Gentle Hands Care Agency Ltd

Gentle Hands Care Agency Limited is a domiciliary care agency. It provides personal care to people living in their own houses. The service also provides care and support to 15 people living in six ‘supported living’ settings.

People supported by the organisation have a range of physical and mental health needs and people who have a learning disability. At the time of our inspection the service was providing care to 25 people.

The supported living service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of the service

People and their relatives were happy with the service and told us staff were kind to them, and understood their needs. Care was provided by staff who had worked on a consistent basis with people which contributed to a good quality service.

Risk assessments were in place to provide guidance to staff and care support plans were comprehensive and up to date. People were safeguarded against the risks of abuse and harm by the systems and by the staff. There were enough staff to meet people’s needs and provide responsive care.

Safe recruitment practices took place so staff were considered appropriate to work with vulnerable people. Staff received training and supervision for their role.

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.

People were supported to access external health professionals to help promote good health and wellbeing.

There were effective quality assurance processes in place including spot checks of staff and audits of medicines.

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 the service was good (published 4 August 2017).

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.

At the last inspection in June 2016, we found the service was in breach of four of the regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe care and treatment of people as risk assessments were not always in place; people’s care was not always person centred; staff had not always received appropriate training and we had concerns regarding the governance of the service. At the last inspection we also made a recommendation in relation to safeguarding adults. At this inspection we found improvements had been made in these areas and that the provider was no longer in breach of the regulations.

Gentle Hands Care Agency Ltd had 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.

The agency specialises in supporting people with learning and physical disabilities and the majority of people receiving a service were under 65 years of age. We were unable to speak with people using the service due to communication requirements, but spoke with their relatives. Relatives told us they were very happy with the service provided by the agency.

At this inspection we saw that support plans were up to date and were comprehensive. There were risk assessments covering the majority of risks identified on people’s care records.

We could see that staff undertook training in key areas and the provider could evidence that refresher training had taken place for staff. Staff supervision took place and staff told us they felt supported in their role.

Staff were able to tell us about safeguarding of vulnerable adults and knew what to do if they had any concerns. They also understood the importance of whistleblowing.

Most family carers took responsibility for the administration of medicines although staff had been trained to support people taking their medicine where required. We identified at this inspection there were issues with the completion of medicine administration records by some members of staff. This had been identified by the registered manager as an issue and following the inspection further training in the completion of medicine administration records took place.

We saw that employment practices were safe and criminal checks were in place prior to staff starting work. This meant staff were considered safe to work with vulnerable adults.

Family carers told us staff treated their relatives with dignity and respect and the staff team were consistent and skilled to carry out their caring role. This meant staff understood people’s needs and preferences and so could provide person centred care. Relatives told us if staff were occasionally running late, they would let them know.

Family carers told us that the registered manager was responsive if they raised any issues and this was confirmed by a health and social care professional.

At the last inspection the provider did not have effective quality assurance systems in place. At this inspection we found improvements in the governance of the service. The provider acknowledged the systems were being refined to become fully effective.

We have made a recommendation in relation to care records.

The Gentle Hands Care Agency Ltd had 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.

The agency specialises in supporting people with a learning disability. We were unable to speak with people using the service, but spoke with their relatives. Relatives were very happy with the service provided by the agency. There were mixed views from health and social care professionals regarding the service at the supported living scheme.

Relatives told us the staff treated the people they cared for with dignity and respect. Relatives also told us staff were reliable and the majority had the skills and experience to do the job of caring.

We saw that staff were supervised regularly and staff told us they felt supported. We saw that training took place but that further training was required to ensure staff were equipped to deal with the people they cared for.

The majority of family carers took responsibility for medicines although staff had been trained to support people taking their medicine, and staff at the supported living scheme supported people with all medicines administration.

The provider told us they were in the process of updating care records. We could see that some had been updated and were person centred. A number were out of date and had not been updated comprehensively since 2013. The provider undertook to update the remaining care plans. We saw risk assessments were in place for the majority of care records, but they did not always contain information on significant health risks, or how to manage those risks.

We saw that employment practices were safe and criminal checks were in place prior to staff starting work. This meant staff were considered safe to work with vulnerable adults.

The provider could show us they undertook reviews and carried out spot checks although they did not have an efficient system at the time of the inspection to evidence what was outstanding. Since the inspection they have provided this information and were able to show they had an improvement plan they were working to.

Relatives told us the registered manager and deputy manager were very responsive to any issues they raised and would recommend the service to other people.

We found four breaches in relation to risk assessments on care records, training for staff, care plans and the governance of the service.

We have made recommendations in relation to safeguarding adults.

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