Archived: Assistants at Hand @The Pearn

Assistants at Hand @The Pearn is a domiciliary care agency (DCA). The service provides personal care services to people in their own homes. At the time of our inspection 14 people received 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

Risks to people were not managed safely. There were no established systems in place to monitor the quality of service. Medicines management was not based on current best practice which exposed people to a significant risk of harm and/ or not receiving their medicines as prescribed.

People were not protected against the employment of unsuitable staff as the provider failed to follow safe recruitment practices. Staffing rotas indicated there were sufficient staff to meet people's needs. However, the service did not deploy staff effectively and this had a negative effect on people's wellbeing and on occasions resulted in people not receiving their planned care visits.

Although some people and relatives told us they felt people received safe care, our findings were that people were not safe and were at risk of avoidable harm associated with their assessed care needs. The findings of our inspection identified a culture that was not based on learning. This means if and when things go wrong, the potential for re-occurrence was probable because there was no action taken to review, investigate and reflect on incidents.

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 23 January 2018).

Why we inspected

This inspection was prompted because we received concerns in relation to people's safety and the management and leadership within the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Inadequate based on the findings of 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 Assistants at Hand @The Pearn 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 monitor the service and will take further action if needed.

At this inspection we have identified four breaches in relation to Safety, Recruitment, Staffing and the overall management of the service.

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

Follow up

We will continue to work with the local authority to ensure people's safety. The provider has taken the decision to de register this service.

The overall rating for this service is ‘Inadequate’ and the service / in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

This was the first inspection of the service since it was registered with the Care Quality Commission in May 2016. Assistants at Hand provide personal care and support to people who have general personal care and mental health needs in the Plymouth, Plympton and surrounding areas. The office is accessible to people with mobility difficulties and there are car parking facilities close by. At the time of this inspection Assistants at Hand were supporting 17 people with personal care needs.

There is a registered manager in post who was also the provider. 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 service was a small family run business and the provider was supported by a team leader and administrator and a staff team of 14 inclusively.

The team were committed to providing a high quality effective service to people. They did this by providing very person centred care, supporting staff well, listening to people’s views and looking at ways to continually improve. One person emailed us to say, “[The provider] hand picks all the staff and they are all outstanding. None of them are work shy and they always maximise their time, keeping everything in order.” Other comments included, "They always ask if there is anything else they can do. They even shook my rugs. We have a chat and a cup of tea. They become like family friends.” The relative said they even had a communication book in the home so they could check what had been done or to write down any anniversaries. A care worker said, “The establishment is excellent and to see the outstanding work they all do is amazing. I am a very happy employee looking forward to a bright future with Assistants at Hand.”

People told us they appreciated the visits from staff who were always cheerful and treated them with respect. One relative said, "We were so lucky to find Assistants at Hand. They go over and above the call of duty and take really good care of [person’s name]. [Person’s name] loves them all and they take their time and see the person behind the [medical condition].

Care workers said they enjoyed working for the service. They were well motivated and committed to providing a service that was personalised to each individual. People were fully involved in planning their care and support and care plans were comprehensive to make sure staff had all the information required to support the person. This helped to make sure people received the support they wanted.

There were quality assurance systems which monitored standards and ensured any shortfalls were addressed. People and care professionals felt listened to and said they could speak with a member of the management team or any staff, at any time. Any complaints, including smaller comments and 'grumbles' made were fully investigated formally and treated as learning to enable the service to improve.

People received effective, safe care which met their individual needs and preferences. People told us the service was flexible and made adjustments to accommodate their wishes and changing needs. For example, when people had health appointments or had a health need or just additional shopping requests. Where any concerns were raised about a person's health or well-being prompt action was taken to make sure they received the support and treatment needed. Staff were pro-active in recognising areas of improvement for people, suggesting and advocating for people, contacting health professionals who could further help promote people’s independence.

People were complimentary about the care workers who supported them. People told us staff were kind, caring and respected their privacy and dignity. There were sufficient numbers of staff employed to ensure people received their care and support at times of their choosing. Staff were matched to people’s needs and there was a ‘no stranger’ policy meaning that people never received support from someone they had not met before.

Care workers were well trained and competent in their roles. Staff undertook training in health and safety subjects and received the training and information they needed to meet people's specific needs. Training needs were linked to regular care worker competency 'spot checks' and supervisions.

People told us they felt safe and comfortable with the care workers who supported them and able to discuss any concerns with the office staff.

Where people received support with medication this was well managed and monitored. Staff had been trained in managing medication and records were completed. Care plans showed how staff were to support people in detail and devised following a very bespoke assessment process.

People described the service as reliable, telling us that care workers arrived on time and stayed for the allocated amount of time. The office computer system alerted office staff to any late calls as care workers were required to log in on visit arrival and departure. People told us there had never been a missed call and care workers who came were as expected.

There was a robust recruitment process to ensure people were protected and cared for by suitable staff. Safeguarding training was completed and staff knew how to recognise and report and action any safeguarding issues to protect people.

Further information is in the detailed findings below