Hands of Compassion Care Ltd

Hands of Compassion is registered with the Care Quality Commission as a domiciliary care agency. It provides the regulated activity of personal care to adults living in their own homes, including older people and people with dementia. At the time of the inspection there were 8 people using the service.

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’s experiences of the service were directly impacted by widespread and significant shortfalls in service delivery.

People’s levels of satisfaction with the service were mixed as they did not always receive consistent, timely care and support from familiar staff who understood their needs. Most people did not have a regular carer and some staff were task focused only providing 14 or 16 minutes of support during a 30 minute call. As a result only half of the people and relatives we spoke to said they would recommend the service to others.

Governance processes remained ineffective in identifying potential risks. Lessons had not been learned which had resulted in the same shortfalls found at the inspection in July 2022 being found at this inspection, a year later. These shortfalls were: Staff did not have guidance to ensure people with specific health needs such as catheters remained healthy. People were at risk of not receiving their medicines as prescribed as the provider was not following safe practices in administration. Staff recruitment processes were not robust due to gaps in employment having not been explored.

When shortfalls had been identified action had not been taken to make the necessary improvements to ensure quality of care. Surveys in May 2023 had identified that action needed to be taken to improve communication. However, there was no evidence of any steps that had been taken to address this shortfall.

Staff continued not to be adequately trained nor have all the skills, knowledge or competency required for their roles. Staff had not received practical training in how to move people safely despite the provider informing us in their action plan, after the last inspection, that this was being addressed. Staff relied on other untrained staff showing them how to move people and manage their medicines which had resulted in people using unsafe practices including the secondary dispensing of medicines. One staff member could not speak English to a sufficient level to discuss their training and another staff member who supported people was not listed as having had any training.

The provider had not met their responsibilities and legal requirements in regularly submitting reports in sufficient detail, as they were required to in their condition of registration. Nor had they notified us of their provider and location change of address.

People were usually 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 this practice.

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 Requires Improvement (published 15 February 2023) and there was a breach of regulation 18 (Staffing). The provider completed an action plan after the last inspection to show what they would do and by when to improve with regards to regulation 18 (staffing). At this inspection we found the provider had not done all the things that they said they had done. The provider remained in breach of regulation 18.

The provider has a condition on their registration due to a continuous breach of regulation 17 (Good governance). These conditions are the registered provider must send monthly reports to the Care Quality Commission. These reports must include the results of audits and actions taken for the management of medicines, care plans, risk assessments, missed calls and accidents and incidents, the oversight and implementation of mental capacity assessments, recruitment records and staff training and competence. The provider had not always sent these reports in sufficient detail, nor on a regular monthly basis.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hands of Compassion on our website at www.cqc.org.uk.

Enforcement

We have identified a continuous breach with regards to staff training and inadequate monitoring of service quality. In addition we have identified a new breach due to shortfalls in staff recruitment, the management of medicines and assessing risks.

We will continue to require the provider to send monthly reports as set out in the condition of their registration.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This is the third time this service has been in rated ‘Inadequate’ and 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 of their 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.

Hands of Compassion is registered with the Care Quality Commission as a domiciliary care agency. It provides the regulated activity of personal care to adults living in their own homes, including older people and people with dementia. At the time of the inspection there were 12 people using the service.

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

The provider's governance systems were inconsistently carried out and did not highlight shortfalls identified at our inspection. The provider did not take action in a timely manner to address shortfalls identified in their quality monitoring processes. Although improvements had been made in a number of areas, there remained continued shortfalls in governance and staff training. Staff who were responsible for moving people with the use of equipment had not received face to face practical training, nor had their competency assessed. The provider did not view this as a safety concern.

Improvements had been made in the recruitment of staff through carrying out necessary checks to ensure staff were suitable. However, the provider continued not to follow their own recruitment policy and only did so once this had been brought to their attention.

There had been improvements in assessing potential risks to people’s health and wellbeing. However, we made a recommendation with regards to ensuring the safety and maintenance of equipment used by staff.

The management of medicines had improved as staff were trained and their competency had been assessed. However, there was room for further improvement in clearer recording of when staff prompted or administered medicines for people.

There had been improvements in protecting people from the risk of abuse. All, but 1 senior staff had received safeguarding training and staff had access to the provider’s safeguarding policy.

People had been asked for their views, but this feedback had not been analysed to ensure their feedback was acted on. People and relatives were positive about the support provided and all said they would recommend the service. A relative told us, “Yes, very much I would recommend them and have done so. No changes needed. They are lovely and wonderful and super. They are like family friends. There is laughter and chatter. So friendly and helpful and accommodating.”

People's care records reflected their needs and set out the actions staff needed to help keep people safe. There was also clear guidance for staff about each person’s health needs and oral health care.

People were supported to have maximum choice and control of their lives and staff did supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, there had been a delay in the provider checking the legal status of people's representatives when making decisions on their behalf.

Staff support had improved due to improved communication, senior staff taking a more active role and formal staff supervision.

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 (published 18 November 2022) and there were continued breaches of regulation 12 (Safe care and treatment) regulation 17 (Good governance) and regulation 19 (Fit and proper persons employed). We issued a requirement with regards to regulation 11 (Need for consent), regulation 13 (Safeguarding service users from abuse and improper treatment) and regulation 18 (Staffing). We issued warning notices with regards to the breaches of regulation 12 and 19.

After the publication in December 2020 of a previous inspection to the service, we had placed conditions on the providers registration for the breach of regulation 17 (Good governance). These conditions were that the registered provider must send monthly reports to the Care Quality Commission. These reports must include the results of audits and actions taken undertaken for the management of medicines, care plans, risk assessments, missed calls and accidents and incidents. We added additional conditions of the providers registration after our last inspection published in November 2022. This was that the provider’s monthly reports must also include audits undertaken in relation to the oversight and implementation of mental capacity assessments, recruitment records and staff training and competence.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of regulations 11, 12, 13 and 19. This was with regards to consent to care, safe care and treatment, management of medicines, safeguarding and staff recruitment. However, we found the provider remained in breach of regulations 17 and 18 in respect of governance and staff training.

This service has been in Special Measures since 2 September 2022. During this inspection the provider demonstrated that improvements have 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 prompted by a review of the information we held about this service. We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

When aggregating ratings with those from a previous inspection add the following wording. Note, ratings cannot be aggregated with ‘inherited ratings’ awarded to a predecessor location. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hands of Compassion on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to ensuring staff receive the training and induction they need to carry out their roles and monitoring the quality of the service.

We will continue to require the provider to send monthly reports as set out in the condition of their registration.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hands of Compassion is a domiciliary care agency. It provides personal care to adults living in their own homes, some of whom are living with age related frailty and dementia. 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. At the time of our inspection, staff supported 10 people with personal care.

People’s experience of using this service and what we found

People’s associated health risks were not always appropriately assessed. People’s care records did not reflect their needs, staff told us they relied on people to tell them what support they required. Risk assessments for people who required support with pressure area care were not in place and their care records were vague. One person had sustained a pressure injury, healthcare professional guidance had not been included in the care plan to inform staff on how to support them with position changes to relieve the pressure and promote healing of their wound. Risk assessments had not been completed for people who had catheters in place or for people who required support with moving and positioning.

People were always not protected from the risk of being supported by unsuitable and untrained staff. The provider’s recruitment policy was not followed; staff were deployed before recruitment checks had been carried out and appropriate training had been given. Staff did not receive ongoing supervision and training to ensure they were following best practice.

People were not always protected from risk of abuse; The registered manager had failed to ensure staff had received safeguarding training and had access to the relevant policy. The registered manager had failed to recognise an incident as a safeguarding concern and had not reported the concern to the local authority.

People’s care records did not include health care professional’s advice or contact information for staff to raise concerns in the event of complications. For example, there was no information on who staff could escalate concerns to for one person who had a catheter.

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. Mental capacity assessments were not always carried out, the provider failed to check the legal status of people’s representatives when making decisions on their behalf.

People were not always asked for their views and their feedback was not always acted on. The provider’s governance systems were inconsistently carried out and did not highlight shortfalls identified at our inspection. The provider had failed to sustain and make improvements to the service following previous inspections.

People told us staff were kind and considerate. Comments included, “They have been very kind and supportive, they have done what I want, and what I need.” And, “The carers are excellent, very friendly, kind and useful.”

People spoke highly of the registered manager and told us they were confident complaints would be handled efficiently. One person told us, “I know I could complain to [registered manager]. I speak to all the staff who come in, they are very friendly, anything small I can speak with them, but I wouldn’t call it a complaint.”

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 requires improvement (published 24 December 2020). There were continued breaches of regulation 12 (Safe care and treatment) and regulation 17 (Good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations 12 and 17 for the third consecutive time and further breaches of regulations have been identified.

As a result of our inspection of 22 January 2020, we placed conditions on the providers registration for the breach of regulation 17 (Good governance). These conditions included the registered provider must a send monthly report to the Care Quality Commission. The report must include the results of audits and actions taken undertaken for the management of medicines, care plans, risk assessments, missed calls and accidents and incidents. The provider had not always complied with this condition since the last inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook this focussed inspection to check the progress of the action plan. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hands of Compassion Limited on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people from risk of abuse, assessing risks to people, medicines management, implementation of the Mental Capacity Act 2005, staff recruitment, staff training and supervision, and good governance at this inspection.

We issued two Warning Notices. The provider failed to ensure the safe care and treatment of people. The provider failed to ensure fit and proper persons were employed to support people with a regulated activity. The provider is required to be compliant by 25 September 2022.

We served a Notice of Decision on the registered provider. They are required to supply monthly submissions to CQC in relation to compliance with governance of the implementation of mental capacity assessments, staff recruitment, staff training and the competency of staff.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

People’s experience of using this service and what we found

Feedback from people and their relatives about the service was positive. Comments included: “They have some wonderful carers.”, “I like them all. They are all very kind.” And, “They have got to know me well. I am quite happy with everything.”

There had been areas of improvement since the last inspection. However, we found there were still areas where further improvement was needed.

Medicines management needed improvement to ensure that medicine administration records provided clearer information for staff. Some risks assessments continued to be missing important information relating to people’s needs and health conditions, although staff now had a better understanding of the risks to people. People had not been offered the opportunity to express any preferences about care at the end of their life. We made a recommendation about end of life care planning.

Checks on the quality of the service through auditing had been undertaken. However, these audits had not identified the concerns we found during the inspection.

People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible and in their best interests. However, the systems in the service did not always support this practice. Care staff understood the principles of the mental capacity act and offered people choices. However, people’s records for consent and capacity were not always complete.

Staff had been recruited safely. There was enough staff to support people and missed and late calls were no longer a concern. Staff were provided with appropriate PPE and people told us staff used this when providing them support. A new system to monitor incidents and accidents had been implemented and incidents were reviewed to ensure that actions had been taken and lessons were learnt.

Staff had undertaken training to enable them to provide care to people. Staff competencies had been checked to ensure staff were following the correct procedures for medicines and manual handling. People’s needs had been assessed and best practice tools had been introduced to improve assessments. Where people needed support to make meals or drinks this support was provided.

Feedback about the staff was positive and people told us staff were kind to them. Staff supported people to maintain their dignity when undertaking personal care tasks such as washing. There was clear information in people’s care plans on what tasks they could undertake for themselves to promote people’s independence. People told us staff listened to them about how they wanted their care to be provided.

Care plans had been improved and were now more person-centred including information on people’s likes and preferences. People’s communication needs had been assessed and there was information for staff on how to support people with communication when this was needed. People and their relatives knew how to complain. Complaints were responded to in a timely way.

Communication had improved. People, their relatives and staff were positive about communication with the office. Staff surveys and surveys for people had been introduced to provide an opportunity to feedback thoughts and opinions. Staff told us they felt supported in their role. The provider had oversight of staff performance and undertook spot checks to ensure staff were following correct procedures and practices. The provider attended learning events to improve their understanding and knowledge and share best practice.

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 (published 11 August 2020).

As a result of our findings we placed conditions on the providers registration for the breaches of regulation 12 Safe Care and Treatment and regulation 17 Good Governance. The conditions were the provider must not accept any new packages of care without the prior written agreement of the Care Quality Commission. And, the registered provider must a send monthly report to the Care Quality Commission. The report must include the results of audits and actions taken undertaken for the management of medicines, care plans, risk assessments, missed calls and accidents and incidents. The provider has complied with these conditions since the last inspection.

For the breaches of regulations 9, 10, 11, 13, 16, 18 and 19 we issued requirement notices. The provider completed an action plan after the last inspection in relation to the requirement notices to show what they would do and by when to improve.

At this inspection enough improvement had not been made in some areas and the provider was still in breach of regulations 12 Safe Care and Treatment and regulation 17 Good Governance.

This service has been in Special Measures since 06/04/2020. During this inspection the provider demonstrated that enough 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 have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Responsive 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hands of Compassion Care Ltd on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hands of Compassion Care Ltd is a domiciliary care service providing personal care to six 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

Feedback about the service was mixed. Some relatives and people were positive about the service. However, others raised concerns such as staff attendance, consistency and the lack information in care plans.

The service was not well managed. The providers did not attend events to keep up to date with best practice and would benefit from doing so and from engaging in relevant learning. Systems and processes were not effective and had not always identified concerns and driven change. Communication needed to be improved and the provider had not sought feedback from people and their relatives.

Risk assessments were not always in place or did not contain the information staff needed to keep people safe. This meant there was a risk staff, particularly new staff, would not know how to support people safely. Good practice was not always followed, for example infection control needed to be improved. Medicines were not well managed, and the support provided to people with their medicines needed to improve.

Incident reporting and investigations were not effective, and the actions planned to reduce the risk of re-occurrence had not always been undertaken. The investigation of incidents had not included assessing if abuse had occurred. Staff training needed to be improved. Some staff had not always undertaken safeguarding training or training in medicine administration. Staff fed back that the induction could be improved, and they would have liked to have undertaken a longer period of shadowing before working alone.

Staff had not always been recruited safely as appropriate references had not always been sought in line with the providers own policies. Staff had missed calls which meant people were left without the support they expected. Staff did not always stay the full length of calls. The provider had recently made changes to the staffing to address this. However, at this inspection was not able to determine if this had been effective in reducing the risk that calls would be missed in future.

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. There was a lack of understanding of the principles of the Mental Capacity Act and there was no evidence decisions were made in line with these principles.

The providers had not worked in partnership with health professionals and had not always sought information on professional recommendations when they had been made.

Support to maintain people’s dignity could be improved. Some language used in daily notes was not respectful. The provider had failed to identify this and provide staff with guidance to modify language used. There was a lack of information in care plans about what people could do independently for themselves. Staff had not always taken the time to sit and talk to people once tasks had been completed to support people to ask questions and express their views.

Care plans were not person centred and relatives and staff told us they needed to be improved. The complaints system was not effective and did not enable the provider to review trends. Where complaints had been made by relatives, they were not always happy with how they were responded to and concerns had arisen again.

Where people were supported with meals and drinks, they were happy with the support provided. People told us staff were kind and caring.

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

Rating at last inspection

This service was registered with us on 04/03/2019 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date the service was registered.

Enforcement

We have identified breaches in relation to safe care, good governance, person centred care, consent, recruitment, staff training and managing safeguarding and complaints.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.