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Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 January 2019

This comprehensive inspection took place on 13 and 14 December 2018 and was announced. This service 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.

Not everyone using Caring Hands received regulated activity. The Care Quality Commission (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. At the time of this inspection the service provided personal care to 32 people.

The service was run by a single provider who was in day to day control of the service. It was therefore not required to have a registered manager. The provider is an individual 'registered person'. 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 provider was supported to run and lead the service by an office care manager and a community care manager.

At the last comprehensive inspection in April 2016 the service was rated Good for each key question. Was the service safe, effective, caring, responsive and well-led? This led to an overall rating of Good. At this inspection the provider had not maintained this standard and we have rated this service as Requires Improvement. This is the first time the service has been rated Requires Improvement.

We identified one breach of the Regulations of the Health and Social Care Act (2008). This related to the lack of governance and audits completed by the provider. The provider had no formal system to check if staff training equipped them for their role. There were no formal medicines or care record audits. This is discussed in more detail in the well-led section of the report.

We identified two breaches of the Care Quality Commission (Registration) Regulations 2009. The provider had not submitted statutory notifications to the CQC to notify us of the death of a person using the service or of an incident of alleged abuse as required. The provider acted to address these concerns during the inspection.

Staff supported some people with their medicines, as required. The provider gave assurances that they completed competency assessments to assess the ability of staff to deliver this care safely. However, these were not documented. This was not in line with the provider’s policy. Without exception, people and their relatives told us, medicines were administered safely. The provider gave assurances at the time of our visit they would ensure they formalised this process in the future. We have made a recommendation about medicines management.

Staff received training to provide them with the knowledge and skills required for their role. However, the training was limited to what the provider considered to be mandatory. A review was required to determine the appropriateness of the training and the potential impact this may have on staff and people using the service. We made a recommendation about the on-going management and recording of staff training and support.

People were protected from harm. Staff received training and understood how to recognise signs of abuse and who to report this to. Staffing levels were sufficient to provide safe care. The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting. When people were at risk, staff had access to assessments and understood the actions needed to minimise harm. The service was responsive when things went wrong, were open and reviewed practices and had a system in place to manage incidents. People were protected by the service's arrangements for the prevention and control of infection.

People were supported by staff, as needed, with meal preparation and the provision of drinks. People received appropriate healthcare sup

Inspection areas

Safe

Good

Updated 17 January 2019

The service was safe.

Medicines competencies were not documented to demonstrate staff had been observed and assessed to support people with medicines. Medicines were not formally audited. We have covered this in well-led as we found no impact to people’s safety.

People and their relatives told us that they felt safe with the staff that supported them.

Staff undertook training and procedures were in place to protect people from abuse. Staff had a clear understanding of what to do if safeguarding concerns were identified.

There were enough staff working to meet the needs of people who used the service. Staff pre-employment checks had been completed.

People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.

Effective

Requires improvement

Updated 17 January 2019

The service was not always effective.

Staff told us they received good training and support to carry out their role. However, training was limited to what the provider considered as mandatory. We have made a recommendation in relation to this.

People consented to their care and the service operated within the principles of the Mental Capacity Act 2005 to protect people's rights.

People's nutritional needs were reviewed and they were supported to have enough to eat and drink.

Staff knew people well and recognised when they may need to be referred to an appropriate healthcare professional.

Caring

Good

Updated 17 January 2019

The service was caring.

Staff treated people and their relatives with kindness and compassion.

People were treated with dignity and respect by staff who took the time to support their independence.

Staff understood the importance of confidentiality, so that people's privacy was protected.

Responsive

Good

Updated 17 January 2019

The service was responsive.

People's care plans were personalised and contained information on the activities in which they preferred to engage.

People knew how to make a complaint and raised any concerns with the managers if they needed to.

People and relatives were involved in their care plan reviews and all were happy with this involvement.

Well-led

Requires improvement

Updated 17 January 2019

The service was not always well led.

Systems and processes were not in place to audit and analyse the safety and quality of the service provided.

Statutory notifications had not been submitted to the Care Quality Commission.

There was a clear vision and values for the service, which staff promoted.

The provider and staff worked in partnership with other services to help ensure people received effective care.

People's views were sought through regular reviews and annual questionnaires.

We received positive comments about the provider in relation to how supportive they were and their commitment to the service.