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Inspection carried out on 29 May 2018

During a routine inspection

This inspection took place on 29 and 31 May 2018. The first day was unannounced, however we informed staff we would be returning for a second day to complete the inspection and announced this in advance.

Helping Hands provides domiciliary support to up to 13 people with learning disabilities, autism, physical disabilities and mental health needs. The service is provided in three units called; Bath house, Milton and New Build. The service is provided over 24 hours. Staff are present in the units at all times. This model of care is known as ‘supported living’.

At our last inspection of Helping Hands in February 2017 the home was rated as ‘Requires improvement’ overall due to not meeting the regulations in relation to record keeping and staff training. At this inspection we found the service had responded effectively and there had been significant improvement in both these areas.

People had been protected from the risk of harm and abuse. Staff understood what might be a safeguarding concern and how to respond to this.

The building and utilities had been maintained to a good standard with all necessary checks and certificates in place, including; gas, electrical, legionella and fire safety equipment.

Medication was safely managed, records were up to date and provided the necessary details in relation to all prescribed medicines including topical creams and dietary supplements and thickeners.

People’s needs had been assessed and care plans developed to ensure their needs were met as they preferred. Risk assessments provided guidance on how to support people to manage the risks in their daily lives.

Staff had received an increased level of training which had provided them with the necessary knowledge and skill to meet people’s needs. Staff reported feeling they had benefited from the training available.

The service was aware of its responsibilities in relation to the Mental Capacity Act 2005 and associate Deprivation of Liberty Safeguards including in domestic settings, known as (DIDs).

Staff were seen to be caring and supported people, kindly and respectfully. People living in the service said they thought the staff were kind and caring.

People received person centred care that was responsive to their needs. Care plans were reviewed and updated regularly.

The management structure was clear and staff reported being happy with the way the service was managed, they felt the manager could be relied on to take appropriate action and was supportive and fair.

Auditing and governance systems had been improved and ensured people received care and support consistently.

Relatives reported feeling able to approach the manager at any time and felt confident they would act on any concerns they raised.

Inspection carried out on 27 February 2017

During a routine inspection

We carried out an unannounced inspection of Helping Hands on 27 February 2017.

Our last inspection of Helping Hands was in October 2015 when the service was rated as ‘requires improvement’ overall and for the key questions of safe, effective, and well-led. The key questions for caring and responsive were rated as good.

Helping Hands provides a 24 hour supported living service in Eccles, Salford. The service provides support to adults whose primary need for care is due to a learning or physical disability. Support is provided for people with varying needs and people with more complex needs were receiving one to one support.

Helping Hands is divided in to three separate accommodations, known as Number 19, the Milton Crescent and Bath house. At the time of the inspection there were 19 people living at the service.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to; good governance (two parts of the regulation) and staffing.

The service had a registered manager. 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 who used the service told us they felt safe and we found suitable safeguarding procedures in place which were designed to protect vulnerable people from abuse and the risk of abuse. The service had a robust recruitment process which included a Disclosure and Barring Service (DBS) check having been undertaken and suitable references obtained before new staff commenced employment.

We found there was no information recorded to guide staff when administering medicines which were prescribed to be given “when required” (PRN). Cream records and body maps were not in place to guide staff regarding application and we found omissions of staff signature on the MAR that had not been explored with staff as to how they had occurred. Records regarding the use of thickeners were not maintained and there was no record on the MAR to determine that this had been administered correctly.

People had risk assessments which were reviewed to meet people’s needs. People confirmed being involved in the assessments and planning of their health and social care. Regular reviews were undertaken collaboratively and people expressed feeling involved.

Staff demonstrated a good understanding of the requirements of the Mental Capacity Act (MCA) and we confirmed the service had engaged with professionals for consideration of application to the court of protection when people were deemed not to have capacity to consent to their care and treatment.

We saw there were gaps in staff training and there was no identified timeframe for completion of this training. The gaps included; MCA and deprivation of liberty safeguards (DoLS), positive behaviour management, autism awareness and learning disabilities. The service is designed to support people with a learning disability so this training is fundamental in ensuring staff have the required knowledge and skills to meet people’s needs. This gap had been identified at our previous inspection and remained an outstanding requirement. This meant staff had not been provided sufficient training to support them in their role.

People were supported by familiar staff that understood their needs and individual communication requirements to ensure people’s needs were met. Staff encouraged people to maintain their independence and to develop their confidence to empower people receiving support to develop new skills.

People’s nutritional needs were closely monitored and additional support provided when people were identified as losing weight. People told us they chose their meals and were supported by staff to shop for the meal provisions. People were encouraged to participate in meal preparation and told us they were given sufficient amounts to eat and drink.

People were promoted to live full and active lives. Activities were meaningful and reflected people’s interests and individual hobbies.

Staff described the management to be open, supportive and approachable. Staff talked about their jobs positively and with pride. Staff told us they were fully supported by the management and that the deputy and registered manager were instrumental in supporting people’s care.

There were systems in place to monitor the quality of the service being provided, however it was not effective given the areas of concern we identified in relation to medication records, audits and training.

Inspection carried out on 27 October 2015

During a routine inspection

Helping Hands is a supported living service in Eccles, Salford and provides 24 hour support to people with learning difficulties. There are three supported living tenancies known as Bath House, Milton Crescent and ‘Number 19’.

We carried out our unannounced inspection of Helping Hands on 27 October 2015. At the previous inspection in 2013 we found the service was meeting all standards assessed.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation 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.

There was a registered manager in day to day charge of 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.

Staff recruitment procedures were safe. We saw appropriate checks were undertaken before staff began work. However, we did identify one member of staff who started their induction before an appropriate DBS had been obtained.

We found that people’s risk assessments were not always reviewed at regular intervals. Some risk assessments showed no evidence of review since 2013. This meant that people’s individual needs and any associated risks were not being monitored regularly enough by staff which could place them at risk. One person had no risk assessment in their support plan, whilst another person, who we had observed to be ‘unsteady’ on their feet, did not have an appropriate mobility risk assessment in place. These concerns meant there had been a breach of Regulation 12 (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to Safe Care and Treatment.

The premises were not always safe on the day of the inspection. This was because there was nothing stopping people walking off the street and gaining unauthorised access to the supported living accommodation. This was mainly in relation to Milton Crescent and Bath House, as the doors leading into these tenancies were not secure.

The people we spoke with said they felt safe as a result of the care and support they received and trusted the staff who looked after them.

People’s medicines were looked after properly by staff that had been given training to help them with this.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. We looked at the staff rotas. We found the service had sufficient skilled staff to meet people's needs. Staff spoken with told us any shortfalls, due to sickness or leave, were covered by existing staff which ensured people were looked after by staff who knew them. They also said staffing numbers were kept under review and adjusted to respond to people’s choices, routines and needs.

We looked at the training matrix to establish the kinds of training staff had undertaken. We found there were gaps on the matrix, which the manager told us was up to date. Some of these courses included safeguarding, moving and handling, infection control and health and safety. The manager said the expectation was to update these courses each year. Additionally, the training matrix stated only three members of staff had completed any training in learning disabilities, which was the main specialism of the service.

Several of the people who used the service could not communicate verbally and we saw staff had been appropriately training in British Sign Language (BSL).

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. At the time of the inspection, there was nobody using the service who was subject to a DoLS.

People living at the service were involved in the planning of the menus and went shopping with staff to local shops and supermarkets each week. People, who were able to, were given support by staff to prepare their own meals. There was no set meal for lunch time and people living in the service were able to choose either to dine in or out at a time convenient to them. The manager told us an evening meal was always prepared by staff and that people who lived at the service were able to contribute where possible. We saw the service promoted healthy eating where possible and were actively encouraging people to lose weight if that was what they wanted.

From looking at records, and from discussions with people who used the service, it was clear there were opportunities for involvement in many interesting activities both inside and outside the service. People were involved in discussions and decisions about the activities they would prefer which would help make sure activities were tailored to each individual. Activities were arranged for groups of people or on a one to one basis. Some people had devised their own ‘weekly planner’, which set out the different types of things they liked to do during the weeks and at weekends.

The service had an appropriate complaints procedure in place. The procedure was available in an easy read format that could be understood by everyone who lived at the service. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.

There was a system in place to monitor accidents and incidents. However we found no analysis of these was done which would identify any trends and prevent future re-occurrences. The manager said this was down to current time constraints.

There were policies and procedures in place, however many of these required updating.

There were systems in place to regularly assess and monitor the quality of the service. These included audits of care plans and medication. The manager also spent time speaking with people who used the service at several points during the year to ask them about the service and if it was to their satisfaction. These were clearly recorded within people’s support plans.

We did find however, that there were no systems in place to ensure that appropriate risk assessments were in place and reviewed at regular intervals, that the premises were safe and that all staff training was up to date. These were areas where we found concerns during the inspection. These concerns meant there had been a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation Good Governance.

Inspection carried out on 22 October 2013

During an inspection in response to concerns

We saw there was a complaints policy and procedure in place that outlined timescales for responding to a complaint. There was a template to record complaints detailing the nature of the complaint, the action taken and the outcome. We saw where letters had been sent to the complainant a copy was held with the initial complaint.

The provider also showed us compliments that had been received from relatives of people using the service.

We saw information about how to make a complaint was available in the service user guide and given to people when they began to use the service.

People were given information in a format that was suitable for them such a symbols, pictures or large print.

Inspection carried out on 22 October 2013

During an inspection in response to concerns

We carried out this inspection in response to concerns we had received about medication and care practices.

The support plans we looked at contained; ‘about me’ (information about preferences), communication needs, contact details for the person’s next of kin, a malnutrition universal screening tool (MUST), a health action plan and risk assessments. The support plans we looked at also contained information about people's current and past medical history.

We saw tablets were dispensed from a monitored dosage system (Blister pack) and liquids were dispensed from bottles. All medication was labelled with the person’s name, the dose and frequency. The medication was stored in a locked filing cabinet.

We looked at the staff rota and saw there were four members of staff on duty each day to support five people. One person spent their day at the day centre. Which meant there were enough support staff on duty to meet peoples assessed support needs.

We saw the manager used a number of methods to gather people’s views about their care and treatment. The service used a pictorial quality assurance questionnaire which relatives or staff helped people complete.

We spoke with two people who used the service. Comments included: “I like it here I wouldn’t want to move anywhere else.” “It is nice here.” “I like living here.” "I like all of them (staff)."

Inspection carried out on 27 September 2012

During a routine inspection

We completed an unannounced inspection on 27 September 2012 to follow up on our last inspection in March 2012, where we found gaps in; risk assessments, staff training and supervision, quality assurance surveys and fire safety checks. We carried out this visit to check what improvements had been made. During the course of this inspection, we found that improvements had been made in all of the areas.

We spoke with two people who received personal care and support, they told us: "The staff are all very kind. They help me throughout the day and we get on well.” We also spoke with a relative of a tenant who used the service and three members of staff.

As part of this inspection, we looked at a sample of records held in the office and in the tenant's homes and in relation to staff supervision. A system was in place to meet with staff on a one to one basis.

We looked at a sample of tenants' care plans and found that they were written from the tenants’ point of view. We saw that tenants' preferences in relation to how they wanted their care delivered were recorded. Improvements had been made to environmental risk assessments.

We found that care plans had been reviewed and that a system for gathering comments from people who used the service or their relatives had been developed although no responses had yet been received.

People we spoke with expressed confidence that the manager would address any issues and make improvements for tenants who used the service.

Inspection carried out on 9 March 2012

During a routine inspection

The people who were able to say told us that they were being treated well by the staff members supporting them and that they were involved in all aspects of their care.

Comments included; “I am helped by kind people who look after me well”. Another person said; “I like living here, the staff are good and they help me.”

We spoke with a relative of a person who was being supported and they were very pleased with the support provided.

People using the service told us that the agency was meeting their care and support needs properly. They also said that they were involved and consulted about how they were cared for and supported and that care staff treated them with respect and maintained their dignity.

For the purposes of report writing, the people receiving a supportive living service will be referred to as tenants. Supported living service is where people live in their own home and receive care and/or support in order to promote their independence. The support that people receive is often continuous and tailored to meet their individual needs. It aims to enable the person to be as independent as possible, and usually involves social support rather than medical care.