Heartfelt Care is a domiciliary care agency providing personal care and support to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection 27 people were receiving personal care from the service. We carried out an assessment of the service which started on 3 September 2024 and was completed on 13 September 2024. This assessment looked at the Effective key question to see if the provider had made the improvements needed following the recommendation we made at the last inspection (published 3 March 2023). This was in relation to the provider ensuring staff received up to date training based on current best practice, in relation to people's needs. At this assessment we found improvements had been made and the provider met the recommendation. As part of the assessment, we used information we had gathered at the assessment we undertook in May 2024. This included feedback from 2 people who use the service and 3 relatives. We emailed all 17 staff members employed by the provider asking for their views (this included staff we had met at the provider’s office). We received responses from 10 of them. We also asked the provider for additional information to support our judgement of this key question and spoke with the registered manager and a member of the management team. We asked the local authority contracts and quality officer who had been working with the provider for their views.
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Heartfelt Care is a domiciliary care agency providing personal care and support to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the assessment 22 people were receiving personal care from the service. We carried out an assessment of the service which started on 29 April 2024 and was completed on 31 May 2024. This was to check if the service had made improvements following the requirements we made at the last inspection (published 3 March 2023) in relation to safe care and treatment, person-centred care and good governance. The provider demonstrated they had been keen to improve and had an action plan in place to evidence this. At this assessment we found improvements had been made and the provider met the requirements. As part of the assessment, we reviewed information we had received about the service since the last inspection. Prior to visiting the office, we reviewed a range of records we had requested from the provider. This included, records relating to the management of the service. We visited the office on 14 May 2024 and spoke with 5 staff members, this included the registered manager, who is also the provider, the office/ HR manager, the compliance manager and 2 team leaders, who have additional roles within the organisation. We looked at the providers electronic medicine and care system, a recruitment folder and audits folder. We sought feedback from 2 people who use the service and 3 relatives. We emailed all, 17 staff members employed by the provider asking for their views (this included staff we had met at the provider’s office). We received responses from 10 of them. We asked the local authority contracts and quality officer who had been working with the provider for their views.
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Heartfelt Care received an overall rating of Requires Improvement at its first inspection, with breaches of Regulations 9, 12 and 17 identified relating to person-centred care planning, unsafe medicines management, inadequate risk assessment and absent governance systems. The service was rated Good for caring, reflecting consistent positive feedback from people and relatives about kind, dignified and respectful staff.
Concerns (12)
criticalMedication management: “Medication administration records (MAR's) were not regularly audited. We found a number of gaps on people's MARs.”
criticalCare planning: “Care plans did not provide care workers with the necessary information to provide person centred care to people who used the service.”
criticalIncident learning: “The service did not have a system to document and review accidents and incidents. Incidents were reported verbally to the office, however no formal record or review.”
criticalGovernance: “Systems and processes were not operated effectively to assess, monitor and improve the quality and safety of the service. Breach of regulation 17.”
criticalPerson-centred care: “One person's care plan stated they were blind, their care plan did not detail how information should be presented to them. Breach of Regulation 9.”
moderateMedication management: “People's MAR's were handwritten, the entries were not signed and countersigned to check their accuracy.”
moderateCare planning: “One person's care plan states they were living with diabetes with no further detail regarding the support required in relation to this.”
moderateRecord keeping: “There was not a robust system in place to ensure oversight of the quality of people's records to ensure they contained detailed information.”
moderateStaff training: “There were gaps in training for subjects such as dysphagia, oral health, diabetes and catheter care. Some staff also required refresher training.”
moderateStaff competency: “The provider told us spot checks were completed on staff to check their competencies. However, there were no records demonstrating this.”
moderateSafeguarding: “One recent safeguarding concern had not been reported to the Care Quality Commission (CQC), the provider confirmed they would complete this.”
moderateLeadership: “At the time of our inspection there was not a registered manager in post. The provider was in the process of applying for the registered manager position.”
Strengths
· People and relatives consistently reported staff were kind, caring, respectful and treated them with dignity.
· There were enough staff to cover visits with no missed visits reported; staff informed people of any delays.
· Staff knew people well and could describe individual risks and mitigation actions despite gaps in written care plans.
· The service worked within the principles of the Mental Capacity Act 2005 and sought consent before providing care.
· Positive partnership working with GPs, local authorities and district nursing teams was evidenced.
Quality-Statement breakdown (17)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced diet
Requires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; promoting privacy, dignity and independenceGood
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 control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learningRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood