Handle With Care

Handle with Care is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 82 people at the time of the inspection, including older people, those living with dementia and people with a physical disability. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People and their relatives told us they felt safe and the provider met their needs. Medicines records did not always contain the required detail, we made a recommendation about this. Some care plans and risk assessments required further detail, but staff knew people well and understood how to support them safely. Staff had good access to PPE to ensure people were protected from the risk of infection.

Information about people’s health needs was not always described within their care plan or risk assessment, although some detail was documented. We made a recommendation about this.

Peoples needs were assessed prior to them using the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff received a variety of training to improve their skills and knowledge and worked with other organisations to deliver effective care, support and treatment. Staff told us how they gained consent from people before supporting them.

People and their relatives told us staff were caring. They were encouraged to share their feedback via yearly questionnaires, during visits and had access to the office numbers if they wanted to speak to the management team? Staff told us how they ensured people’s privacy, dignity and independence was respected and promoted.

Care plans were person centred and people were supported to have personalised care which met their needs. All people and relatives we spoke to told us they knew how to make a complaint and felt their concerns would be listened to and acted upon. The provider had an end of life policy in place when required.

The registered manager had good oversite of the service. Systems and processes were in place to review and improve the service. The provider engaged people, their relatives and staff to ensure the service was moving forward and continuously improving. The registered manager had a good understanding of their regulatory requirements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Published 19 August 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Handle With Care is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 90 people at the time of the inspection, including older people and those living with dementia, people with a physical disability and younger adults.

People’s experience of using this service and what we found

People told us they received safe care. The provider had made improvements in the risk assessment of people’s needs, some records required further detail, but staff understood how to support people safely. Staff were safely recruited and knew how to safeguard people from abuse. People were protected from the risk of infection and staff were checked to ensure they used the appropriate equipment to promote safe and hygienic care. People told us they were satisfied with the management of their care and enough staff were available to meet their needs. Medicines were managed safely but some information about ‘as required’ medicines and creams, which could be a fire risk was missing from the records. This was addressed during our inspection. Incidents and accidents were reviewed daily and action were taken to prevent a reoccurrence.

People’s needs were assessed prior to them using the service. Policies and procedures were in place to guide staff on delivering care in line with current legislation and guidance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff completed training to meet people’s needs and this was monitored for completion and staff competency was checked. People who received support to eat and drink told us they were satisfied with this support. People were supported to access healthcare services when needed.

People and their relatives told us staff were kind and caring. Staff knew how to provide respectful care that promoted people’s dignity and privacy. People told us they were involved in decisions about their care and their consent was sought by staff.

The provider had made improvements in their practice to meet the needs of people at the end of their life. However, further improvement was needed in the end of life care plan the provider had developed, to ensure people’s needs at this time were fully explored. We have made a recommendation about this. Care plans demonstrated people had been asked about their preferences and needs, and people told us their needs were met. Complaints about the service were investigated, responded to and used to identify trends and improve practice. People were asked about their communication needs and the service was expanding on this to check whether people required any other support to understand information.

Since our last inspection in March 2018, the provider had submitted monthly updates and supporting evidence on their actions for improvement. At this inspection we found improvements had been made in the quality and safety of the service people received. An effective system was in place to monitor the service and to achieve continuous improvements. People and staff spoke positively about their experience of the culture and management of the service. The registered manager had worked effectively with staff to achieve improvements in communication and staff morale.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement and there were three breaches of Regulation (published 4 July 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. They submitted monthly reports about their progress to us. At this inspection we found improvements had been made and the provider was no longer in breach of regulations

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Handle With Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Handle With Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, including people living with dementia, younger adults and people with a physical disability. Not everyone using Handle With Care receives a service which is a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There was a registered manager was in place who was also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Another manager had also been recruited and they were in the process of applying for registration. We have therefore referred to the ‘registered manager’ and the ‘manager’ in this report.

At our last inspection in July 2017, we found risks to the health and safety of people were not always assessed and were not always safely managed. At this inspection, whilst we found some improvements, we also found that information about people’s risks was not always clear, up to date and available to staff. This meant that staff may not have access to the information they needed to guide them to provide safe care and all the actions they could take to reduce risks as much as they could. The provider had not sustained the improvements they told us they had made to people’s risk assessments following the last inspection.

At our last inspection in July 2017, we found the provider had failed to operate effective systems and processes to monitor and mitigate risks to people and maintain an accurate, complete record in respect of each service user and staff member. At this inspection we found that some improvements had been made. However, we also found other concerns about the quality and safety monitoring of the service and the accuracy and completeness of records.

People’s rights under the Mental Capacity Act (2005) were not always fully supported through recorded mental capacity assessments to assess their ability to make decisions about their care and treatment. This is important to ensure people are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible.

Although the provider had a procedure for end of life care planning, people, their families or carers had not been involved in creating and recording a care plan which would support staff to know, understand and act on people’s end of life care needs and wishes. The lack of information and guidance could put people at the end of their life at risk of receiving inappropriate care and treatment.

At our last inspection in July 2017, we found the provider had failed to safely manage and dispose of people’s medicines. At this inspection, we found systems and processes had been improved and medicines were disposed of safely. Some improvements were still required in record keeping to support safe disposal and administration.

At our last inspection in July 2017, we found the provider had failed to establish and operate effective systems and processes to prevent abuse of people. At this inspection we found improvements had been made and safeguarding concerns had been raised with the Local Authority and investigated appropriately.

At our last inspection in July 2017, we found the provider had failed to operate an effective recruitment procedure. At this inspection we found improvements had been made and safe recruitment practice had been followed. However, records did not always evidence that plans in place to monitor risks associated with the employment of staff had been adhered to. We have made a recommendation about this.

Incidents and accidents were monitored to check action had been taken to address safety issues and prevent a reoccurrence.

People and their relatives reported some dissatisfaction with the timing of their calls, the duration of their call and communication from the office when care staff were running late. We discussed this with the provider who told us care was contracted to be delivered within a two hour window. However, from the feedback we received people were not always aware of these arrangements and said the service was not meeting their expectations. We have made a recommendation about this.

At our last inspection in July 2017, we found the provider had failed to provide appropriate supervision and training to enable staff to carry out their duties effectively. At this inspection we found a system was in use to check staff competencies through observed supervision. This system enabled senior staff to confirm people were cared for effectively.

People’s needs were assessed and these included information about people’s cultural and spiritual needs. Staff demonstrated an awareness of people’s diverse needs and a respect for people’s chosen lifestyles.

People’s dietary needs were assessed and people told us they were supported with these appropriately.

People were supported to access healthcare services as required. However, where there was a delay in the response from a healthcare service, this was not always robustly followed up to protect people from deterioration in their condition. The provider has assured us future delays will be reported to the local authority safeguarding team to protect people from this risk.

People and their relatives told us staff were kind and caring and their privacy and dignity were respected by staff.

Staff we spoke with knew about the interests of the people they supported and some people told us they were cared for by familiar staff who showed an interest in their lives and wellbeing. The provider checked staff were delivering kind and compassionate care through competency based supervisions, although not all of these were up to date.

At our last inspection in July 2017, we found the provider had failed to operate an effective and accessible system for dealing with people’s complaints. At this inspection, we found improvements had been made. However, records to evidence the outcomes and actions taken in response to complaints were not always fully completed to show the complaints system was operated effectively for people.

People told us the care they received met their needs, even when they expressed dissatisfaction with the timing and duration of their care calls. People’s care plans were not always up to date and this was being acted on by the manager to ensure care plan guidance for staff was accurate.

Peoples needs in relation to the protected characteristics under the Equalities Act 2010, were taken into account in the planning of their care. People’s communication needs were assessed and staff demonstrated an understanding of how to meet these.

At our last inspection in July 2017, we found the provider had failed to notify the Commission without delay of any abuse or allegation of abuse in relation to a person. At this inspection we found the provider had failed to notify us of one allegation of abuse. The provider had notified the

local authority and the appropriate action had been taken in response to this concern. We have

made a recommendation about this.

At our last inspection in July 2017, we found the provider had failed to display their current rating on their website. At this inspection we found there was a link on the provider’s website to the most recent report.

Staff spoke positively about changes in the service since our previous inspection. This included the appointment of a new manager, improved communication between managers and staff and an improved team culture.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Handle With Care provides personal care services to people living in their own home. At the time of our inspection there were 167 people receiving this service. There were 56 staff members who provided personal care to people which included two senior managers, one trainee manager, three senior care assistants, five risk assessors, and two co-ordinators.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection in November 2016 we found safe medicine practices were not followed. At this inspection we found safe medicines practice continued to not be followed.

At our last inspection in November 2016 we found risk assessments were completed but not always dated and did not contain all the information on how risks to people could be minimised. At this inspection we did not find an improvement with this concern.

At our last inspection in November 2016 we found safe recruitment processes were not followed. At this inspection we found safe recruitment practices continued to not be followed.

At our last inspection in November 2016 we found staff training was not always effective. Staff competencies were not checked and staff did not receive an effective supervision to support them to carry out their duties. At this inspection we found training and supervisions did not always equip staff with the skills and knowledge to support people effectively because their competencies were not checked.

At our last inspection in November 2016 we found consent was not always sought when people were considered to lack capacity. At this inspection we found staff and the registered manager demonstrated an improved knowledge of how to support people who lacked capacity to consent to their care.

At our last inspection in November 2016 we found assessments of need were not always completed prior to the commencement of care. Care plans contained insufficient detail regarding people’s preferences, choice, wishes and risks and the information in care plans were not always accurate. At this inspection we found care plans contained people’s preferences, choice and wishes.

At the last inspection in November 2016 we found systems to assess the overall quality and safety of the service were not in place. At this inspection we found quality and safety audits were in place but they were ineffective and records were not complete in respect of each service user and staff member.

At our previous inspection in November 2016 we found the Commission were not always notified of safeguarding concerns. At this inspection we found the Commission had been notified, however, there was a delay in notifying the Commission of these safeguarding concerns.

The rating from the previous inspection in November 2017 had been clearly displayed in the front office of the service, however; the rating had not been displayed on the website.

Staff felt mostly supported but did not have a lot to do with the registered manager. Team meetings did not take place. People felt the management were unorganised and lacked effective communication.

Although people experienced missed visits, late and rushed calls, particularly during times of unplanned staff absences, there were enough staff.

Safeguarding concerns were not dealt with appropriately.

People’s dignity and privacy was not always respected and staff were not always kind, caring or compassionate. Communication was not always effective between care staff, people and the office.

An effective complaints process was not operated.

People were supported to eat and drink effectively and access external health care professionals.

People were involved in their assessment of needs, development of their care plan and were involved in making daily decisions about their care requirements.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) regulations 2009. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Handle with care provides personal care services to people living in their own home. At the time of our inspection there were 162 people receiving this service. There were 62 staff members who provided personal care to people which included, two senior managers, one trainee manager, three senior care assistants, three risk assessors, and two co-ordinators.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives said they or their relative received safe care. However this was not our overall findings.

People’s medicines were not managed or disposed of in a safe way and risks to people were not appropriately identified, assessed or action taken to minimise the risk to people and others. Staff’s fitness for work had not been assessed. Missed visits had occurred but was currently being managed. Safeguarding concerns had been received into the service and was dealt with in line with the provider’s policy; however the Commission had not been notified of these safeguarding concerns.

People said staff were sufficiently skilled and experienced to care for them because they had regular staff who knew them well. However we found staff training was not always effective because the registered manager’s knowledge of the subjects they trained staff on was lacking. Staff received an induction programme but their understanding and competency was not checked.

Although staff received a yearly appraisal; staff did not receive an effective supervision to support them to carry out their duties.

Consent was not always sought when people were considered to lack capacity, though staff did confirm they asked people for consent when providing personal care. Capacity assessments had not been completed for people who were considered to lack capacity and people were not involved in the development of their care plan when they were considered to lack capacity. Staff and the registered manager could not demonstrate a good understanding of how the Mental Capacity Act was used in their role.

People were not always supported sufficiently to have enough to eat and drink because records did not accurately detail the support people required and the risks associated with this.

People were unable to recall if they had been involved in their assessment of care and their care plans did not include their preferences, how they would like to receive their support and what they were able to complete themselves. However staff said they asked people how they would like their support to be provided on a daily basis and ensured people were involved in carrying out care for themselves.

Assessments of need were not always completed prior to the commencement of care. Care plans contained insufficient detail regarding people’s preferences, choice, wishes and risks and the information in the care plans were not always accurate. People were not always involved in their care planning

There was a registered manager who was supported by two senior managers with the day to day running of the service, although staff said they could speak with the registered manager when required they mostly spoke with the senior managers to discuss their concerns. The registered manager failed to complete a Provider Information Return when requested and did not have systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of the service user and others who may be at risk.

Audits had not been completed of people’s care plans and risk assessments and as a result we found people’s care records did not contain all the information required to meet their needs and keep them safe.

There were shortfalls in record keeping in a number of areas which has had an impact on the quality and safety of support people have received.

Following the inspection the provider had sent us information which demonstrated they had taken immediate action to address some of these concerns.

People who required access to healthcare services were supported to do so.

Staff had received training on safeguarding and demonstrated good knowledge of how to keep people safe from harm.

People and two relatives confirmed they felt listened to and received a kind and caring approach from staff who respected their privacy and dignity.

Complaints had been received into the service and were dealt with to people’s satisfaction.

Feedback about the service had been sought from people or their relatives and the information was analysed. Staff felt well supported by the management team and were supported to question practice and raise concerns.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We used this inspection to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led?

This is a summary of what people told us and what we found. If you wish to see the evidence supporting our summary please read the full report

Is the Service Safe?

People we spoke with and their relatives said they were satisfied the standard of care provided by agency. Everyone told us they felt safe with the people who provided care to them. One person who used the service told us, 'I am happy with the staff who come to support me'. Another person said' I am always treated with dignity and respect'.

We saw risk assessments were in place. We found the service had systems in place to ensure people were protected from abuse, or the risk of abuse. Staff had an understanding of safeguarding issues and how to report abuse or allegations of abuse.

CQC monitors the operation of the Mental Capacity Act 2005. The provider and manager at Handle With Care had a good understanding of the Mental Capacity Act 2005 and their responsibilities.

Is the service effective?

People who used the service told us that they were satisfied with the care and support they received.

Staff told us that the management were very supportive and that there was always someone available to offer advice and support.

Is the Service Caring?

People who used the service and their relatives told us support was provided in a caring way. They said that staff were kind and caring and treated them with dignity and respect.

Staff we spoke with said they were motivated to provide high quality care. They were aware of people's needs and how they preferred to have their care delivered.

Is the service Responsive?

People's care plans took into account information about people's needs and preferences. Where people were not able to communicate, information from family members or others was used. Care plans were reviewed regularly and we found the service had systems in place to ensure the care and treatment provided was appropriate to people's changing needs.

Is the service well- led?

Systems were in place to regularly assess and monitor the quality of the service provided. There were processes in place to review and learn from incidents, accidents and complaints.

People who used the service, their relatives and staff were asked for their views about how the agency was meeting people's needs. One person told us 'The management have asked me and my relatives if everything is OK and asked me if there was anything extra they could do - I said no because I am very content with my carers'.

Staff told us that there were regular staff meetings and that they received spot checks to evidence they were supporting people effectively.

The manager said staff received regular supervision and also had annual appraisals. Staff confirmed this.

One person told us. 'They talk to me, never rush me and always ask me what I want them to do. I try to be independent and they encourage me.' Other comments from people included: 'I can't fault them in any way. I am very happy with the care service I get.' 'I am perfectly happy with the service and they provide a great service.' And 'I am quite satisfied.'

We spoke with the manager and nine members of staff. They all told us they were well supported by Handle With Care. They told us training was good and they were provided with the information they needed to support people effectively.

One person told us, 'The staff are wonderful'. Other comments from people included: 'I am happy with the carers who call,' and, 'I can not fault the staff, I have not had any problems'.

Each person we spoke with told us that they had an information pack in their home and this had details about the care and support they needed as well as importance contact telephone numbers. Relatives of people told us that their family members were well supported by staff to receive the care they needed.

We were told by people who used the service that they felt safe and had no concerns about the staff who supported them. They said that staff treated them well. Relatives of the people we spoke with were all happy with the support their relatives received.

We spoke with eight members of staff. They said that they were well supported by the agency and confirmed that the recruitment process was thorough. They told us that management were very supportive and approachable.