We undertook this focused inspection to assess the level of risk to people who used the service following information of concern we had received. Concerns included the safe care and treatment of people using the service, and the management of the service. Care at Hand Limited provides personal care to people in their own homes. At the time of inspection 100 people were using the service.

This report only covers our findings in relation to the location being safe and well-led. You can read the report from our comprehensive inspection carried out 10 November 2016 by selecting the ‘all reports’ link for Care at Hand Limited on our website at www.cqc.org.uk. In the comprehensive inspection Care at Hand was meeting the standards and had been rated as ‘Good’.

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.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Risk assessments were in place for people using the service. Risk assessments in place were reviewed and updated regularly. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

There were sufficient numbers of care staff available to meet people’s care needs and people received their medicine as prescribed. However, we did receive mixed feedback about reliability of timings of visits. We have made a recommendation about improving systems for recording late visits and last minute changes.

The provider had a robust recruitment process in place to protect people and staff had been recruited safely. Staff had the right skills and knowledge to provide care and support to people.

The registered manager was visible in the service and worked well together with the team. People were well cared for by staff who were supported and valued.

Management systems were in place to check and audit the quality of the service.

This announced inspection took place on 10 November 2016.

Care at Hand provides a domiciliary support service to enable people to continue living at home. The service predominantly supports older people although some adults with a range of support needs arising from physical or learning disabilities are also provided with a service. When we inspected the service provided support with personal care to upwards of 100 people living at home in and around the Harlow area.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were supported in their own home by staff that were able to meet their needs safely. Staff had the skills and knowledge they needed to provide people’s care. People said they felt cared for safely in their own home. There were risk assessments in place to reduce and manage the risks to people’s health and welfare. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

People benefited from receiving a service from a staff team that knew their job. Staff were supported by a registered manager that was receptive to ideas and committed to providing consistently good standards of care. People also benefitted from receiving personal care and support from trained staff that were caring, friendly, and responsive to people’s changing needs. People’s right to make day-to-day choices about how they preferred their care and support to be provided was respected and this was reflected in their agreed care plans.

People received a reliable service that was well-led. There were sufficient numbers of staff employed to meet people’s assessed needs. People were protected from the risks associated with the recruitment of staff unsuited to the role by the provider’s recruitment procedures.

People had the guidance they needed to raise concerns or make a complaint. There were procedures in place to ensure complaints were appropriately investigated and action was taken to make improvements to the service when necessary. There were systems in place to monitor the quality of the service provided on a day-to-day basis as well as longer term.

This was a follow up inspection as when we inspected Care at Hand on 3 October 2013 we found them to be non compliant with management of medication. During our inspection we reviewed training records, minutes of meetings, policy's. We looked at seven care records and three medication administration charts. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? This is a summary of what we found;

Is the service safe?

The management of medication falls into this category, we found the service had put systems in place to safely support people with their medication.

During the course of our inspection, we spoke with 12 people who used the service, two relatives and a support co-ordinator.

A majority of people we spoke with said that they consented to their plan of care and treatment. One person said, "I, and my [relative] were fully involved alongside Social Services and the hospital.” However, another person stated, “Nobody asked me it was just put in place a long time ago. I am happy with the provision and I suppose I am happy with the times.”

We asked people if they were treated in a way that reflected their individual needs. One person replied, “I am happy with most of my care, especially when they take me for my weekly shopping..." However, another person said, "No I am not. I have used this agency for a number of years now and things are getting worse."

We found that care plans were relevant to people's needs. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had regard to comments and complaints raised by people who used the service. One person told us, “I feel safe now but had a problem in the past which was dealt with.”

We spoke with one person who used the service and five relatives of people who used the service. All of the people that we spoke with had positive things to say about the care that they or their relatives received.

They all said that they, or their relatives, were involved in the care. One relative explained, "They talk to [my relative]. [My relative] can't speak but [they've] got a sense of humour. They're always laughing and joking with [my relative] and I get on well with them as well."

A person who used the service said, "Although I'm disabled, I can still do things myself. We work together.” This reflected how people were involved in their care.

A relative said, "They are very good...very pleased with them. On Wednesdays I asked for an early morning call so that [my relative] can go to the Parkinson's club. All the carers are very helpful."