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Inspection carried out on 28 October 2019

During a routine inspection

About the service

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 substantiate 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

Inspection carried out on 14 June 2017

During a routine inspection

UR Hands Care is a domiciliary care agency which provides personal care to people in their own homes to enable them to maintain their independence. At the time of our inspection five people were receiving support with live in care or personal care.

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.