected their specific needs and preferences for how they were cared for and supported. These gave staff guidance and instructions on how people’s n

We spoke with four people who used the service or their relatives. People told us they were happy with the service they received. Typical comments included “a good service”, “I feel absolutely involved with my care”, “the service has worked out very well” and “they really want to do the best they can.”

We looked at the care records for four people using the service. People received a client household guide when they first started using HFH Healthcare. This gave detailed information about the service and what people could expect in terms of their care and support. We saw how assessments had been used to develop a plan of care and support. People told us they had been involved in their initial assessments of care and felt their on-going care and support had been explained to them and met their individual needs. All the people we spoke with told us they were happy with their or their relative’s assessment of care.

People told us their carers were introduced to them before they started working with them. One person told us “I have been involved in choosing the carers that assist me, now I have a team I am happy with” another told us “HFH introduced the carers to us, we had a few changes but now we have good relationships with all our carers.”

We spoke with the registered manager, the director of healthcare, head of clinical governance, a member of staff from the clinical team, two care co-ordinators and three care workers. We found there were effective recruitment procedures in place for new staff and existing staff told us they felt properly supported to provide care to people using the services. People we spoke with felt their carers were skilled enough and had been adequately trained to give them the support they needed.

We saw there were effective systems in place to monitor the quality of care provided to people who use the service.