Archived: Helping Hands Domiciliary Care Limited

At our last inspection the provider was found to be in breach of Regulation 19 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 improve the key questions of: Is the service Safe? and Is the service Well-led? to at least good.

At this inspection we found that sufficient improvement had been made to say that the breach of regulation had been met.

Helping Hands Domiciliary Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, some of who may be living with dementia. At the time of inspection 60 older people used the service.

There was a manager in post who had registered with CQC. 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 two directors, one of whom was the registered manager, were present throughout the inspection.

The recruitment process had been strengthened to ensure all appropriate pre-employment checks were completed prior to new staff commencing employment.

Risk assessments had been implemented and reviewed where required. They provided staff with sufficient information to manage and reduce risks where possible.

Staff had received safeguarding training and appropriate policies and procedures were in place. Staff were able to explain the action they would take if they suspected abuse.

Medicines had been administered and recorded appropriately. Staff had received sufficient training in this area. The registered manager completed competency assessments to ensure staff had the skills required to manage medicines safely. A robust auditing system was not in place to highlight and respond to any shortfalls.

There was a sufficient number of staff employed. People received support from a consistent team of staff who were familiar with their needs.

Staff had received training and supervisions to ensure they had the skills and knowledge to carry out their roles. Staff were encouraged to develop their skills through continuous training.

People were provided with support which helped them maintain a balanced diet. People were encouraged to remain as independent as possible and their choices were respected by staff.

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. People had signed consent to acknowledge they had read and understood the support they were to receive.

Care plans contained person-centred information which enabled staff to provide support in accordance with people’s wishes.

A complaints policy and procedure was in place. People knew how to make a complaint and were confident any issues would be promptly addressed.

Quality audits had been further developed to ensure they included all aspects of the service. When shortfalls had been identified, appropriate remedial action had been taken.

People, relatives and staff spoke extremely positively about the registered manager and their approach. They had developed an open, honest culture that was respected by all staff. Regular staff meetings had taken place and staff were encouraged to contribute their ideas to further develop the service.

The registered manager was keen to continuously seek feedback from people and relatives to improve the quality of care provided.

Helping Hands Domiciliary Care Limited is based in Malton and provides personal care to people in their own homes within Malton and surrounding areas. The service was registered with CQC in June 2016 and this was the first inspection. At the time of inspection 40 older people used the service, some of which were living with a dementia or receiving end of life care. The two directors, one of whom was the registered manager, were present throughout the inspection.

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.

Robust recruitment procedures were not in place. We found that appropriate checks had not been completed before new staff commenced employment. Staff recruitment records did not always contain full employment histories and gaps in employment had not been explored. References had not been obtained and there was no recorded evidence of interviews taking place.

We judged this to be a breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act (Regulated Activities) Regulation 2014.

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

Procedures were in place to guide staff on the safe administration of medicines and staff had received medicines training. The records we checked showed that people had received their medicines as prescribed. We found that the use of topical medicines was not appropriately recorded. We have made a recommendation about the management of this.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about the different types of abuse and what actions they would take if they suspected abuse was taking place. Any safeguarding concerns had been appropriately managed.

Risk assessments had been developed and were in place for people who needed them. They had been regularly reviewed and updated to ensure they contained the most up to date information. Risks regarding people’s home environment had been identified and appropriate risk assessments were in place.

People told us they trusted the staff and felt very much included in decisions about their care and support. They were supported by a regular team of staff who knew their likes, dislikes and preferences.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005. Staff were aware of the procedure to follow if they suspected a person lacked capacity to make decisions.

There was a process for completing and recording staff supervisions, competency assessments and annual appraisals. Systems in place ensured staff received the induction, training and experience they required to carry out their roles.

Some people were supported by staff with meal preparation. Records and people confirmed that they were given choice and appropriate support was provided in this area.

Care records contained evidence of close working relationships with other professionals to maintain and promote people’s health. People were clear about how they could get access to their own GP and other professionals and staff at the service could arrange this for them.

People usually consented to their care and support from staff by verbally agreeing to it. Records included provision for people to sign, giving their agreement to the support they received. People we spoke with confirmed they had input in their care planning and access to their care records.

People said they were always treated with dignity and respect. Care plans detailed people's needs, wishes and preferences and were person centred which helped staff to deliver personalised support. Care plans were reviewed and updated regularly.

The provider had an effective system in place for responding to people’s concerns and complaints and they were regularly asked for their views. People said they would talk to the manager or staff if they were unhappy or had any concerns.

Staff told us they felt supported by the management and that the manager was approachable. They were confident they would deal with any issues raised. Staff were kept informed about the operation of the service through regular staff meetings. They were given the opportunity to suggest areas for improvement and were recognised for their contributions to the service.

The manager carried out a number of quality assurance checks to monitor and improve the standards of the service. However, the quality assurance processes had not identified our findings with regards to pre-employment checks and recording of topical medicines.

The manager had a good understanding of their role and responsibilities. However, they had not appreciated the importance of safe recruitment processes. We have made a recommendation about the need for governance and quality assurance.