Caring Hands (Care Services) Limited provide personal care and support to disabled adults who need care in their own homes. The service is run from an office in Tibshelf and they provide care to people in the surrounding villages.

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.

Caring Hands (Care Services) Limited provide personal care and support to disabled adults who need care in their own homes. The service is run from an office in Tibshelf and they provide care to people in the surrounding villages. We carried out this inspection on 18 September 2015. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure that the registered manager would be available to support our inspection, or someone who could act on their behalf.

At our last inspection of this service in July 2014, we found that the provider did not have appropriate arrangements for the management of medicines, safeguarding people and quality assurance monitoring. These were breaches of Regulations 18, 11 & 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond with Regulations 11, 12 and 17, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection, the provider told us about the action they were taking to address this and at this inspection we found that the required improvement had been made.

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.

People spoke positively about the service they received. They told us they were well cared for and felt comfortable and safe with the staff who provided their support. One person told us “I’m much blessed with my carers and I wouldn’t like to be without them.”

Staff were appropriately recruited, trained and supported. They had all 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 medicine management.

Staff understanding and competency regarding medication handling was subject to regular monitoring checks and medicine training was updated appropriately.

Staff knew the people they were supporting and provided a personalised service. 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.

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 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.

Caring Hands (Care Services) Limited provides personal care to people in their own homes. Care and support is provided to older people, some of whom have dementia, and also people with physical and other disabilities. As part of the inspection we spoke with the registered managers, care coordinator and staff working at the service. We also spoke with people receiving care and examined records relating to the service provided.

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.

We received the views, by telephone, of 22 people who use the service. They thought their needs were understood by their support workers. One person said of staff, “They do understand me…we have a good rapport.” Records showed that support workers were aware of people’s needs and the potential risks to which they were exposed. However, many people were concerned by workers’ timekeeping and lack of communication from the agency.

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 six people who used the service or their representatives. They all spoke very highly of the standard of the care that they received. One person told us "The girls are lovely" and another person told us "You do get different staff but I think they're all very good".

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.