JHN Healthcare Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This assessment considered the following five quality statements: Learning culture; Safe systems, pathways and transitions; Safeguarding; Involving people to manage risks; Safe and effective staffing. At this inspection there was no evidence of closed cultures. There were enough suitably trained staff to meet people’s needs. Staff contacted other professionals appropriately to source additional health and social care support when required. Staff were able to raise issues and felt listened to and supported. Management and staff understood their responsibilities to safeguard people from abuse and harm. Whilst people told us they felt safe and well-supported, we identified gaps in some care records and risk assessments. This was discussed with the management team who took prompt action to ensure records were complete and provided staff with clear guidance on how to mitigate risks to individuals. There was evidence of learning from incidents and concerns, though clearer records were needed to demonstrate issues had been thoroughly investigated and followed-up. The management team undertook to update their records to ensure all activity was clearly recorded. The rating for this key question remains Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us about recent improvements in the service and the care they received. A person said, “When they [staff] first started coming, communication could be a bit difficult, but their [staff’s] English is getting much better. I have regular staff the rotating has really improved, and it means I have good consistency.” Another person said, “In the beginning it was all a bit tricky, but it is settled down now. I would recommend the service to others, but I would also suggest people just need to give them [JHN] a chance and time to settle in.” People and relatives told us they knew how to complain should they need to and said they were confident immediate action would be taken.

Staff told us when incidents had occurred, these were reflected on and used as case studies to inform their practice. Staff confirmed they had received additional training in pressure area care and guidance on the checks and recording they were expected to complete following concerns previously raised. The management team described actions they had taken to support continued learning and to help identify themes and trends. These included staff meetings and workshops, additional training, supervision, spot checks on staff practice, investigations of concerns and the completion of logs for incidents, accidents, potential safeguarding events and complaints. The management team were able to demonstrate they understood their responsibilities under the duty of candour which requires services to act in an open and transparent way when accidents or incidents occur.

There were processes in place to monitor incidents, accidents, communication, complaints and potential safeguarding events, however due to the limited information on these records, we could not be assured these processes were effective to support continuous improvement and embed good practices. For example, where incidents/accidents and concerns had been documented, there was a lack of written evidence that these had been investigated and followed up, with actions taken to prevent reoccurrence. This concern was discussed with the management team and the inspector was advised the follow up and outcomes of the information logged on the complaints log, communication logs and safeguarding logs were evidenced in emails, but this had not always been incorporated in the records. The management team agreed to review the current systems to ensure they were streamlined to reflect actions taken, learning and outcomes.

People and relatives confirmed they received care from a regular staff team which helped to ensure their needs were met safely. A person said, “I have regular staff.” Another person told us, “I mostly see the same faces. It's clear that the agency want to put staff together that get on well and I do believe they've considered if they will get on with the customers.” People and relatives told us they were supported to source additional health and social care support should it be required. Communication logs and daily records provided us with evidence that a deterioration in people's health needs or when an increase in the level of care was required this was discussed with health or social care professionals. These records also demonstrated where people's health needs deteriorated, staff and the office/management team were able to support people to access medical support, if required.

Staff feedback indicated a high continuity of care. Staff demonstrated an understanding of people’s individual needs and preferences and spoke fondly about the people they supported. Staff told us they received good support from healthcare professionals and that guidance from professionals was shared and followed.

Partners spoke well of the service and did not raise any concerns about the timeliness of contact or of the staff team supporting people in line with their recommendations and guidance.

People’s needs were assessed prior to starting with the service to ensure their needs could be met in a safe way. There were robust systems in place to ensure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Communication logs and daily records demonstrated that deterioration in people's health needs or when an increase in the level of care was required this was discussed with health or social care professionals. Documentation within people’s homes included an emergency ‘grab sheet’ which included information about people’s needs including medicines they were prescribed. This was shared with healthcare professionals where required.

All people spoken with told us they felt safe and had no concerns about their safety when staff visited them. Comments included, “The staff are brilliant they know what they're doing”, “I do feel safe with the staff, and I believe they are well trained” and “I think the staff know what they're doing and are very keen on following the rules.” Relatives were also reported people were safe. A relative told us, “Staff seem very experienced and know what they're doing we never worry about the care. Another relative said, “All the staff are exceptionally trustworthy.”

Staff confirmed they had received safeguarding training and demonstrated they knew how to prevent, identify and report allegations of abuse. They were confident the management and office staff would take appropriate action if concerns were raised. The registered manager was aware of their role and responsibilities to safeguard people from harm and abuse.

There were processes in place to monitor complaints and potential safeguarding events. Due to the limited information on these records, we could not be assured these processes were effective to support people’s safety and mitigate potential risks. For example, formal safeguarding concerns reported to the service by the local safeguarding team were fully investigated and responded to in detail. However, where concerns had been raised via complaints or concerns, we could not be assured that these had always been fully investigated and actioned due to lack of written evidence. This concern was discussed with the management team and the inspector was advised the follow up and outcomes of the information logged on the complaints log and safeguarding logs were evidenced in emails, but this had not always been incorporated on the completed logs. The management team agreed to review the current systems to ensure they were streamlined to reflect actions taken, learning and outcomes.

People told us safe care was provided and staff understood their specific needs and how best to support them.

Staff demonstrated they understood people’s needs and described how they kept people safe. For example, a staff member said, “One client has difficulty swallowing so I have to give time to swallow.” Another staff member told us, “They [management team] told us to do skin monitoring very well, not to rush, to check everything. We do a skin inspection on every call and if you find any redness or bruising you inform the office or management staff.” Staff confirmed they received specific training where required to enable them to provide safe and personalised care.

The registered manager and office staff provided us with evidence on how they monitored staff practice to ensure safe care was provided. These included unannounced spot checks, supervisions and gathering regular feedback from people who use the service about their experiences. Although processes were in place to help ensure safe care was provided and people told us they felt safe, we identified detailed care plans and specific person-centred risk assessments had not been completed as required. For example, no risk assessments had been implemented for people at risk of choking or developing pressure sores. Additionally, risk assessments in place for people requiring hoists to enable safe transfers or for those with catheters in place were generic and not person specific. This meant we could not be assured staff had been provided with guidance on how to mitigate the risk associated with these needs, how to identify concerns and actions to take should issues arise. The above concerns were discussed with the registered manager and office staff on day 2 of the site visit who acknowledged shortfalls in this area. The registered manager agreed to review care plans and implement person centred risk assessments where appropriate. Following the site visit completed on 16 January 2024 the inspector was provided with some updated care plans and risk assessments for people. These records demonstrated improvements had been made.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received positive feedback from people and relatives about the timing of the care calls. People told us they were not rushed by staff and were happy with the care they received. Comments included, “The staff are brilliant”, “They are usually on time and always stay the correct length of time” and, “They don't rush me and they do everything I need them to do.”

The registered manager and office staff confirmed that consideration is given to the geographical area in which people live to ensure staff do not need to travel too far. This supports care calls being delivered on time. This was confirmed verbally by staff. Staff rotas viewed showed consistency, regular call times and gaps for travel when required. Staff reported feeling happy with the training they received and told us they were well supported by the senior team. Staff shared they generally visited the same people and have developed good relationships with them. They confirmed they had sufficient time on calls to meet people’s needs and to travel between visits. Recently recruited staff confirmed that pre-employment checks, including a DBS and references, had been completed.

Systems were in place and followed to ensure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Safe recruitment practices were followed. We checked the recruitment records of three staff and found that all the required pre-employment checks had been completed prior to staff commencing their employment. This included disclosure and barring service (DBS) checks and obtaining up to date references.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.