Healthvision Hounslow improved from Requires Improvement to Good overall, having remediated all five regulatory breaches identified at the previous inspection across safe, effective, caring and responsive domains. The sole remaining weakness is in well-led, where a care plan not updated following a fall and inconsistent complaints recording indicate quality assurance processes require further strengthening.
Concerns (3)
moderate
Record keeping
— “we found 1 care plan of the 8 we reviewed had not been updated to reflect a fall by the person.”
minorGovernance — “although complaints were responded to appropriately, the provider was not following their own procedures in terms of recording complaints.”
minorMissed or late visits — “some people telling us their care workers sometimes arrived late that they were not always notified if staff were running late.”
Strengths
· Provider resolved all previous breaches of regulations (12, 17, 18, 19, 11, 9) identified at last inspection, improving overall rating from Requires Improvement to Good.
· Consistent care workers assigned to people, promoting familiarity, safety and relationship continuity.
· Robust medicines management including a dedicated Medication Compliance Officer, competency testing and regular spot checks.
· Person-centred care plans with detailed communication, nutritional, cultural and end-of-life needs recorded.
· Strong safeguarding processes with appropriate investigation, documentation, and lessons-learned shared with staff.
Quality-Statement breakdown (24)
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
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; supporting people to live healthier livesGood
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 controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to maintain relationships and take part in activitiesGood
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; continuous learning and improving careRequires 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
Healthvision - Hounslow was rated Requires Improvement overall (Inadequate for well-led) with breaches identified in safe care, consent, person-centred care, staffing, recruitment and good governance, including repeated failures around medicines management, risk assessments and late/overlapping calls. CQC issued warning notices for breaches of Regulations 12 and 17, marking the third consecutive Requires Improvement rating.
Concerns (15)
criticalMedication management — “Medicines were not always managed safely... One person had a PRN medicine prescribed but it was not listed on the medicines administration records (MAR).”
criticalCare planning — “when a risk was identified, care plans did not always provide adequate guidelines for care workers to meet the person's needs and reduce the risk of harm.”
criticalMissed or late visits — “Care workers were not always appropriately deployed to help ensure care visits were carried out as planned.”
criticalStaffing levels — “one care worker had 33 calls that week and 22 of them did not have travel time. This meant people might not have received the care they needed in a timely manner”
criticalConsent / capacity — “Where it was indicated a person may not have capacity to consent to their care, a mental capacity assessment or a best interest decision had not been carried out.”
criticalGovernance — “Quality assurance systems such as audits were not being operated effectively as demonstrated by the number of shortfalls identified during the inspection.”
criticalLeadership — “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalPerson-centred care — “Care plans were not always personalised to indicate people's current needs and wishes.”
criticalOther — “two applicants did not have any record of a criminal record check being carried out... two applicants did not have two references in line with the provider's own recruitment procedures”
moderateStaff training — “for key training such as dementia awareness, safeguarding adults, medicines awareness and infection control training, only 68% of care workers had up to date training in these areas.”
moderateCultural competency — “I don't feel that our culture is really respected properly by the weekend carers”
moderateRecord keeping — “The falls risk assessment for one person indicated their last fall was in January 2020. However, we found an incident form indicating they had a fall in October 2021 which was not reflected”
moderateInfection control — “they did not have COVID-19 risk assessments in place for care workers. COVID-19 risk assessments for people using the service were not robust enough”
moderateEnd-of-life care — “The care plans for eight out of nine people whose care plans we looked at regarding end of life care, recorded the person did not want to discuss their end of life wishes.”
moderateCommunication with families — “messages left at the office did not always get passed on to the relevant person”
Strengths
· Safeguarding policies and procedures in place; provider worked with other agencies including local authority and notified CQC
· Incidents and accidents were recorded and lessons learnt shared with care workers via emails with safeguarding and complaints scenarios
· Adequate PPE provided; care workers tested regularly for COVID-19 and most were vaccinated
· Complaints procedure in place with most people satisfied with how complaints were resolved
· Provider worked in partnership with health and social care professionals including occupational therapists and dementia nurses
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law