Care Hand Service Ltd

Updated 4 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection on 12 June 2018 was carried out by an inspector and a British Sign Language (BSL) interpreter. A BSL interpreter assisted with this inspection because the nominated individual, registered manager and care staff were all registered as deaf. We gave the provider notice of our inspection as we needed to make sure that someone was at the office in order for us to carry out the inspection. We also wanted to speak with care staff on the day of the inspection and providing advanced notice gave the service time to arrange for care staff to visit on the day of the inspection.

At the time of the inspection, the service provided personal care to three people.

Before we visited the service we checked the information that we held about the service and the service provider including notifications we had received from the provider about events and incidents affecting the safety and well-being of people. The provider also completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR also provides data about the organisation and service.

During our inspection we went to the provider’s office. We reviewed three people’s care plans, four staff files, training records and records relating to the management of the service such as audits, policies and procedures. People who used the service were registered deaf and were unable to verbally communicate with us. We therefore spoke with three representatives for people who received care from the service. We also spoke with two care staff, the registered manager and the nominated individual.

Updated 4 July 2018

We undertook an announced inspection of Care Hand Service Ltd on 12 June 2018.

Care Hand Service Ltd is a small domiciliary care agency registered to provide personal care to people in their own homes. The service focuses on providing care to people who are registered deaf, those with multi-sensory needs and other disabilities. At the time of the inspection, the service provided personal care to three people. CQC only inspect the service received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

During our previous inspection in June 2017, we noted that there was no registered manager in post. The service had taken action in respect of this and this inspection in June 2018 found that 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.

The previous inspection on 12 June 2017 found three breaches of regulation and made one recommendation. We rated the service as "requires improvement". During this inspection on 12 June 2018, we found that the service had made improvements in respect of care documentation, risk assessments, staff training, supervision, quality checks and audits. We also noted that the service had made some improvements in respect of their medicines management. However, there were still areas within the medicines management that required improvement. We also observed that the service had introduced various checks and audits. However, we noted that medicines audits were not effective.

People who used the service were registered deaf and therefore were unable to verbally communicate with us. We therefore spoke with their representatives. They informed us that overall, they were satisfied with the care and services provided. They said that people were treated with respect and people were safe when cared for by care workers.

Our previous inspection found a breach of regulation in respect of risk assessments. We found that the service did not always identify all potential risks and there was limited information contained in risk assessments. During this inspection in June 2018, we found that the service had taken appropriate action and made improvements to their risk assessments. Appropriate risk assessments were in place and included details of the nature of the risk, action required to minimise the risk and details of progress of actions taken by the service.

Our previous inspection found a breach in respect of medicines management. We found that the service was not completing Medication Administration Records (MARs) when administering medicines to people. People were therefore at risk of not receiving their medicines safely. During this inspection, we noted that the service had taken action in respect of this and made improvements. The service had introduced systems to ensure that medicines were administered safely. However, we found that there were still some issues with regards to the completion of MARs and raised this with the service. Following the inspection, the nominated individual confirmed that they had reviewed their MARs and had implemented a revised format that enabled them to document medication administration consistently.

Representatives told us there were no issues with regards to care worker's punctuality and attendance. They told us that care workers were usually on time and if they were running late, the office contacted them to inform them of the delay. They told us that people experienced consistency in the care they received and had regular care workers.

At the time of the previous inspection in June 2017, the service did not have an electronic system for monitoring care worker's timekeeping and duration of their visit. During this inspection in June 2018, the service had a telelogging system in place which flagged up if a care worker had not logged a call to indicate they had arrived at the person's home or that they were running late.

We looked at the recruitment records and found background checks for safer recruitment had been carried out to ensure staff were suitable to care for people.

Care plans included information about peoples’ mental health and their levels of capacity to make decisions and provide consent to their care.

Representatives told us that people were treated with respect and dignity. They told us that care staff were caring and helpful. Staff were able to give us examples of how they ensured that they were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care.

Our previous inspection found that there was a lack of consistency and the quality of care documentation varied. During this inspection in June 2018, we noted that the service had made improvements and ensured that care records were consistent.

We previously found that communication records were poorly written and not professional and we made a recommendation in respect of this. During this inspection, we noted that the service had taken action to address this. We looked at a sample of communication records and found that these were consistent and were written in a professional manner.

Care support plans were individualised and addressed areas such as people’s personal care, what tasks needed to be done each day, time of visits, people’s needs and how these needs were to be met. They also included details of people’s preferences.

The service had a formal complaints procedure in place. We noted that the service had not received any formal complaints since the previous inspection.

Representatives and care workers we spoke with were satisfied with the management at the service. They said that management were approachable and supportive. Our previous inspection found that the service did not have a system in place to monitor the quality of the service and we found a breach of regulation in respect of this.

During this inspection in June 2018, we found that the service had made improvements to address the breach of regulation. We noted that the service had introduced care plan and risk assessment audits. The service also carried out regular staff spot checks and supervisions to monitor care workers. We also noted that the service had introduced an electronic telelogging system to monitor staff punctuality and attendance. However, during this inspection we noted the service did not have an effective medicine administration audit in place. The service had failed to identify the gaps and inconsistencies in a sample of MARs we looked at. We raised this with the service. Following, the inspection the service sent us evidence of the new format of medicines audit they had devised and said it would be implemented immediately.