Archived: Safe Hands Homecare Services

When we reviewed the service on 06 June 2011 we found that care planning and risk assessment processes continued to be poor although we had previously identified that these processes were inadequate in March 2011. We told the provider that they must improve their care administration, care planning and risk assessment processes so that peoples' care was properly planned and managed, and therefore was provided safely.

We issued a Warning Notice on 11 July 2011 requiring the provider to become compliant with Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Our inspection on 25 August 2011 found that the Warning Notice had been complied with. During our visit we looked closely at peoples care planning documentation including their assessments of needs, plans of care and risk assessments and found that these had been reformatted and significantly improved. The management of care documentation was now well structured and contained all the necessary information to plan and safely deliver the complex care required by some of the people supported by the agency.

However people also told us they had had difficulties with staff not changing their protective gloves, not showing understanding for their feelings, and having made mistakes with their medication. One person told us that they thought the agency did a good job where people did not need a lot of help but they did not think they would do so well when people had more complex and high dependency needs.

When we last reviewed this service at the end of March 2011 we found that both the administration of the agency and of the management of peoples' care was poor. We also found that the staff were being poorly recruited, had a severe lack of training, and that they had little supervision. When all these issues were combined we found that the agency was placing the people they supported at high risk.

When we carried out this review on the 06 and 07 June 2011 we found that the providers had obtained basic training for themselves and for some previously employed staff. However the agency was not employing any staff at the time of this review and so it wasn't possible to see if staff would now be recruited, trained and supported properly.

We were concerned at the continued poor administration of both peoples' records and of the other functions of the agency. The providers had considerable difficulty in finding peoples records and care planning. They did not tell us about all the people being supported by the agency. We had to advise them on how to obtain important information. Some record keeping was still poor. The poor administration of the agency we found in March 2011 had not been rectified by the time we returned eight weeks after our previous visit.

Some efforts had been made to improve the management of peoples' care but we found that the assessment of peoples' needs, the planning of their care and the assessment of risks affecting people, was still poor. There still wasn't the right information, enough assessment of information, and the information there was wasn't structured so that people could understand and use it to manage and deliver peoples' care.

We also found that where the agency was involved in helping with peoples' medication that this was also poorly managed and that some of the practices the agency was taking part in were potentially putting those providing care for the agency and the people receiving the medication at risk.

When we visited the agency's office we saw that peoples' records were being poorly managed and administered, and that the providers were not managing peoples care in an organised manner.

We also saw that complaints had been poorly managed and recorded. We found evidence that staff had developed inappropriate and unprofessional relationships with people that used the service. The agency had not supported staff to understand the necessary professional boundaries between the people that use the service and the representatives of the agency.

We did find that the providers of the service had obtained some basic training for themselves since the last review. However the provider who is also the Registered Manager had not obtained a relevant professional qualification within three years of their registration as agreed during their registration in 2007.

We have major concerns that the providers do not have the skills to administer the service, or the delivery of peoples' care, to a standard that ensures that all the people that use the service receive safe care.

We are taking enforcement action to ensure that people that use the service are safely cared for.

However we found that both the administration of the agency, and of the care the service was delivering, was poor and this, combined with a severe lack of training for the staff and the service's owners, was placing the people receiving care from the agency at high risk.

When we visited the agency's office we saw that the management of; peoples' needs assessment, the planning of their care and the assessments of their risks, were very poor and were not adequate to deliver safe professional care.

We looked at the service's ability to take part in the administration of peoples' medication in their homes. The service was not assessing or planning their involvement in peoples' medication administration processes. Also both the services' owners and the staff had not received any medication administration training to inform them about how to appropriately support people with their medication.

We saw that the agency had no programme of staff training, had no records of staff training, and was delivering barely any necessary basic training, such as how to physically support a person to move safely, how to work safely and reduce the risk of cross infection, and how to protect vulnerable people from abuse. In addition the agency was inadequately supervising their staff so that any care delivery or work issues were not be managed in a structured way.

We also found that the owners of the agency had not obtained enough training for themselves to enable them to safely manage and deliver care to the people that were using the service.

We checked the recruitment processes for the majority of the staff. We found that many of the checks that should have been done when staff were recruited had not been carried out. Also when new staff began work without previous care experience they did not get either, an adequate induction, or a training programme to give them the skills they needed to care for people properly. These recruitment failures were so extensive that we judged that the safety of the vulnerable people that use the service was being put at serious risk.