Archived: Hartwig Care (Waltham Forest)

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

We identified 2 breaches of regulations. Improvements were needed to the level of detail and information within people’s care plans and risk assessments, along with processes in the management of people’s medicines to ensure people received safe care. Whilst there were safeguarding policies in place, they had not always been followed and there were concerns with the robustness and openness of how safeguarding investigations had been carried out. Where safeguarding investigations had occurred, the provider did not always ensure there was learning from them to reduce the risk of repeat incidents. Minor improvements were needed for staff to be recruited safely and further partnership working was needed with the on-site housing associations to ensure better awareness around fire safety. However, staff had access to training and supervision and felt the provider supported them to be confident within their roles. There were appropriate infection prevention and control policies and people were positive about the safety and security of their homes.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was limited feedback from people and their relatives about whether there was a learning culture within the service. Whilst people did not raise any specific concerns with us about this during our assessment, a relative raised concerns regarding a safeguarding incident, which was still being investigated at the time of the assessment.

Staff told us they were regularly reminded to report any changes in people’s health to ensure there was a joined-up approach with a range of health and social care professionals. For example, staff at one scheme told us how a person had been discharged from hospital and there was limited information about their new support needs. They discussed this with the scheme leader and communication was sent out to the team, while information was gathered to be able to update their care records.

Whilst there were systems in place for the reporting of accidents and incidents, there were inconsistencies in how the provider ensured lessons were learnt across the organisation. For example, where paramedics struggled to gain entry into one of the schemes to deal with a medical issue, this had been discussed across all the schemes and information had been displayed outside for how visitors could contact staff out of hours in the event of an emergency to enter the building. However, where there had been concerns around how people were supported with their finances and the systems in place to minimise the risk of financial abuse, learning had not been shared or discussed across the schemes and there were inconsistent and ineffective systems in place to safeguard people and staff. This had resulted in negative outcomes for people.

There was limited feedback from people and their relatives about this quality statement. Whilst no significant concerns were raised with us during our assessment, people did not have experience about being supported moving between services. However, feedback from some people and their relatives highlighted care and support was not always planned or organised with them to ensure they were aware of the care that should be provided to them.

Staff told us they were regularly reminded to report any changes in people’s health to ensure there was a joined-up approach with a range of health and social care professionals. For example, staff at one scheme told us how a person had been discharged from hospital and there was limited information about their new support needs. They discussed this with the scheme leader and communication was sent out to the team, while information was gathered to be able to update their care records.

Feedback from partners highlighted concerns with how information had been shared and how investigations had been carried out. Partners were not assured the provider’s approach to identifying and managing risks was effective. Due to these concerns the local authority had suspended placements within the 4 schemes until they had assurances improvements could be made.

During our site visits we identified areas around people’s care and medicines records where improvements were needed. This is covered in more detail in other sections of this report. The provider told us they were in the process of updating all records and moving to a new digital software system, which was one of the reasons why there were acknowledged gaps within the records we reviewed. We were not fully assured there were effective systems in place for sharing risk with relevant partners in people’s care. For example, staff in one scheme told us about a change in a person’s health conditions where they had reported their concerns to the management team. We followed this up with the provider and the local authority to see what action had been taken, as we had been told it had been reported to the local authority. However, the concerns had not been shared with the relevant health and social care professionals.

People and their relatives told us they felt safe living in their homes and did not raise any concerns in relation to safeguarding or other safety concerns. A person said, “I have 4 visits a day and they also do welfare checks in the evening. This is a good thing and definitely helps me to feel safe.” A relative told us they had been satisfied with how the provider had dealt with a safeguarding incident their family member had been involved in.

Staff told us they had completed training in safeguarding and had opportunities to discuss their safeguarding responsibilities during supervision sessions. Staff also knew they could report any concerns to the local authority or the CQC if they felt no action was being taken. A staff member said, “Safeguarding is important. They are always reminding us about this and how we must report anything.” However, members of the senior management team were not able to provide us with relevant information and did not have full oversight of the current investigations. A member of the senior management team had also told us misleading and inaccurate information about current safeguarding investigations and their findings.

Although the provider had safeguarding policies in place, there were not effective systems and processes in place to ensure people were protected from abuse and neglect. Investigations had not always been carried out effectively and there had been delays in safeguarding referrals being raised. For example, for a serious safeguarding incident that occurred in April 2024, information was not made available to us at the time of the assessment and there were significant delays in information being provided, including contradictory and inconsistent information provided by members of the management team. The local authority had to request the re-opening of this safeguarding investigation after the initial investigation had been completed due to a lack of robust oversight in how it had been carried out. The provider acknowledged this and confirmed further investigations were required.

We received mixed feedback from people and their relatives about how involved they had been in the development of their care records and making decisions about their care. Positive comments included, “'I have been involved in the care planning from the start and have seen a copy of the care plan” and “They have good knowledge about my care needs and know me well.” However, this was inconsistent across all schemes as people and their relatives also told us they were unaware of these records and unsure about the levels of care they should be receiving. During a site visit, a relative told us a care plan had been placed in their family member’s room but they had not been involved in it and was the first time they had seen it.

The majority of staff had a good understanding of people’s risks related to their care and support and told us how they kept them safe. However, this was not consistent across all the schemes as some staff told us they did not have a full understanding of risks and had not seen a copy of the relevant care plans on how to support people safely. For example, a staff member in one scheme did not know if there was a care plan available for the person they were supporting. As they did not have access to a digital care plan at the time of the site visit, we could not be assured the relevant risks had been assessed or the staff understood them. A scheme leader added that this had been identified at a recent local authority monitoring visit where care records had not been updated. They said, “Not all of the records are up to date, it is still a work in progress for the existing residents.” The provider told us they were in the process of updating all records and moving to a new digital software system, which was one of the reasons why there were acknowledged gaps within the records we reviewed.

During our site visits we identified inconsistencies within people's care records, where information about people’s risks related to their care lacked sufficient detail or guidance for staff to follow. This included risks related to people’s mobility and moving and handling processes, plus health conditions such as diabetes and epilepsy. Records were not always person-centred and we were not always assured staff were viewing up to date information as samples of people’s records had not been updated, including samples of care plans that had not been updated since the provider had taken over from the previous provider in August 2023.

People and their relatives told us they felt safe living in their home. A person told us they had alarm bells in their rooms and were able to speak with staff through them if needed. They added, “They do answer it if needed. I feel safe and secure here.” A relative said, “I do know that [family member] is safe here. There is security and CCTV within the building. It does give me that reassurance.”

Staff were positive about the support they had in this area and had a good understanding of their responsibilities to help keep people safe. A staff member said, “We make sure we do safety checks before leaving people’s homes, such as making sure windows are closed and alarm pendants are in place. We also make sure all cooking appliances are turned off.” Whilst staff told us they had completed basic fire safety training and had an understanding of how they would respond in an emergency, some staff confirmed they had never been involved in a fire drill since they had started. They also did not have access to a personal emergency evacuation plan for people. This is important to ensure they understand the responsibilities where people may require individual support to leave the building.

The provider did not have an established system in place to ensure people had personal emergency evacuation plans in place in the event of an emergency. During a site visit on 29 May 2024, the registered manager at the time of the assessment acknowledged it was an area that needed improvement on and better partnership working was needed with the housing associations who were based on site. The local authority had contacted the London Fire Brigade to carry out checks to get assurances of the building. During a call with the provider on 15 August 2024, there were still disputes around who had the contractual responsibility for managing this. Our findings also highlighted improvements were needed in how staff were given opportunities to be involved in fire drills, as not all staff had taken part in one. The provider acknowledged again more effective partnership working was needed with the housing associations.

The majority of people we spoke with across all 4 schemes were positive about staffing levels and the competence of staff that supported them. Comments included, “They do come when needed and I’ve never had to wait a long time” and “In general I think there are enough staff. They seem to know what they are doing and I’ve never had any issues.” However, some people told us they did not always receive their scheduled care. A person said, “They are supposed to spend 30 minutes with me 3 times a day but they only really do this in the morning.”

Most staff members told us they felt there were enough staff to support people, as staffing levels had been increased since the provider had taken over in August 2023. However, staff from one scheme felt the staffing levels impacted their ability to meet people’s needs. This was due to an increase in people’s needs along with added tasks to their daily duties. A staff member added, “We have 4 people who need double handed care, but there are only 3 of us on, and only 1 of us at night. It can sometimes impact the care people receive and the breaks we can get.” Staff told us they received regular training and were positive about how it helped them to carry out their roles and meet people’s needs. Staff also confirmed they completed an induction and shadowed senior staff when they first started. Staff comments included, “The training is both online and face to face, which is very helpful and informative” and “We also have a refresher training session and I think it gives a good level of understanding.” At the time of the inspection the provider was following up concerns raised by the local authority regarding the alleged misuse of care hours and feedback about missed visits.

The provider was just in the process of introducing senior care worker roles into the schemes to help provide further support to the staff team. This had been received well by the staff team. The provider was in the process of implementing an electronic call monitoring system where staff had to log in and out of calls, to ensure they had a better oversight of people’s care calls and address some of the feedback around alleged missed visits and staff not always staying for the full duration of care calls. Minor improvements were needed to ensure staff were recruited safely and in line with best practice. This related to appropriate references not being sought for a staff member at the time of their recruitment. The provider acknowledged this and confirmed they would follow up with their recruitment team.

People did not raise any issues or concerns with us in relation to infection prevention and control (IPC). People told us staff wore the relevant personal protective equipment (PPE) when necessary and washed their hands before carrying out any food preparation. A person said, “They keep my home clean. They hoover, polish, wash up and mop my floors so no issues at all.”

Staff told us they completed training in IPC and there were sufficient supplies of PPE across the schemes. A staff member said, “We have online training for this and no issues with having gloves and aprons when needed. They do check this during spot checks and get feedback from the residents as well if we keep their homes clean.”

Staff were responsible for cleaning within people’s homes whilst the on-site housing association within each scheme was responsible for the cleaning of all communal areas within the building. The provider had appropriate infection prevention and control policies in place. This included monthly infection control audits and spot checks on staff that ensured PPE was worn effectively and best practice was followed.

Although people did not raise any major issues or concerns with us in relation to the management of their medicines, some people had been impacted and had negative outcomes from the issues we found during the inspection. This included an incident where medicines were not administered to a person and concerns about their refusal had not been escalated to the relevant health professionals. This resulted in a serious safeguarding incident which was still under investigation.

Staff told us they completed medicines training and had an annual competency assessment. Due to a recent safeguarding investigation related to concerns around medicines management, staff told us they were having refresher training to ensure they followed best practice. Staff told us they had recently been tasked with carrying out daily checks on people’s medicines records to minimise the risk of any medicine errors. Whilst some found this positive, feedback was mixed as staff felt this should be the responsibility of the scheme leader or a more senior member of staff. A staff member added, “I don’t feel this is my job and gives us an extra burden. It can be difficult to address issues with your colleagues and should be done by a scheme leader.” We discussed this with the provider during a feedback call on 14 June 2024, who told us they had implemented medicines champions across the schemes to help support staff and improve the quality of record keeping.

Systems and processes for auditing medicines administration records (MARs) were not always effective and we identified inconsistencies across all of the schemes. This included inconsistencies in recording on people’s MARs and a lack of detail in care plans about the medicines people received. For example, we identified gaps within people’s MARs and poor recording practices that had not been picked up. There were also inconsistencies in people’s records where they received PRN medicines, which are medicines ‘as and when required’. Staff had not always recorded this in line with the provider’s medicines policy.