UR Hands Care

UR Hands Care is a domiciliary care agency providing personal care to people living in their own homes. The domiciliary care agency provides a service to older people, people living with dementia and people with physical disabilities. At the time of inspection there were three people using the service, all of whom received 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

Risk and consent to care assessments were completed for people; however, some of the records included conflicting information. Medication administration records (MAR) and completion of observations did not always follow the provider’s policy nor best practice requirements. This could have placed people at risk of harm.

The provider’s statement of purpose was not up to date and they were signposted to the CQC website to review this. The provider had improved auditing and quality systems following the last inspection, however, there were still further improvements to be made. We found the provider’s policies were not always reflective of the service provided to people in their own homes.

We have made a recommendation for the provider to review their records and policies.

People and their relatives were positive about the service provided to them and the difference it made to their lives. One relative said, “They [the staff] attend, great continuity which is what we wanted. They have never let us down. They come in singing to [person], they are just lovely! They are a joy. Nothing is too much bother.”

People said they felt safe with the staff. Staff had completed a range of training courses and knew how to respond and keep people safe from harm. There were enough staff and safe recruitment had taken place. Infection control procedures and safe practice was evidenced. The provider demonstrated lessons had been learnt from past concerns.

People’s needs were assessed, and staff had the skills and knowledge to meet them. Staff supported people to access healthcare services and consulted with healthcare professionals as needed.

People told us staff were kind and caring towards them, and assistance was provided in an unhurried manner. Care records were kept securely, and people had access to information in their own homes.

People’s care records were person centred and provided staff with relevant personalised information. People and their relatives told us they were confident to raise concerns and felt action would be taken by the provider. End of life care training had been completed by staff.

People were positive about how the service was delivered and said they were involved in decisions surrounding their care. The provider promoted equality and diversity and was committed to treating people as individuals.

Staff told us they felt supported by the provider and contact had remained consistent during the COVID-19 pandemic. Staff had access to personal protective equipment (PPE), and people told us of the PPE staff used.

People were supported to have choice and control of their lives. Care was provided in the least restrictive way possible and in the best interests of people.

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

Rating at last inspection and update

The last rating for this service was inadequate (inspection undertaken 28 and 30 October 2019. Inspection report published 16 January 2021). There were multiple breaches of regulation and the service was in Special Measures. The provider sent us an action plan to evidence how they met the requirements and communicated with us regularly following the inspection.

This service has been in Special Measures since November 2019. During this inspection (April 2021) the provider demonstrated improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out a comprehensive inspection.

Following our last inspection, we took urgent enforcement action to restrict any further care packages being delivered by the provider. We also required the provider to carry out a number of actions during the month of November 2019. We were provided with evidence of the actions completed which allowed us to monitor the quality of the service being provided to people. During this inspection we noted improvements had been made.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

UR hands care is a domiciliary care service providing personal care to people living in their own houses and flats in the community. The service was supporting 13 people at the time of the inspection.

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

People were not safe because the provider had not assessed risks related to their needs and complex health conditions. People were not supported by a staff team who were sufficiently trained, and peoples care plans offered little to no guidance.

The provider had not ensured that recruitment procedures were safe. People were put at risk of harm because Disclosure and Barring Scheme (DBS) checks had not always been completed, employment references had not always been obtained and many staff members had gaps in employment history. This meant that staff members employed may not have suitable character or skills to care for people.

Peoples were not receiving medicines safely. Specialist medicines for people were being given to people without appropriate guidelines and instruction for staff. As and when required medicines had no guidelines in place for staff to follow and many people’s medicine administration records (MAR) had gaps where people may not have received their medicine with no reason recorded.

Staff competency was not being checked. The management team were not checking if staff were supporting people safely. Staff received training, but the management team were not checking if this training was effective. We found some shortfalls in staff skills and knowledge which the

management team were not aware of.

People's abilities were not assessed to enable them to make their own decisions. People's permission to receive care and support was not sought.

People did not have holistic care assessments and reviews in place to check that they were having a positive experience from the service. The management team were not identifying any areas requiring improvement to the care being delivered.

Care records did not contain any information about people’s choices and personal preferences. There was no information about people’s life history, preferences and cultural needs.

People did not have any end of life care plans in place despite providing care for people at the end of their lives.

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 did not support this practice.

The service did not promote a positive person-centred culture which promoted good outcomes for people. Audits and checks at the service were not effective in identifying where improvements could be made. Feedback was not consistently being collected from people and their relatives to inform and possibly improve the service.

Rating at last inspection

The last rating for this service was good (report published on 04 July 2017). At this inspection the service is now rated as inadequate.

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 with multiple criminal convictions and the provider not having adequate risk assessments in place to monitor staff with such records. A decision was made for us to inspect and examine those risks.

We have found evidence that substantiated some but not all of those concerns. 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 person centred care, safe care and treatment, good governance, staffing, need for consent and fit and proper persons employed.

We have taken urgent action to impose conditions on the provider's registration as a result of our findings. These conditions lay out immediate action the provider was to take in response to the concerns raised at this inspection. A further condition restricts the provider from taking on new care packages without our written consent.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

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

The inspection was announced and took place on 14 and 16 June 2017.

The service had 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 and associated Regulations about how the service is run.

Staff were knowledgeable about the risks of abuse and understood how to respond appropriately to any safeguarding concerns. Risks to people and the environment had been assessed and identified hazards which people may face. They provided guidance for staff to manage any risk of harm.

Staff had been recruited in to their roles safely. Effective recruitment processes were in place and followed by the service and there were sufficient numbers of staff available to meet people’s care and support needs. Staff had undergone appropriate checks before commencing their employment to ensure they were safe to work with people. Medicines were not currently administered as part of people’s care at this time, but the systems were in place to enable this to happen safely should the need arise.

Staff members had induction training when joining the service, as well as regular on-going training. The service had a robust training system that was based upon the specific needs of the people receiving support. Staff also received regular supervision.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People and relatives were happy with the support they received with food and drink. People told us that staff were able to support them with access to health appointments when necessary.

Staff supported people in a caring manner. They knew the people they were supporting well and understood their requirements for care. People told us their privacy and dignity was respected and felt that the provision of care had enabled meaningful relationships to be forged between them and staff.

Care plans had been written with people's involvement to ensure they were reflective of their needs, wishes and preferences and were reviewed on a regular basis to ensure they were accurate and up-to-date. The service had a complaints procedure in place and people knew how to use it. Any complaints made were dealt with appropriately.

People, relatives and staff were positive about the leadership at the service. They felt well supported and were able to approach the registered manager whenever they needed to. Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed.