Caring Hands

Caring Hands is a domiciliary care service providing personal care and support to people in their own homes. They were providing a service to 75 people at the time of inspection; 73 of whom were receiving 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’s current care needs and risks were not always assessed or recorded accurately which exposed them to the risk of harm. Medicine records were not completed accurately and audits did not identify gaps in medicine administration. People’s health conditions were not assessed to mitigate the risks associated with Covid-19.

There were not always enough care staff to meet the needs of people and staff had not received regular training to provide care and support safely. However, people felt safe with the care they received and care staff understood people’s needs well.

We found significant concerns about the management of the service. Their systems were either not in place or not effective to assess, monitor, and improve the quality and safety of the service. The systems had failed to ensure risks were properly assessed, documented and mitigated. The provider had failed to ensure care staff had guidance in place to provide safe care and treatment to people.

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.

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 7 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safe staffing. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people's safe care and treatment, managing risks to people's safety; staffing and governance and oversight of the service at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Caring Hands is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults with a disability. At the time of our inspection 55 people were receiving personal care as part of their care package.

There was a registered manager at the service. 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.

At our last inspection we rated the service as Requires Improvement. We asked the provider to make improvements when they completed mental capacity assessments and how they audited the service. At this inspection we saw these improvements had been made, however we made a recommendation in relation to the recording of medicines.

The provider had improved their quality audits to ensure that all care plans and risk assessments were up to date in people’s homes. Other quality systems were used to monitor that people received their calls on time and for the allocated time. People and their relatives were included in developing the service and found the registered manager approachable.

People received support with their medicine; however the reporting system were not in line with medical guidance. We have made a recommendation that the provider reviews their administration process to meet the current guidance in medicine management. The provider had recruited enough staff to meet the current needs of the people requiring the service. When people were recruited the necessary checks had been completed. People received assessments of their property and any identified risks and guidance provided to reduce these risks. Lessons were learnt from when things went wrong. This was reflected through supervisions of staff to support their practice, when observations identified further training was required.

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. Staff received training and support for their role and the care for people. Staff monitored people’s health; and worked in partnership with other organisations when needed. Some people were supported to eat and drink and this was monitored and recorded.

People told us they had established positive relationships with the staff who were caring and treated people with respect and kindness. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s care and goals and these were regularly reviewed. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they received.

Caring Hands is registered to provide care to people in their own home. At the time of our inspection 41 people were receiving personal care.

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.

Staff did not fully understand how to support people who were unable to make decisions for themselves. People’s care was not reviewed as regularly as the provider planned. Care plans were not up to date and contained contradictory information which could lead to confusion about people's support needs. The provider did not have a quality monitoring system in place which identified trends and shortfalls in the service.

People were protected from harm and poor care as staff understood how to recognise and report concerns of abuse. There were a sufficient number of suitably recruited staff to provide people with consistent support. Staff supported people with their medicines when this was required and they received managerial guidance to understand complicated prescriptions.

People and staff had developed kind, caring and polite relationships. Staff knew people well and they supported people’s privacy and promoted their dignity when delivering personal care. People were asked to provide details about their previous lives, likes and dislikes so that staff could provide care in the way people preferred.

People were aware how to make a complaint and felt they would be listened to. There was a procedure in place to ensure if people or their relatives raised a concern this was investigated and responded to.

We found a breach 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.

Everyone told us they were satisfied with their service. Comments included: " Very happy. My carer is marvellous", "I know my relative is looked after" and "I am happy with the service". People that had regular care workers were all very happy with their care and the way it was provided. Those that did not yet have regular care workers were satisfied with their care but would have liked to have continuity of care and to develop an ongoing relationship with their care workers.

The new plans of care that were being introduced provided information specific to the person. This meant that care workers had the information to provide people with care in the way they wanted.

The agency's recruitment procedures meant that meant that people received care from care workers that were suitable to undertake their role.

Systems were in place to review and monitor the care people received. Some checks should be completed more regularly so that any shortfalls could be identified and acted upon more quickly. People's views about their care were taken into account to improve their service.

People said that all their care workers spoke with them in a in a respectful way. One person commented, 'They (Care workers) all have good manners'. Another person told us, 'I don't have any concerns my carers are always friendly and speak nicely to me'.

All of the people we spoke with felt that staff were well trained and understood their needs. People told us that they felt safe and happy with the staff that visited them. Comments we received included, "I have no complaints, I am happy with everything, the care staff are kind'. Four people told us that they usually had the same carers.

We spoke with senior staff at the time of our visit to the office and also spoke with two care workers over the telephone. The two care staff we spoke with told us that they had received training which helped them to meet the needs of the people they cared for. We saw that systems were in place to monitor the quality of care that people had received.