3HA is a domiciliary care agency, and at the time of our assessment, they were supporting approximately 183 people with a regulated activity of personal care. The assessment took place from 1 October 2024 to 15 October 2024. An announced site visit to the service was carried out on 7 October 2024. The assessment was completed to follow up on the breaches of the regulations from the last inspection (published 27 August 2023). The service was rated as requires improvement. We found the registered manager had made significant improvements to the oversight and management of the service, safe care and treatment for people using the service and the recruitment of staff. The service was no longer in breach of the regulations and the rating at this assessment was good based on the review of the quality statements in the key questions we looked at. We expect health and social care providers to guarantee people with a learning disability and autistic people the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. The service met this guidance. Staff had received training and demonstrated an understanding of their responsibilities to support people to manage risks and live their lives as they chose.
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3HA Care Services requires improvement overall, with breaches of Regulations 12, 17 and 19 identified in relation to unsafe medicines management, incomplete and unclear risk assessments in care plans, and weaknesses in staff recruitment and governance auditing. The service demonstrates genuine strengths in the caring and responsive domains, with people and relatives consistently praising staff kindness, personalised support, and responsive management.
Concerns (8)
criticalCare planning: “Some people's care plans were not clear and did not always provide context as to how to support a person with their care and any risks identified.”
criticalMedication management: “Care plans did not always provide clear information as to the medicines people were taking where the staff where responsible for administering them.”
criticalGovernance: “The service did not have robust processes to monitor the quality and safety of the service. This was a breach of Regulation 17.”
criticalStaff training: “Systems were not in place for the safe recruitment of staff. This was a breach of regulation 19 of the Health and Social Care Act 2008.”
moderateMedication management: “The electronic system was not adequately monitored as information was confusing and incorrect. For example, there were system errors when two staff signed in.”
moderateRecord keeping: “Some staff had only written basic information about tasks completed and 'All well'. This did not provide detail about how the person was or any observation of their physical or mental health.”
moderateStaff competency: “Training to support people who had specific needs such as diabetes, epilepsy and learning disabilities and autism had not been provided.”
moderateConsent / capacity: “We noted in many of the care plans we saw that people had not signed their consent to the care arrangements, as some said 'UTS' (unable to sign).”
Strengths
· People and relatives consistently described staff as kind, caring and respectful, with strong person-to-person relationships.
· There were enough staff to meet people's needs, with no missed calls and an electronic alert system for late visits.
· Staff had a good understanding of safeguarding and knew how to escalate concerns to relevant authorities.
· Infection control procedures were in place and staff had adequate PPE supplies.
· The service demonstrated compliance with 'Right support, right care, right culture' principles for people with a learning disability and autistic people.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
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: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
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 staffGood
well-led: Continuous learning and improving care; Working in partnership with othersGood