Caring Hands (Care Services) Limited

Caring Hands (Care Services) Ltd is a domiciliary care provider based in Tibshelf. They provide personal care to people living in their own homes in the surrounding villages, so they can live as independently as possible. At the time of our inspection 33 people were using the service. 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

There were enough staff to effectively meet the current packages of care for people’s needs. People were supported by staff who had the knowledge and skills to ensure they were safe from harm. Risk assessments had been completed, to assess and reduce any risks associated with the required support. Staff were recruited in line with best practice. The provider had reflected on any incidents and lessons had been learned.

People were supported by a regular team of care staff, people said they usually received their calls on time. Where people received assistance to take medicines, records were kept so this was done safely. When people required assistance to eat or drink, the provider ensured this was planned to meet their preferences and their current assessed need. People had support when required, to liaise with healthcare professionals to ensure they remained well.

People had developed caring relationships with staff, and people told us they treated them with respect. People were appreciative and spoke fondly of staff who provided their care. The provider had developed good working relationships with other health and social care professionals to support the needs of people using the service.

There were systems in place to further monitor and drive improvement through auditing. People were involved in their care and were asked for feedback. This helped to support the development of the service. There was a complaints procedure and any received were investigated and responded to.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported his practice.

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 25 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

We carried out this inspection on 10 April 2017. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure the registered manager, or someone who could act on their behalf, would be available to talk with us.

The last inspection was carried out on 18 September 2015, where no concerns were identified and the service was rated good overall.

A registered manager was 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 2008 and associated Regulations about how the service is run.

Staff were appropriately recruited, trained and supported. They had undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. Communication was effective and regular meetings were held to discuss issues and share best practice. Staff understood their roles and responsibilities and spoke enthusiastically about the work they did and the people they cared for.

The provider had detailed policies and procedures relating to medicines management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicines training was updated appropriately.

Staff knew the people they were supporting and provided a personalised service and used effective systems for gaining consent. Individual care plans, based on a full assessment of need, were in place detailing how people wished to be supported. This helped ensure that personal care was provided in a structured and consistent manner. Risk assessments were also in place to effectively identify and manage potential risks.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Systems were in place to effectively monitor the safety and quality of the service and to gather the views and experiences of people and their relatives. The service was flexible and responded positively to people’s changing needs and any issues or concerns raised. People and their relatives told us they were confident that any concerns they might have would be listened to, taken seriously and acted upon.

We completed a responsive inspection of Caring Hands because of concerns we received about aspects of practice at the service. The CQC do not investigate individual complaints but we looked at whether effective systems were in place to protect the welfare and safety of people receiving care.

Below is a summary of what we found.

Is the service safe?

We found that enough staff were provided to meet people's care needs at the service.

Although assessments and care plans were in place, the provider was not fully ensuring risks to peoples' welfare and safety were identified and managed. Care plans did not always contain information about the care that staff were actually giving and risks were not always identified promptly and appropriate action taken for the planning and delivering safe care. Although a care coordinator was able to tell us how some incidents and concerns had been responded to, there were no effective systems to show whether this always happened; what had been done in response to incidents or how any risks had been reviewed or reduced.

Systems for managing people's medication were not protecting them from risks. This was because there were no detailed plans about what support people needed with medication and records were inaccurate and incomplete.

The registered managers were able to describe who they would contact with concerns about neglect or abuse. Although the training staff received included all relevant information, two staff we spoke with were not aware of the correct procedure for recording allegations or concerns about the safety of people receiving care.

We met with the provider on 21 August 2014 and one of the registered managers told us they had delivered more training to staff and reinforced the need to use correct procedures where there were concerns about abuse or neglect. We also saw that arrangements for the safe administration of people's medication were being improved.

Is the service effective?

Care plans were in place at the service that covered different areas of people's care needs. Some care plans included detailed assessments, including about moving and handling. Records about people's care needs did not contain sufficient guidance for staff about any diagnosed health conditions or disabilities to ensure they were alerted to risks and people's care effectively met their needs.

Is the service caring?

People told us that they were happy with the staff that provided their care. One person told us, 'I would employ all of the carers.'

Care plans were in place but were brief and focussed on care tasks that would be completed by staff. Care planning did not provide detailed information about how people's care was actually delivered to ensure they received personalised care that met their individual needs and preferences.

Is the service responsive?

Systems were in place for obtaining people's views about the service provided and people were contacted regularly to give feedback about their care. Staff we spoke with said team meetings were held to allow them to discuss the quality of practice at the service.

We found complaints and comments about the service were not properly recorded including a record of how they were responded to.

Is the service well-led?

The registered managers did not have an effective system for identifying and managing risks or provide an overview of current concerns or areas of development at the service. Although we saw on-call records that showed incidents had occurred that could cause harm to people using the service, there was no system for recording or analysing these.

Care plans we saw had not been updated to take account of incidents that had occurred in order that risks could be managed effectively.

We met with the provider on 21 August 2014 and saw that systems were being introduced to record and review incidents that occurred at the service.

The registered managers had not notified the CQC of three deaths that had occurred in the presence of staff from the service, as required by law.

The people we spoke with felt that most support workers were competent and did a good job. One person said, 'Can't fault them. If it weren't for them I wouldn't be here now.' Those people who required assistance from staff in administering their medicines were satisfied with the way their support workers managed this. Many people told us that support staff did not rush them and stayed for the agreed length of time.

People's views on the service they received were being sought by the agency and these views were acted on. We saw records which showed that people were being sent annual satisfaction questionnaires and regular telephone call surveys were made.

We spoke with three staff members who told us that they received regular supervisions and training opportunities and that they felt well supported in their roles. One member of staff told us "with this company you are an individual person not just a number" and "the care that people get is fantastic".

We found that needs of people using the service had been assessed and a care plan put in place to meet those needs. We saw that peoples care plans included information about their preferences.

We found that the provider had responded appropriately to allegations of abuse. We saw that staff received regular supervision and spot checks and that they were supported to achieve relevant qualifications. We found the provider had identified risks to the health, safety and well being of people using the service and others involved.