Safe Hands Home Care Limited

Safe Hands Home Care Limited is a domiciliary care agency providing personal care to older people, those with a physical disability, people living with dementia and people with a learning disability who are living in their own homes. At the time of our inspection there were 8 people using the service who received the regulated service of personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The registered manager had not read this guidance and therefore they were not fully able to demonstrate how the service was meeting the underpinning principles of ‘Right support, right care, right culture.’

Right Support

An effective system to assess, monitor and manage risk was not in place. Risks relating to people’s care and support and medicines had not been fully assessed.

Relatives told us that people were generally supported by the same staff and there had been no missed calls. One relative said, “There is more or less the same carers, they have been there a long time, more than 14 years. She is quite happy with them.”

Right Care

Care plans did not fully reflect people’s needs. The registered manager told us these were being updated.

People were supported to access the local community and take part in activities, where this was part of their plan of care.

People and relatives we spoke with talked positively about the caring nature of staff. One relative told us, “When [name of staff member] goes in, she will put bird food out for her, she likes to see the birds.”

Right Culture

An effective system was not in place to monitor and manage the quality and safety of the service and ensure regulatory requirements were met. We identified shortfalls across many areas of the service including the assessment of risk, medicines management, the maintenance of records relating to people, staff and the management of the service. These had not been identified by the provider’s monitoring systems.

Whilst we did not identify any impact on people, there was the potential for people to come to harm, as risks were not adequately assessed and records were not well maintained. The registered manager told us they were reviewing their whole governance system to ensure it effectively monitored the quality and safety of the service.

People and relatives spoke positively about the service. One relative said, “I’m happy with it all - I would recommend it. I would say that they are good at their jobs, know what they are doing and are nice and kind people.” Staff also spoke enthusiastically about working at the service and the people they supported.

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 requires improvement (published 1 June 2023).

At our last inspection there were 3 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Safe care and treatment; Staffing [in relation to training] and Good governance. We issued a warning notice in relation to Regulation 17 [Good governance] and told the provider and registered manager, action needed to be taken to improve. The provider completed an action plan to show what they would do and by when to improve. We also met with the provider and registered manager to discuss how they would make changes to ensure they improve their rating to at least good.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the full report below for further details.

Enforcement and Recommendations

We identified 3 continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Safe care and treatment, Staffing [in relation to training] and Good governance. 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.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Safe Hands Home Care Limited is a domiciliary care agency providing personal care to older people, those with a physical disability, people living with dementia and people with a learning disability who are living in their own homes. At the time of our inspection there were 17 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The registered manager was not aware of this guidance and therefore they were not fully able to demonstrate how the service was meeting the underpinning principles of ‘Right support, right care, right culture.’

Right Support

An effective system to assess, monitor and manage risk was not in place. Risks relating to people’s care and support, infection control and medicines had not been fully assessed.

Records did not fully demonstrate how people were supported to have maximum choice and control of their lives.

Right Care

The person and relatives we spoke with talked positively about the caring nature of staff. Comments included, “All my experience is that they’re all very nice,” and, “Some of them go above and beyond and spend a bit of extra time if she needs it.”

Care plans did not fully reflect people’s needs. The registered manager told us these were being updated.

People were supported to access the local community and take part in activities, where this was part of their plan of care.

Right Culture

An effective system was not fully in place to monitor and manage the quality and safety of the service and ensure regulatory requirements were met. We identified shortfalls across many areas of the service including the assessment of risk, medicines management, the maintenance of records relating to people, staff and the management of the service. These had not been identified by the provider’s monitoring systems.

Whilst we did not identify any impact on people, there was the potential for people to come to harm, as risks were not adequately assessed and records were not well maintained. The registered manager told us they were reviewing their whole governance system to ensure it effectively monitored the quality and safety of the service.

We visited 1 person at home and observed positive interactions between the person and staff. Staff also spoke enthusiastically about working at the service and the people they supported.

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 28 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. A decision was made for us to inspect and review the key questions of safe, effective and well-led. When we inspected, we found there were shortfalls across many areas, so we widened the scope of the inspection to include the key question of responsive. For the caring key question not inspected, we used the rating awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the full report below for further details.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We identified 3 breaches of the regulations relating to safe care and treatment, staffing (in relation to training) and good governance.

Please see the action we have told the provider to take at the end of this 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

Not everyone using Safe Hands receives a regulated activity; The Care Quality Commission (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.

The service had a registered manager in post. The registered manager had been in post since the service first registered in 2010. A registered manager is a person who has registered with the CQC 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.

At the last inspection in April 2017, we asked the provider to take immediate action to make improvements to the governance of the service. We found these actions had been completed.

People told us they felt safe and were comfortable with the staff who supported them on a regular basis. Policies and procedures were in place to help staff safeguard people from harm and staff we spoke with understood their responsibilities in relation to protecting people. Incidents of a safeguarding nature had been appropriately recorded, investigated, reported and monitored. The local authorities told us that they had no current concerns about the service.

Staff supported people to maintain their health, safety and welfare within their own home. The registered manager had completed risk assessments where individual risks had been identified. We saw these were now regularly reviewed and updated to reflect the changes in people’s needs. Staff followed best practice in relation to the prevention and control of infection.

Staff felt there were enough of them employed to meet people’s needs and look after people safely. Care workers said they did not feel rushed with their duties. People and relatives told us that overall, they had regular care workers who arrived when expected.

Staff recruitment continued to be safe and robust. New staff had received a company induction but a comprehensive induction to meet national minimum standards had not been fully adopted. Staff training was up to date. Records showed and staff confirmed that they received regular supervision sessions, an annual appraisal and staff meetings took place to discuss any issues. Staff told us they felt valued by the office team and there was an open culture, which gave them the confidence to discuss anything with the registered manager and know it would be acted upon.

People and relatives told us medicines were received safely and when they expected it. Medicine administration records were accurate and up to date. Competency checks on care workers were now in place to ensure staff remained competent at administering medicines. Regular unannounced spot checks were also conducted to ensure high standards of care were delivered.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and relatives told us that staff encouraged a healthy and balanced diet. They told us care workers made meals they had chosen. External healthcare professionals were involved with people’s care to ensure their ongoing well-being.

People and relatives told us care workers were friendly and that they respected their home, their visitors and their belongings. People said care workers upheld their dignity and privacy. All staff we spoke with displayed kind and caring attitudes.

There was a complaints policy in place; this has been reviewed and a new process was in place to record all complaints and to ensure matters were escalated to the registered manager as necessary. We saw all complaints and minor issues had been logged, investigated and resolved in a timely manner. Everyone we spoke with had no complaints about the service.

Monitoring of the service was now thorough and robust. Record keeping had improved. We saw audits tools had been reviewed; existing audits had been improved and new audits had been implemented. This demonstrated that checks on service delivery were now routinely undertaken and where issues were identified, the registered manager took action.

A quality check analysis carried out by the registered manager showed that 100% of people were satisfied with the service they received. Our pre-inspection questionnaire responses corroborated this.

At our previous comprehensive inspection in June 2016, we identified two breaches of regulations relating to safe care and treatment regarding the management of medicines and good governance. We rated the service as requires improvement.

The inspection was announced. The provider was given 48 hours' notice because they are a domiciliary care agency and we wanted to make sure that key staff were available. We attended the provider’s head office and visited three people in Newcastle, Northumberland and North Tyneside on 30 and 31 March 2017 to find out how care and support was provided in these areas. Our expert by experience contacted people by phone from the 5 to the 10 April 2017.

There was a registered manager in post. 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 told us they felt safe with the staff who visited them at their homes. The provider had not notified CQC of several safeguarding allegations in line with legal requirements.

We looked at the management of medicines. We found that improvements had been made and care files contained an up to date list of medicines. There were some inconsistencies with the recording of medicines which the registered manager stated would be addressed.

People and relatives did not raise any concerns about staffing levels. The registered manager told us they were recruiting more staff. Recruitment checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS].

Training was carried out in safe working practices. Competency based assessments however, were not carried out to ensure that staff had the necessary skills in areas such as medicines management and moving and handling. In addition, ongoing documented checks to make sure staff were adhering to the correct procedures were not completed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We noted however, that records did not always evidence how staff followed the principles of the MCA.

People were supported to access to a range of healthcare services to ensure their health needs were met. This was confirmed by our observations and the health and social care professionals with whom we spoke.

People and relatives told us that staff were caring. We saw positive interactions between people and staff. People’s privacy and dignity was promoted. Care plans were person centred. We found that some care plans required updating to reflect changes in people’s preferences and needs.

The service provided enabling support where this was identified in people’s care assessment. Staff assisted people to access the local community to help meet their social needs.

There was a complaints process in place. We found however, that not all complaints were documented or monitored.

An effective quality monitoring system was not in place. Certain audits and checks were not carried out in areas such as medicines and care files. In addition, we found shortfalls in record keeping relating to people, staff and the management of the service.

The provider had not ensured they were meeting all their responsibilities under the conditions of their registration.

This is the second time we have rated the service as requires improvement. Sufficient action had not been taken by the provider to improve the overall rating of the service and ensure good outcomes for people in each of the five key questions we reviewed.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This relates to good governance. 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.

Safe Hands Home Care Limited provided home care and housing support to 18 adults living in their own homes living in the Northumberland, Newcastle and North Tyneside areas. People were provided with a variety of support times depending on their care package and needs, with some receiving 24 hour care. It should be noted that the numbers of people being supported and the number of hours they receive will fluctuate due to the nature of the service.

The service had a registered manager in post. 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.

We found shortfalls in the management of medicines. The terminology used in recordings by staff was not in line with best practice guidance and the process adopted when administering people's medicines process needed to be improved. Full details about needs related to ‘as required’ medicines, were not always available to staff.

Record keeping within the service was not always maintained to suitable standards. Care planning, medicines records, risk assessments, best interest decisions and quality assurance checks were not always documented thoroughly or not at all in some cases.

Quality assurance checks were completed in some areas of the service, for example finances and staff confirmed this. However, we saw very little documented evidence that either the registered manager or the provider had a full and clear oversight of the service to ensure people received good quality care and support. People, and their relatives confirmed, however, that they received good care from the staff team. Accidents and incidents were recorded but not fully monitored for emerging trends by the registered manager or provider.

People told us they felt safe with the staff team that supported them and their relatives confirmed those thoughts. Staff were confident and had been trained in safeguarding procedures. They confirmed they would have no doubts about reporting any issues to management or other appropriate bodies if the need arose.

Risk assessments in place needed to be tailored to individual need and not completed as a blanket approach. The provider had contingency plans in place and staff knew what to do in the event of an emergency.

Staffing levels were maintained by timely and safe recruitment procedures. The registered manager told us they tried to ensure people were visited by the same care staff but that was not always possible due to sickness or holidays.

Staff had received an induction into the service and completed appropriate training. Staff said they felt supported by management and supervisions and appraisals were completed, although these were behind schedule and the registered manager was in the process of bringing them up to date.

Some people received support with mealtimes as part of their care package. People were supported to prepare meals and eat meals they had chosen. Staff ensured drinks were left between visits for people if they required them.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. Although best interest decisions were made, these were not always documented fully.

Staff promoted people’s independence and treated people with warmth and kindness in a respectful and dignified manner. People were involved in the care planning process, although this was not always fully documented.

People had choice and could decide how they wanted to receive care and support. There was a complaints procedure in place and people and their relatives knew how to access and use it.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.

You can see what action we told the provider to take at the back of the full version of this report.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care records contained risk assessments and instructions on how these risks should be managed. For example, infection control, accessing facilities in the community and assisting with cooking.

Systems were in place to make sure that managers and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

Staff had undergone training on safeguarding vulnerable adults and were aware of the procedure to follow if they observed any bad practice in the service.

The provider contracted a health and safety consultant and they were currently in the process of reviewing the health and safety policy. We saw that health and safety checks were carried out in one person's home where 24 hour care was provided.

Is the service effective?

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met.

People's health and care needs were assessed and the majority of care plans provided staff with information about how each person's care needs should be met. However, one person's care plan did not contain sufficient information on managing a medical condition although the staff on duty were fully aware of this.

Is the service caring?

We spoke with three people who used the service and their comments included, "I am highly satisfied with the service I receive. The carers have a nice attitude and they don't rush me." A relative told us they had no problems with the service and their relation was well cared for. People said they received regular carers unless a member of staff was off sick or on holidays. When this happened they were told who would be covering for them and they had the office telephone number if they were any problems.

People said the staff generally turned up on time and stayed the correct amount of time to complete the necessary tasks.

We observed the interactions between staff and a person they cared for. We saw staff interacted well with the person and were attentive and sensitive to their individual needs.

Is the service responsive?

There was a complaints procedure in place and each person who used the service was provided with a copy of this. A complaints book was maintained to record any complaints received in the home and the outcome of the investigation.

Records showed, and staff told us, that appropriate training was provided for the staff to help meet individual needs.

Is the service well-led?

The provider had systems in place to monitor the quality of the service people received. People were asked their opinion of the service and quality spot checks were carried out by the manager. One person said, "X (the manager) calls to see me about once a month so I would tell him if I wasn't happy." Regular staff meetings were held to discuss day to day issues in the service, for example, book keeping/recording, communication and responsibilities. Management meetings were held in the office to discuss day to day issues such as paperwork, recruitment, rotas, communication and fire drills.

Staff said they were well supported by the manager and he carried out regular spot checks and they had supervision meetings every six to eight weeks. Comments included, "They are a good company to work for," "If you have a problem the manager sorts it out," "If I have any concerns someone is always available" and "I'm very happy working here. They were absolutely marvellous when I came back from sick leave."

We saw evidence to show that the manager visited people who used the service to carry out quality spot checks and these had provided positive feedback about the service. We found people's care records, accidents and complaints were monitored regularly by the manager.

The people who used the service and the staff told us the manager was very approachable if they had any concerns or suggestions.

We visited two people and their relatives in their own homes and spoke to one person on the telephone. People told us they were always asked for their consent before staff provided them with care and support. Comments included, "They always check with X before they do anything" and "They always ask me what I would like."

We viewed the care records for five people and found that care needs were assessed, planned and delivered in a way which met people's individual needs. People's comments included, "I wouldn't change a thing" and "I've had no problems."

We looked at four staff files and there was evidence that they received regular supervision to help them carry out their roles. The staff we spoke with said they felt well supported by the manager.

People told us they felt confident to discuss any concerns they had with the manager and staff. They all said they had never needed to complain.

We found the records were not easy to follow and some entries were not signed and dated. Some care records had not been reviewed which meant people's needs may not be fully met if they had changed.

We found that people's privacy and dignity were respected and they received appropriate care which met their needs. People said, "They always cover me with a sheet or towel when they are dressing me" and "They are very good and I don't feel embarrassed anymore".

We spoke with four people who used the service and two relatives. Positive comments were received about the quality of care. People said the staff were very caring and they were reliable. Comments included; "I like the girls because they listen to me". "They always turn up on time and if there is a problem they ring to let me know" and "The carers are friendly and make me laugh if I feel down".

We found the provider had systems in place to prevent abuse from happening and people who used the service told us they felt safe.

There were systems in place to help ensure appropriate and competent staff were recruited to care for the people who used the service. Comments included, "They are very good"and "They all know what needs to be done".

The provider had effective systems in place to assess and monitor the quality of service that people received.