• Services in your home
  • Homecare service

Archived: Caring Hands Homecare

Overall: Inadequate read more about inspection ratings

3 Riversway Business Village, Navigation Way, Preston, Lancashire, PR2 2YP (01772) 747386

Provided and run by:
Caring Hands Homecare (Fylde & Wyre) Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

11 December 2019

During a routine inspection

About the service

Caring Hands Homecare (Fylde & Wyre) Limited is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection the service was supporting 12 people with personal care. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

At this inspection we found failures in the provider's quality and assurance systems. Records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. This compromised the quality and safety of the service provided.

People were not safeguarded from the risk of abuse because the provider could not show staff had been trained or informed how to recognise the potential signs of abuse. There was no evidence incidents of potential abuse had been referred to the local authority safeguarding team or investigated adequately by the provider.

People did not always have risks to their personal safety identified. When they had been identified, control measures were not in place or were contradictory, therefore risks were not mitigated. People's medicines were not always managed safely. Not all staff who administered medicines had received training or guidance as to how to do this safely.

Staff were not safely recruited. Recruitment files seen were incomplete and there were some missing. We could not be assured who was currently employed by the provider or what checks had been made before employing them.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service were not followed to support this practice.

We found not all staff had received training to complete their role. Staff had not received adequate support in their role. We saw evidence health professionals were contacted when required.

We saw some caring staff and positive interactions during our inspection. However, failures in systems resulted in people not always receiving a caring service. The way care provision was being managed was not respectful of people.

The service did not promote a positive person-centred culture which promoted good outcomes for people. Audits and checks at the service were not completed to identify areas of improvement. The provider had failed to notify appropriate agencies, including CQC of safeguarding concerns. There was no evidence people had been consulted about the care they received.

The service was not well led. There was a registered manager who had not worked at the service for some time. The managers employed by the provider to run the service had all subsequently left. On the day of inspection, the provider was being supported by temporary staff who did not have access to the full information they required to assist the provider. The provider had begun discussions with an alternative provider to transition care packages and de-register.

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 this service was Good (published 17 May 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staff members being employed without barring and disclosure checks (DBS). The commission also received intelligence suggesting staff members were working for the service without training and that care visits were not being completed. A decision was made for us to inspect and examine those risks.

We planned to complete a focussed inspection to look at the risks. However, we have found evidence to substantiate the concerns. Therefore, as per our guidance we completed a full comprehensive inspection. We found concerns in relation to staff employment checks, staff training, management of risks, medicines, leadership and care records. Please see the safe, effective, responsive, caring 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.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing, need for consent and fit and proper persons employed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’. Since our inspection the provider has submitted the form to de-register this service. This means that they will no longer be registered to carry out a regulated activity. Therefore, the service does not need to be placed into special measures.

16 April 2019

During a routine inspection

About the service: Caring Hands Homecare aims to help people live an independent and fulfilling life, whatever challenges they face. They offer services from personal care and companionship to specialised services for people living with complex conditions. At the time of our inspection the service was supporting 15 people with personal care.

People’s experience of using this service:

People received personalised care which was responsive to their individual needs. Staff had a good understanding of the care and support people required and provided this with care and patience.

People’s care and support had been planned proactively and in partnership with them. People felt consulted and listened to about how their care would be delivered. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had been recruited safely, appropriately trained and supported. People told us their visits were well managed and staff who visited them knew and met their care needs.

People were supported to have access to healthcare professionals and their healthcare needs had been met. The service worked in partnership with other organisations to ensure they followed good practice and people in their care were safe.

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. People told us they had no concerns about their safety whilst in the care of staff supporting them.

The service had a complaints procedure which was made available to people and their family members. People told us they were happy with their service and had no complaints.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek people’s views about the service provided.

Rating at last inspection:

At the last inspection the service was rated requires improvement (report published 05 June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

At the last inspection on 17 and 18 April 2018 we asked the provider to take action to make improvements because we found a breach of legal requirements. This was in relation to the need for consent.

We received a provider action plan and the provider said they would meet the relevant legal requirement by 06 June 2018. At this inspection we found this action had been completed.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

17 April 2018

During a routine inspection

The inspection of the service took place 17 and 18 April 2018. The service was given 24 hours' notice prior to the inspection this was done to ensure there would be someone available to speak with us.

Caring Hands Homecare (Fylde and Wyre) Limited is managed from well-equipped offices located in Preston. Services are provided to support people to live independently in the community. During this inspection there were 31 people who used the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing.

Not everyone using Caring Hands Homecare (Fylde and Wyre) Limited receives regulated activity; CQC only inspects the service being 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.

There is 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.

At the last inspection of the service we found breaches of the regulations these were in relation to Regulation 11 HSCA RA Regulations 2014 (Need for consent), Regulation 12 HSCA RA Regulations 2014 (Safe care and treatment), Regulation 17 HSCA RA Regulations 2014 (Good Governance), and Regulation 18 HSCA RA Regulations 2014 (Staffing), and Regulation 19 HSCA RA Regulations 2014 (Fit and proper persons employed).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations. During this inspection we checked to see if there had been improvements at the service. We found all the breaches of regulation had been improved however we found a further breach of Regulation 11 HSCA RA Regulations 2014 (Need for consent) at this inspection.

At this inspection, we found mental capacity had been considered however in two care files we saw the next of kin had signed the consent documentation where the person’s mental capacity had not been considered. People were not always supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the systems in the service did not support this practice.

This resulted in a breach of Regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Need for consent). You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we found care planning and assessment around risk had been improved. We saw people had individualised risk assessments which covered areas such as mobility, nutrition, pressure areas and physical health. However, we found information to guide staff about how to lessen risks to people was not always recorded in detail. We discussed this with the registered manager and the provider during the inspection, who agreed with our findings. We have made a recommendation around this.

During this inspection we found the service had not always worked within best practice guidelines to identify record and meet communication and support needs of people with a disability, impairment or sensory loss. We have made a recommendation about this.

We found staff had received medicines training and felt confident to support people with their medicines regimes. People had support plans around medicines and audits were being completed. We found protocols for ‘as and when required’ medicines were in place for all but one person. We checked the record around the medicines for this person and spoke to staff. Staff were able to tell us how the medicines were to be given safely.

We found people were protected from the risk of abuse because staff understood how to identify and report it. We found people were protected from risks associated with their care because the registered provider had completed risk assessments. These provided updated guidance for staff in order to keep people safe. We found recruitment to be safe. We reviewed staffing at the service and did not find any concerns.

We were able to see staff supervision was taking place. Staff we spoke with confirmed they felt supported in their role. Staff training was ongoing and evidence has been seen of staff completing training.

We found in depth assessments were carried out by the service before any person was accepted, to ensure people’s needs could be met. Peoples needs for nutrition and fluids had been considered. People were supported by staff to live healthier lives. Staff supported people to healthcare appointments and arranged these if necessary.

We received consistently positive feedback about staff and about the care people received. People told us, "The staff are good, really caring." And, “They are very nice; I like the staff as they help me.” Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights.

We saw care records were written in a person centred way. The service is not currently supporting people who were considered end of life. We discussed this with the registered manager and they were aware of best practice guidelines to identify record and meet people’s end of life preferences and wishes.

People told us they were encouraged to raise any concerns or complaints. The service had a complaints procedure.

People were supported by staff with activities to minimise the risk of becoming socially isolated. An example was seen in one person's care file where the person enjoyed an afternoon walk, staff supported them with this.

We saw evidence systems and processes for quality assurance had been developed and put into practice. These systems at present were not always robust and effective. We did discuss this with the registered manager and the provider and improvements have been put in place and require time to embed into practice.

The provider has purchased a quality compliance system to help ensure the policies and procedures they work within were up to date and inclusive of current best practice.

The provider and registered manager had clear visions around the registered activities and plans for improvement moving forward. The management team receptive to feedback and keen to improve the service. The management team worked with us in a positive manner and provided all the information we requested.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

23 August 2017

During a routine inspection

Caring Hands Homecare (Fylde & Wyre) Limited is a domiciliary care service. Caring Hands Group aim to help people live an independent and fulfilling life, whatever challenges they face. They offer services from personal care and companionship, to specialised services for people living with complex conditions.

Caring Hands Homecare (Fylde & Wyre) Limited was newly registered on 27 April 2016. Consequently, this was their first inspection.

The service did not have a registered manager in place. 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.

During this inspection we looked at how the service managed medicines and found the provider's medicines policy and procedures were not being implemented. We spoke with four care workers who all told us there had been no medicines training provided to them by the provider. This meant there was a risk staff would not have the necessary skills, knowledge and competency to administer medicines safely.

We found the service did not take appropriate and effective action to risk assess service users safety and then follow plans to mitigate and reduce risks to service users.

We looked at how people were supported to eat and drink, in order to maintain good health. We found where concerns about people's abilities to eat and drink were identified; referrals had not always been made to external professionals for support and guidance.

The concerns with medicines management and risk management amounted to a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We reviewed personnel records of nine staff members. We found people were not always protected by suitable procedures for the recruitment of staff. We had concerns with all of the recruitment files we looked at. We were not confident the service had followed safe and legal recruitment processes. We raised this with the registered provider and requested they take immediate action to assure staff working at the service were safe.

The concerns we found with recruitment amounted to a breach of regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act 2005 (MCA). We found the principles of the MCA were not consistently embedded in practice. We found people’s capacity to consent to care had not been assessed and decisions had not always been recorded.

The above concerns amounted to a breach of regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

We found staff were not being supported by way of regular and effective supervision and appraisals

We found training was not considered for key areas such as dementia, mental health and sensory impairments. A relative we spoke with told us, “Some of the carers have not been trained; they don’t understand the needs of a blind person. They don’t put things back in the same place so my relative can find them.”

The concerns we found with supervision arrangements and training amounted to a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We reviewed five care files and found current needs were not always identified. Care plan information was not always an accurate, complete and contemporaneous record. We found there was an assessment process; however, in the five care files we viewed this was not always completed fully. The information contained within the assessment did not always ensure staff had a good understanding of people's needs before they started to support them.

We asked the management and registered provider to tell us how they monitored and reviewed the service to make sure people received safe, effective and appropriate care. We found the service did not have a robust quality auditing system.

We reviewed the policies and procedures and found that these were not reviewed and updated regularly. For example, we found the medicines policy had not been reviewed to include the most up to date NICE guidance for medicine in a community setting. Therefore staff did not always have access to up to date information and guidance.

These shortfalls in quality assurance amounted to a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance). You can see what action we asked the provider to take at the back of the full version of the report.

We have made a recommendation about the central recording of accidents and incidents to allow for more robust oversight.

We have made a recommendation about involving people in the care planning process.

We have made a recommendation about the central recording of complaints and concerns to allow for more robust oversight.

People who used the service and staff told us there were enough staff and that visits were not rushed. We looked at how people were protected from bullying, harassment, avoidable harm and abuse. We found the service followed safeguarding reporting systems as outlined in its policies and procedures.

People were consistently positive about the care and treatment they received. Everyone we spoke with, who received care and support, told us they were treated with kindness by the care staff who supported them.

People were supported by staff with activities to minimise the risk of becoming socially isolated. One staff member told us how there was always enough staff on to support with one to one hours, so the person they supported could take part in their chosen activity.

We found all the staff members we spoke with reported a positive staff culture, and staff told us they felt supported by management. We looked at how staff worked as a team and how effective communication between staff members was maintained. We saw evidence of staff meetings being held which allowed for information sharing.

We found the management team receptive to feedback and keen to improve the service. They worked with us in a positive manner and provided all the information we requested.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.