This focused inspection of H & H Healthcare Limited found both Safe and Well-Led key questions improved to Good, following a previous rating of Requires Improvement overall. No overall rating was awarded as only two key questions were assessed in this focused inspection.
Concerns (2)
minorInfection control: “Some staff were unsure of the order they should put on and take off Personal Protective Equipment (PPE).”
minorStaff competency: “One person and one relative told us some staff were not meeting their needs as well as others.”
Strengths
· Detailed risk assessments completed for each person with up-to-date guidance for staff on reducing risks.
· Medicines Administration Records fully completed with PRN guidance; regular medicines audits carried out.
· Safe recruitment practices in place including employment history, references, and DBS checks.
· Electronic call monitoring system introduced to track visit times and durations.
· Leadership restructured with new care co-ordinators, care planners and senior care workers with clear accountability.
H&H Healthcare Limited was rated Requires Improvement overall following a September 2019 inspection, with six regulatory breaches identified spanning medicines management, unsafe recruitment, absent mental capacity assessments, inadequate care planning, insufficient staff training, and failed governance. The Well-Led domain was rated Inadequate due to wholesale absence of auditing and oversight systems, while the Caring domain retained a Good rating reflecting consistently compassionate and respectful staff practice.
Concerns (12)
criticalMedication management: “We saw multiple gaps in recording with no explanation on the Medicines Administration Record (MAR) or daily records to account for medicines or medicated creams not administered.”
criticalGovernance: “There were no auditing systems in place to check the service was operating effectively. For example, care plan audits or medicines audits.”
criticalCare planning: “People did not have personalised care plans in place. People's records were not written in a person-centred way and contained insufficient guidance for staff.”
criticalConsent / capacity: “Mental capacity assessments for people who were considered to lack the capacity to make decisions about their care and support, were not in place.”
criticalStaff training: “Training records did not demonstrate that all staff had been trained in mandatory subjects such as; fire safety, safeguarding adults, health and safety, first aid, infection control.”
criticalRecord keeping: “There was a failure to maintain accurate and fit for purpose care records. These included missing, incomplete or insufficiently detailed care plans and risk assessments.”
criticalLeadership: “The registered manager did not demonstrate that they were clear about their role and the arrangements in place to manage the service had not been suitable.”
moderateStaff competency: “Staffs' competency was not assessed prior to administering people's medicines or routinely to ensure they continued to have the correct skills and followed safe practice.”
moderateMissed or late visits: “The provider did not record, monitor and review late or missed visits to identify how to reduce these occurring.”
moderateIncident learning: “The service did not have a systematic recording process for analysing incidents, outcomes and themes, nor lessons learnt for future practice.”
moderatePerson-centred care: “One person was living with dementia. There was no care plan and care records only stated, 'I have a diagnosis of dementia so please be patient with me'.”
minorInfection control: “Some staff had completed training about infection control but not all. There were no infection control audits in place.”
Strengths
· People consistently reported feeling safe and spoke positively about the caring, kind and respectful attitude of staff.
· Staff knew people well, formed familiar relationships, and supported people's dignity, privacy and independence effectively.
· The service was responsive to people's changing needs, referring people to other agencies and liaising with families and health professionals.
· Complaints were investigated and responded to promptly with apologies given.
· Following inspection, the provider took immediate remedial action including sourcing specialist training, reviewing medicines competencies and reassessing care needs.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experience
H & H Healthcare Limited improved from Requires Improvement to Good following a focused inspection of Effective, Responsive and Well-led key questions, with all previously breached regulations now met. Two recommendations were made regarding inconsistent staff supervision and poor communication of rotas to people using the service.
Concerns (2)
moderateSupervision / appraisal: “formal staff supervisions to discuss performance and training needs were not being completed for all staff regularly.”
minorCommunication with families: “people told us they were unhappy that they did not always get a rota and were not sure who was coming and what time they were coming.”
Strengths
· Personalised care plans improved since last inspection, now including people's likes, dislikes, interests and detailed support instructions.
· Training arrangements overhauled since 2019 with a training matrix, online programme, and specialised face-to-face training for specific needs.
· Staff demonstrated strong knowledge of individual people's needs consistent with care records.
· Effective complaints procedure with full investigations completed and appropriate professional liaison.
· Monthly audits on care plans, medicines, complaints and staff training with unannounced spot checks on staff.
H & H Healthcare Limited received a Good rating across all five key questions at its first inspection in January 2015, demonstrating safe, well-staffed and person-centred domiciliary care in the Plymouth area. Health and social care professionals praised the service's flexibility, integrity and commitment to continuous improvement, with no failures or regulatory breaches identified.
Strengths
· Staff had thorough knowledge of safeguarding procedures and people felt safe using the service
· Sufficient staffing levels with realistic travel time built into rotas; no missed visits reported
· All care staff working towards or holding NVQ/Diploma in Health and Social Care with regular supervision and appraisal
· Strong person-centred culture with staff matched to people by skills, interests and needs
· Clear understanding of Mental Capacity Act 2005 with capacity recorded in care records
H & H Healthcare Limited is a domiciliary care service rated Good across all five key questions at its March 2017 inspection, maintaining the rating from its previous inspection. The service demonstrated consistent strengths in personalised care, staff compassion, safe staffing, and effective leadership with robust quality assurance processes.
Strengths
· Staff were consistently described as kind, caring and compassionate by people and relatives, with numerous thank you cards and positive comments on record.
· No missed visits reported; staff covered shifts at short notice without use of agency staff, providing continuity of care.
· Personalised, individualised support plans guided staff clearly on people's needs, preferences and routines.
· Safe recruitment practices with all necessary pre-employment checks undertaken.
· Medicines managed safely with an improved medicine recording system introduced since the last inspection.
Requires improvement
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
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 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, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
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 staffRequires improvement