The Care Quality Commission (CQC) has rated a Staffordshire-based clinical homecare provider as inadequate and placed it in special measures.
This morning the CQC revealed Burton-on-Trent-based Healthcare at Home (HaH) has been placed in special measures following an inspection in November and December which found people using the service had been harmed.
HaH provides care and treatment to people with chronic conditions – including Crohn’s disease, haemophilia and HIV – in their own homes and at the time of the inspection delivered around 110,000 prescriptions a month.
The firm told Health & Protection it had taken swift action to address the CQC’s concerns.
The CQC said its inspection followed reports that people were not receiving their medicines on time or able to contact the service to raise concerns, as a result of a new computer system.
After this latest inspection the CQC rated HaH’s service inadequate overall, and for being safe and well-led, it was also rated as requiring improvement for being responsive to people’s need.
The service was also placed in special measures meaning it is subject to close monitoring to help it improve its care and ensure patient safety.
It was rated as good for being effective and maintained its good rating for being caring from a previous inspection.
Should insufficient progress be made, CQC adds it will use its enforcement powers further to protect patients from the risk of harm and hold the service’s leaders to account.
What inspectors found
Shortfalls CQC inspectors found included:
- Unsuitable IT systems, leading to almost 10,000 missed medicine deliveries from October to December 2020. This meant some patients experienced avoidable harm and needed hospital treatment
- A failure to always investigate safety breaches and assess risk
- Poor record keeping, including regarding people’s allergies
- Insufficient governance, oversight and assurance systems to manage quality, performance and patient safety
- A failure to provide statutory notifications to CQC following service disruption
- A culture where patients, their families and staff were not empowered to raise concerns. Some patients reported fearing their medicine deliveries would be cancelled if they complained, and some staff reported fearing dismissal if they raised concerns or contacted CQC.
However, the CQC adds their inspectors identified some areas of good practice, including:
- Staff trained in key skills who received manager-led appraisals
- Instances where care and treatment were delivered in line with best practice, including when nurses administered chemotherapy
- Patients receiving regular health assessments and practical support to lead healthier lives
Good infection control, including for Covid-19
- Staff knowledge of the service’s vision and values, teamwork and a focus on patient need and improvement.
- Following the inspection, the service developed an action plan to drive improvement. It also communicated its plans to rebrand and implement a new patient app to CQC.
HaH’s leadership team also complied with a condition, imposed following the inspection, to provide regular performance reports to CQC and the CQC says these reports indicate the performance of the service has improved since the inspection.
An HaH spokesperson told Health & Protection that it has taken immediate steps with the issues identified by the CQC and as result patient service returned to normal in a short period of time, adding the CQC report notes that the performance reports they required Healthcare at Home to produce showed “an improving picture of recovery to pre-incident levels” after their inspection at the end of last year.
On specific points, where the CQC inspectors said HaH “did not always have enough staff deployed across all its services to ensure patients’ needs were met,” the spokesperson revealed the provider has made significant investment meaning that during 2021 more than 90% of calls have been answered within target times – which is their strongest performance to date.
Where inspectors said “the leadership and culture of the organisation did not always encourage all staff and patients to raise concerns”, the spokesperson said patients are given full details on how to contact HaH in their welcome pack – and HaH has relaunched its whistle-blowing strategy.
On the point raised where inspectors said “the provider failed to ensure its information systems met the needs of the service” the spokesperson said the provider has made significant investment in its IT platform and that transformation is leading to real improvements in customer service.
Where inspectors said “we found the provider did not always include patients in the investigation of their complaint”, all patients now receive an acknowledgement of their complaint and all patients are informed of the outcome of their complaint and who they may contact if they are unhappy with the outcome.
And where inspectors said “the registered persons had not done all that was reasonably practicable to mitigate risks to the health and safety of service users,” the spokesperson said HaH now has improved visibility of safety risks to service users due to the new IT platform transformation meaning the provider is now able to identify if a patient is likely to miss a medication dose.
Healthcare at Home chief executive Darryn Gibson said: “Healthcare at Home’s top priority has always been delivering the best possible care and service for patients and we therefore deeply regret the difficulties some patients faced as a result of problems with our new computer system last October.
“We took swift action to deal with the issue and within a short time patient service had returned to normal. We look forward to a rapid reinspection by the Care Quality Commission to confirm our patients are receiving a high-quality service. Our new computer system is already delivering an even better service to patients.”