JHN Healthcare Ltd

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This assessment considered the following four quality statements: Shared direction and culture; Freedom to speak up; Governance, management and sustainability; Learning, improvement and innovation. We found areas of concern in relation to good governance. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. We identified improvements needed to systems and processes to ensure management had effective oversight and could identify areas requiring improvement. Clearer records were needed to demonstrate effective systems of governance and improvement. We identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The management team had a shared vision, strategy and culture which was communicated and shared by the staff team. Staff felt able and confident to speak up if they had any concerns. Processes encouraged feedback from people who used and were involved with the service. Staff felt supported by the senior team.

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.

The management team had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion and engagement. Staff appeared very content in their roles and said they would recommend working for the service. They told us they felt supported and that they were ‘pulling in the same direction as a team.’ Through general discussion with the management team, it was evident they wanted to provide a good quality, person-centred and safe service to people. The registered manager explained they had an open-door policy and an inclusive culture to ensure staff or people/relatives could raise concerns or make suggestions. The management team ensured all people and staff were treated fairly and were not discriminated against due to any protected characteristics. The management team were responsive to the concerns raised during the inspection and demonstrated a keen willingness to address these issues and concerns. At this inspection there was no evidence of closed cultures. Staff were able to raise issues and felt listened to and supported.

All people were provided with a ‘service users guide’ which detailed the core values and vision of JHN Healthcare Ltd. The vision was, ‘To provide homecare that is easily accessible, community cantered and culturally relative, delivered with compassion, dignity and respect. That begins with every life we encounter: our employees, our service users and those who love and care for them, our stakeholders and those who are yet to become our service users.’ Processes were in place to enable this vision to be met. Staff had received training in equality and diversity. Regular feedback was gathered from people, relatives and staff and regular spot checks of staff practices were completed.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff felt confident to share any ideas or concerns with the senior team. They told us their suggestions were welcomed and considered. Staff understood how to raise concerns, including safeguarding, and the procedure for whistleblowing. Staff said management listened to them and they felt their feedback was valued. They told us people were invited to give feedback about their care to carers or supervisors. Staff were able to describe the action they would take if a person raised a complaint with them.

There were processes in place to allow and encourage people, relatives and staff to speak up. Feedback was sought from people and relatives in a range of ways, including through regular contact on the phone, during frequent care reviews and during regular spot checks of staff performance. People, relatives and staff were provided with quality assurance questionnaires approximately every 3 months to help ensure the smooth running of the service.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff expressed satisfaction with the senior team. They told us they were available and offered support. Staff described some of the quality assurance processes in place, for example supervision and spot checks on staff practice.

There were systems and processes in place for assessing, monitoring and improving the quality of the care provided by the service. However, we found some of these systems were not effective in identifying areas of poor practice, to support the implementation of improvement and ensure people were provided with safe and effective care to meet their individual needs. Without effective systems and processes, the provider and registered manager could not be proactive in identifying and acting on issues and concerns in a timely way. The concerns found at the inspection included, records of consent, management of the Mental Capacity Act 2005 (MCA), a lack of detailed and specific risk assessment and person-centred care information, evidence of learning from and acting on concerns and complaints. The failure to have effective systems in place to assess, monitor and improve the quality and safety of the service placed people at risk of potential harm. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The concerns identified were discussed with the management team who confirmed immediate action would be taken to address these. Updated risk assessments and care plans shared as part of this assessment demonstrated the action take to make improvements. Some audits reviewed were more robust. For example, monthly audits were completed in relation to the daily logs which were completed by staff following each visit. Content of information and times and length of calls were considered, and action was taken should any shortfall be identified. Policies and procedures were in place to aid the running of the service. For example, there were policies in relation to safeguarding, whistleblowing, complaints and training. The registered manager understood their responsibilities and had notified CQC about all incidents, safeguarding concerns and events that were required.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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. 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 to help identify themes and trends.

There were processes in place to monitor incidents, accidents, communication, and potential safeguarding events however, due to the quality of records, we could not be assured these processes were effective. For example, where incidents/accidents and concerns had been documented, there was a lack of written evidence that these had been investigated, followed up or actions taken to prevent reoccurrence. The systems and processes in place were not robust and effective to support continuous improvement and embed good practices. 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. The concerns above contribute to the breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.