About the service: Humble Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and younger adults with physical disabilities, learning disabilities and mental health needs. At the time of our inspection six people were using the service. People lived within the London Boroughs of Southwark and Hounslow and Surry. Humble Healthcare Limited is the only location for this provider.

People’s experience of using this service:

¿ There had been improvements in the way the service was managed. These included improved record keeping, staff supervision and training.

¿ However, there were a number of areas where improvements were still needed. For example, some care plans did not always clearly describe people's needs. The provider was in the process of changing from paper records to a computerised system for care planning, recording care provided, medicines records and call monitoring. At the time of the inspection, some of information was not clear because of this change over.

¿ At the last inspection of the service we identified that the provider was not carrying out effective recruitment checks. There had not been any new staff employed since the last inspection, so we could not judge whether improvements had been made in this area.

¿ People who had the mental capacity to make decisions about their care had consented to this. However, when relatives had been involved in making decisions, the processes for this and whether they had the legal authority to do so, had not always been clearly recorded.

¿ People using the service and their relatives told us that they received personalised care which met their needs. They were cared for by the same regular staff, who they liked and had good relationships with. They said that the care workers arrived on time for care visits and did everything that was expected of them. They had the support they needed about what they ate, and they were able to make decisions about their own care.

¿ There had been improvements in the way staff were supported, supervised and trained. They had undertaken a range of different training courses and there was a plan to make sure they received ongoing training and support. The registered manager regularly met with the staff and carried out observations of the care they provided and assessments of their skills and knowledge.

¿ People using the service and their relatives told us they knew how to make a complaint and felt confident speaking with the registered manager. They said that they had regular contact with the registered manager who asked them about their experiences. The registered manager had introduced new systems for monitoring the quality of the service and acting on feedback from others.

¿ We identified breaches of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to good governance. You can see what action we have asked the provider to take within our table of actions.

Rating at last inspection: The service was rated as inadequate at the last inspection of 2 October 2018 (Published 13 November 2018). The service had been placed in 'special measures' since May 2018, when it was also rated inadequate. Since the registration of the service, the service has been inspected six times, in July 2016, July 2017, November 2017, May 2018, October 2018 and this inspection. The provider has failed to achieve a good rating at any of these inspections.

Why we inspected: This inspection was carried out in line with our schedule of planned inspections based on the previous rating of inadequate and because the service was in 'special measures.'

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service d

The inspection took place on 2 October 2018. We told the provider two working days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

The last inspection of the service was on 11 May 2018, when we rated the service inadequate and placed it in special measures. We identified breaches of five Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing.

Following this inspection of 11 May 2018, we asked the provider to complete an action plan to show what they would do and by when to improve to at least ‘good’. The provider completed an action plan.

At the inspection of 2 October 2018, we found some improvements had been made. However, we identified continuing breaches of Regulations relating to safe care and treatment, staffing and good governance. In addition, we identified two new breaches relating to fit and proper persons employed and the provider's failure to comply with the Regulations in carrying on the regulated activity of personal care. The questions, 'Is the service safe?' and 'Is the service well-led?' continue to be rated inadequate.

Humble Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and younger adults with physical disabilities, learning disabilities and mental health needs. At the time of our inspection seven people were using the service. People lived within the London Boroughs of Southwark and Hounslow. Some people's care was commissioned by the local authorities. Humble Healthcare Limited is the only location for this provider.

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 and associated Regulations about how the service is run.

The provider did not have effective systems and processes for recruiting staff to make sure they were suitable, competent, skilled or experienced. Furthermore, they had failed to ensure the staff received the appropriate support, training, supervision or appraisal to delivered effective care. This meant that people were placed at risk of inappropriate or unsafe care.

The risks to people's safety and wellbeing had been identified, but the provider had not always developed processes to mitigate these risks. For example, the guidance for staff was not detailed enough for them to provide safe care and treatment. The risks to people's wellbeing was further exacerbated by the risks associated with having staff who did not have the training or support to develop the skills, competence, qualifications or experience to care for people safely.

The provider's systems for monitoring and improving the quality of the service, as well as identifying and mitigating risks, were not always effective. Whilst they had made improvements in some areas, these were not enough to ensure people were being safely cared for. Furthermore, the provider has a history of failing to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They had sourced two different consultants to support them in making the improvements but these improvements were not sufficient.

People using the service were happy with the care and support they received. They liked their care workers and told us they were involved in planning and reviewing their care. They told us their individual needs were being met. They felt able to contact the provider and raise any concerns or speak about their care.

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that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

At the last inspection of 8 November 2017 we rated the service Requires Improvement overall and in the key questions of Safe and Well-led. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-Led to at least ‘good’.

At this inspection of 11 May 2018 we found they had not made the required improvements and have rated the service Inadequate overall and in the key questions of Safe and Well-led. We have rated the key questions of Effective, Caring and Responsive as Requires Improvement.

Humble Healthcare Limited is domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and younger adults with physical disabilities, learning disabilities and mental health needs. At the time of our inspection 24 people were using the service. All the people lived within the London Borough of Southwark and their care was commissioned by this local authority. Humble Healthcare Limited is the only location for this provider.

There was a registered manager in post; they were also the owner of the company. 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.

The provider had not made suitable arrangements to ensure that people received their medicines as prescribed and in a safe way.

The provider's governance arrangements had failed to identify when things had gone wrong and take action to put this right. For example, we found medicines administration records which had errors. These had been audited by the registered manager, although the errors had not been identified or investigated.

Some people were supported by staff who undertook shopping for them. There was no system to ensure that people were not financially abused because the staff did not keep records of expenditure and the provider did not carry out checks on this.

Records about people were not always accurate or complete. The provider had used the same information in a number of different people's care plans and this was not relevant to them and did not describe their needs. Therefore, there was a risk that people would receive care and treatment which was not appropriate and did not meet their needs.

Where risks had been identified by the local authority, the provider had not ensured that these were recorded within risk assessments or care plans and there was no guidance for the staff on how to minimise these risks.

The provider was unable to evidence that staff had been suitably trained and supervised to provide care and support to people who used the service.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our en

The inspection took place on 7 November 2017 and was unannounced.

The last inspection took place on 12 July 2017 when we rated the service Requires Improvement. We rated the key question of Safe as inadequate, the key questions of Effective, Responsive and Well-Led as Requires Improvement and the key question of Caring as Good. We issued three warning notices and made two requirements because the provider was not meeting five of the Regulations we checked.

At the inspection of 7 November 2017 we found that improvements had been made in all areas. However, the provider needed to make further improvements to their systems for auditing how care was provided and record keeping. The service has been rated Requires Improvement in the key questions of Safe and Well-led and overall. We have rated the key questions of Effective, Caring and Responsive as Good.

Humble Healthcare Limited is a domiciliary care agency registered to provide personal care to people living within their own homes. At the time of the inspection 19 people were using the service. People using the service lived in the London Borough of Southwark. The majority were older people (over the age of 65 years). There were 14 active care workers at the time of our visit. Humble Healthcare Limited is the only location for the provider of the same name. The service is privately owned and has been operating since 2016.

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 and associated Regulations about how the service is run.

The provider's audits of medicines administration records had failed to identify when these records showed that medicines may not have been administered as prescribed. Four people using the service at the time of our inspection were being supported by the agency to take their medicines. Records for three of these people included gaps where no administration had been recorded. In one case the records indicated an additional dose of one medicine had been administered. The provider had audited all these records but had not identified any areas of concern and therefore had not investigated what had happened.

Some of the provider's records were not appropriately maintained. For example, we found information relating to one person in the care notes of other people.

We found breaches of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service and their representatives were happy with the care they received. They told us that care workers arrived on time and stayed the agreed length of time. They explained that care workers did everything they asked and offered them choices. They were happy with support they received with medicines and in preparing meals, as well as with support with their personal care. People told us that the care workers were kind, polite, caring and compassionate. They said that their privacy was respected and they were happy with all aspects of the service.

The staff told us that they received the information they needed to carry out their jobs. They were supported to attend training and had meetings with the registered manager. The care workers explained that the registered manager observed them when they were providing care during spot checks to make sure they were doing everything right. The care workers told us they could contact the registered manager and ask for help whenever they needed.

Care plans were clear and showed the support people needed. Individual preferences were included within the plans. There was evidence that the plans had been discussed with the person, and/or their representative and they had

The inspection took place on 12 July 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.

The last inspection took place 5 July 2016 when we rated the service Requires Improvement. We made breaches in respect of safe care and treatment, fit and proper persons employed and good governance. At the inspection of 12 July 2017we found that there had not been enough improvements in any of these areas. In addition we found other areas of concern which included the management of medicines, supervision of staff and the assessment of people's needs.

Humble Healthcare Limited is a domiciliary care agency registered to provide personal care to people living within their own homes. At the time of the inspection 28 people were using the service. People using the service lived in the London Boroughs of Southwark and Hounslow. The majority were older people (over the age of 65 years). Four people had been using the service since 2016. The other 24 people started using the service between March and June 2017. There were 16 active care workers at the time of our visit. Humble Healthcare Limited is the only location for the provider of the same name. The service is privately owned and has been operating since 2016.

The owner of the company was also the registered manager. 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.

The risks to people's safety and wellbeing had not been assessed and there was no guidance to ensure the staff minimised these risks.

Medicines were not managed safely so people were at risk of harm.

The provider had not undertaken all the required checks on the staff employed. Therefore people were at risk of receiving care from staff who were not suitable. The provider did not ensure that staff were suitably supervised to make sure they were competent.

The provider had not assessed or planned for people's needs. Therefore there was a risk that they would receive care which was not suitable.

Records were not accurately maintained. Therefore staff did not have clear information about how they should meet people's needs.

The provider's systems for monitoring the quality of the service, mitigating risks and making improvements were insufficient and this meant people were at risk of receiving care which was not safe and did not meet their needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For the breaches of Regulations in relation to person centred care and staff support you can see what action we have asked the provider to take at the back of the report. We are taking further action against the provider for breaches of Regulations in relation to safe care and treatment, good governance and fit and proper persons employed. Full information about CQC’s regulatory response to the concerns found during this inspection is added to reports after any representations and appeals have been concluded.

Following receipt of the draft inspection report the provider sent us evidence of more detailed care plans and assessments for some people and these had more information to enable the staff to know how to care for them.

People who used the service, their relatives and the local authority representatives felt the service met their needs. They said that care workers were kind, caring and polite. The care workers arrived on time and carried out all the tasks they expected. People told us that they were given choices and the care workers respected these.

The staff told us they were well supported and were happy working with the agency. They told us they had all the training they needed.

The regis

The inspection took place on 5 July 2016 and was announced. We gave the provider 48 hours' notice because we wanted to make sure someone would be available to assist with the inspection.

This was the first inspection of the service since it was registered in November 2014. The service started providing care to people in 2016.

Humble Healthcare Limited is a domiciliary care agency providing personal care and support to people who live in their own homes. The agency is privately owned and this is the only registered location run by the provider. At the time of our inspection five people were receiving a service. Some people paid for their own care and some people were funded by the London Borough of Hounslow. The agency provided care and support to some older people and also younger adults with long term health conditions and mental health needs.

The registered manager had left the organisation. The provider was in the process of registering himself as the manager of the service. He had submitted an application to do this. 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.

The way in which new staff were recruited did not include sufficient checks on their suitability to work with vulnerable people. For example, the provider had not obtained a full employment history or references from previous employers for some members of staff. Information on staff job application forms was incomplete and the provider had not sought further information. Therefore the provider could not be sure that the staff who they employed were suitable.

The assessments of the risks people were exposed to did not include information for the staff about how they could support people and reduce the likelihood of harm.

Some of the records at the service were incomplete and not sufficiently detailed. In addition some information, such as staff supervision and quality monitoring had not been recorded.

You can see what action we told the provider to take at the back of the full version of the report.

People who used the service were happy with the care they received they found the care staff kind and helpful. They told us care workers arrived on time and met their needs. They found the provider responsive when they had a query or needed information. They had agreed to the way in which their care was delivered.

The staff felt supported and told us they had the information they needed to care for people. They had received training and information relevant to their role. They told us they were able to speak with the manager for extra information, support and training whenever they needed.

The provider was responsible for the daily management of the service. They knew the needs of the people who they cared for well and regularly checked that people were receiving good quality care.