Surrey Helping Hands Limited

Surrey Helping Hands is a domiciliary care agency that provides personal care to people in their own homes in the West Surrey area. People who receive a service include those living with frailty, mobility needs and health conditions including dementia. At the time of our inspection the service provided personal care to 42 people.

People’s experience of using this service and what we found

Assessments were not always undertaken to identify risks to people to protect them from harm. The management of medicines required improvement particularly around recording. However, people did say they received their medicines when needed. Accidents and incidents were not always recorded appropriately or analysed.

Quality assurance was not always effective. Where shortfalls had been identified with staff this had not been addressed robustly. Staff were not given travel time in between calls which meant they were not always staying for the full length of the call. However, people, relatives and staff were complimentary of the management team.

People told us that they felt safe with staff and that staff followed good infection control procedures. Staff underwent a robust recruitment process before they started work.

Rating at last inspection

The last rating for this service was Good (published 17 November 2017).

Why we inspected

We received concerns in relation to the missed calls and the safe delivery of medicines. As a result, we undertook a focused inspection to review the key questions of Safe 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, 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.

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

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 risks related to the care being provided to people, the management of medicines, incident and accident reporting and the lack of robust provider and management quality assurance at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published. Please see the action we have told the provider to take at the end of this report.

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.

At the previous inspection in August 2016 we found that staff did not have a good understanding of the principles of MCA, robust recruitment was not undertaken and quality assurance processes were not in place. We found that this had improved on this inspection. There were some improvements still required around the provider ensuring that records were kept securely and to ensure they knew that staff had turned up at the call. We have made a recommendation around this.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

People said that they felt safe in their own homes with staff.

Robust recruitment practices took place to ensure that staff were suitable to work with people. Staff understood to how protect people from the risk of abuse.

Risks to people were managed well and staff understood these risks. People’s medicines were managed by staff who understood how to record and administer medicines. There was a service contingency plan in place in the event of an emergency. Incidents and accidents were recorded by staff and actions taken to reduce the risks.

There were sufficient numbers of staff to deliver care. When there was staff absence management provided support to people.

Staff followed the principles of the Mental Capacity Act 2005 (MCA). People confirmed that their consent was obtained before care was delivered.

Staff were appropriately trained and were supervised in their roles. People felt that staff were competent when carrying out care.

People were provided with sufficient food and drinks when needed. If staff suspected people were unwell they contacted the appropriate health care professional.

People felt that staff were caring, well-meaning and pleasant towards them. They felt that staff treated them with dignity and were respectful towards them.

People were involved in their care planning and where asked how they wanted their care to be delivered. The provider ensured that care was provided in lines with people’s wishes.

People were provided with a complaints policy and encouraged to raise complaints if needed. Complaints were investigated to people’s satisfaction and improvements were made as a result.

Care plans were detailed with guidance for staff in relation to the care that was required. These care plans were reviewed regularly and any changes were communicated to staff.

People and staff felt that the service was well managed. People were at the heart of the service and the provider ensured that the quality of care that was provided was of a high standard.

Staff felt supported, valued and listened to. There were systems in place to assess the quality of care. Any shortfalls identified were addressed.

The registered manager had informed the CQC of significant events including safeguarding and incidents.

At the previous inspection in August 2016 we identified breaches which had been met on this inspection.

The inspection took place on 3 August 2016, and was announced. We gave ‘48 hours’ notice of the inspection to ensure that staff would be available in the office, as this is our methodology for inspecting domiciliary care agencies.

During our inspection the registered provider was present. The registered provider was covering the manager’s role. 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 were not always protected from being cared for by unsuitable staff because although recruitment processes were in place, they were not always followed.

Staff did not have a clear understanding of their responsibilities regarding the Mental Capacity Act 2005. Where people lacked capacity they were not fully protected and best practices were not being followed.

Quality assurance systems and arrangements to regularly assess and monitor the quality of the service were in place, but they were not effective enough to identify shortfalls in the systems.

People told us that they received their medicines safely and on time. However people were at risk of harm as the medicine administration records (MARs) in use at the time of the inspection were not always completed correctly. We made recommendation that the registered provider ensures that MARs chart are completed in line with current guidelines with regard to the administration of medicines.

People were supported by staff who had the knowledge and skills required to meet their needs. Everyone that we spoke with said that staff were trained and were competent in their work. All new staff completed an induction programme at the start of their employment. Training was provided during induction and then on an ongoing basis.

Risk assessments included information about action to be taken to minimise the chance of harm occurring. Staff were able to explain the procedures that should be followed in the event of an emergency.

People said that staff generally arrived on time and if they were delayed for a significant amount of time then they were informed. People also said that they knew the staff well and generally received a service from a group of known workers.

People were supported at mealtimes to have the food and drink of their choice. The support people received varied depending on people’s individual circumstances. Staff were available to support people to attend healthcare appointments if needed and liaised with health and social care professionals involved in their care if their health or support needs changed.

People confirmed that they had consented to the care they received. They told us that staff checked with them that they were happy with support being provided on a regular basis.

People had care plans in place for identified needs. Staff understood the importance of promoting independence and this was reinforced in people’s care plans. People were supported to express their views and to be involved in making decisions about their care and support. People told us that the agency was responsive in changing the times of their visits and accommodating last minute appointments when needed.

Positive, caring relationships had been developed with people. Everyone that we spoke with told us they were treated with kindness and respect by the staff who supported them. Staff were respectful of people’s privacy and maintained their dignity.

People and their relatives told us they were aware of the formal complaints procedure and that they were confident that the registered provider or staff would address concerns if they had any.

People and their relatives said that the agency provided a good service. Staff were motivated and told us that they felt fully supported by the registered provider. They said that the registered provider and senior staff was approachable and kept them informed of any changes to the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made one recommendation to the provider. You can see what action we have told the provider to take at the back of the full version of the report.