The inspection took place on 9 and 10 October 2018.

24/7 Helping Hands Ltd is a ‘domiciliary care service.’ People receive personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates the care provided, and this was looked at during this inspection. The service provides personal care for older people and younger adults. The registered manager stated that 15 people were receiving a personal care service at the time of the inspection.

This was the second comprehensive inspection carried out at 24/7 Helping Hands Ltd. The last comprehensive inspection was in April 2016 where we rated the service as Good. The overall rating for this inspection was ‘Requires Improvement’ as there were areas that required improvement in the Safe, Effective and Well Led domains.

The inspection was announced because we wanted to make sure that the registered manager was available to conduct the inspection.

A registered manager was in post. This is a condition of the registration of the service. 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.

We identified concerns about a number of issues. A requirement notice has been issued due to a breach of Regulation 17, Good Governance.

Risk assessments were not always comprehensively in place to protect people from risks to their health and welfare.

Management had not carried out comprehensive audits to check that the service was meeting people's needs and to ensure people were provided with a quality service.

Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

Policies set out that when a safeguarding incident occurred management needed to take appropriate action by referring to the relevant safeguarding agency. However, an incident had not been reported to us at the time the service had been aware of them, as legally required.

Staff had largely received training to ensure they had skills and knowledge to meet people's needs, though training on other relevant issues had not yet been provided. Training had not been checked to ensure staff understood care issues. Staff appraisals had not been comprehensive to ensure staff had been providing an effective service.

Staffing was in place to always provide people safe personal care.

People and relatives told us that they thought staff provided safe personal care.

Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

People and relatives told us that medicines had been supplied so that people could take their medicine safely.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. A capacity assessment was in place to assess whether any restrictions on choice were needed in the person’s best interests.

People and relatives told us that staff were friendly, kind, positive and caring. They said they had been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans did not always contain detailed information individual to the people using the service, to ensure that their needs were met.

People and relatives were confident that concerns had been followed up. They were satisfied with how the service was run.

Staff said they had been fully supported in their work by management.

The inspection took place on 12 April 2016 and was announced. We gave the provider 48 hours’ notice because the service is a small home care agency and the registered manager is often out of the office supporting staff or providing care. We needed to be sure they would be in.

24 / 7 Helping Hands is a home care agency supporting people who live in their own homes in the Leicester and Leicestershire. At the time of our inspection 13 people used the service.

The service had a registered manager. 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.

People who used the service were safe when they received care and support. The provider advised them about safety in their home. The provider had a robust recruitment policy and procedure but this was not always followed. Reasons why staff were considered suitable were not recorded.

People’s care plans included risk assessments of activities associated with their personal care routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting people’s independence.

Enough suitably skilled and knowledgeable staff were deployed to meet the needs of the people who used the service. This meant that home care visits were consistently made at times that people expected. Staff arranging home care visits were skilled and knowledgeable about people’s needs and ensured that people were supported by the same care workers.

All staff were trained in how to support people with their medicines. Support was restricted to reminding people when to take their medicines.

People were cared for and supported by care workers who had the appropriate training and support to understand their needs. People who used the service and their relatives spoke about staff in consistently complimentary and positive terms. Staff were supported through supervision, appraisal and training. Staff valued the support that they received.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA. They understood they could provide care and support only if a person consented to it.

Care workers either prepared meals for people or supported people to make their meals.

Care workers received training to help them understand about medical conditions people lived with. They supported people to attend healthcare appointments and to access health services when they needed them.

Care workers were caring and knowledgeable about people’s needs. People were consistently supported by the same care workers. The registered manager had `matched’ care workers language skills with those of people they supported.

People who used the service were involved in decisions about their care and support. They received the information they needed about the service and about their care and support. People told us they were always treated with dignity and respect.

People contributed to the assessment of their needs and to reviews of their care plans. People’s care plans were centred on their individual needs. People knew how to raise concerns if they felt they had to and they were confident they would be taken seriously by the provider. Only one complaint had been received by the service.

People who used the service and staff had opportunities to be involved in the development of the service. The registered manager and care workers were well regarded by people who used the service and their relatives.

The provider had effective arrangements for monitoring the quality of the service. These arrangements placed a high value to people’s feedback which was acted upon. The quality assurance procedures were used to co