We carried out an announced inspection of the service on 14 and 22 December 2017

Caring Hands EM Limited is a domiciliary care agency and provides personal care and support to people living in their own homes. There were 132 people receiving care at the time of our visit. The service was last inspected 9 November 2015 and the rating for that inspection was Good.

We inspected the service due to concern raised by the Local Authority and East Midlands Ambulance Service. There was an on-going safeguarding, which we discussed with the registered manager during the inspection. The registered manager had reviewed the safeguarding issue as far as they were able to with the information available to them.

There was a manager registered with the Care Quality Commission (CQC). 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 told us they felt safe when staff supported them within their home. Systems were in place to monitor and report safeguarding concerns. Staff understood what constituted as abuse and that abuse should be reported. Risks were assessed and reviewed regularly and reflected people’s current needs.

There were sufficient numbers of suitably qualified and experienced staff in place to keep people safe. Safe recruitment processes were in place. There were processes in place to ensure medicines were handled and administered safely.

Staff received sufficient training, regular supervision and felt supported by the management team. The principles of the Mental Capacity Act 2005 (MCA) were considered when supporting people. People were supported and encouraged to follow a healthy and balanced diet. People’s day to day health needs were met effectively by the staff.

People and their families continued to have a good relationship with the staff that cared and supported them. People were treated with respect and dignity by kind and compassionate staff. People received information if they wished to speak with an independent advocate.

Care was planned and reflected people’s needs. People knew how to raise concerns or complaints and were encouraged to do so if needed. The provider followed their procedures to ensure any complaints or concerns were dealt with in a timely manner.

People felt the service was run well, but the geographic of the care routes could be better organised. Staff felt supported by the manager of the service and the registered manager. There were systems in place to monitor the quality of the service. The service was open and transparent.

We have made a recommendation regarding people's call times and the consistency of the calls to people.

The service was inspected on 9 November 2015. The provider was given 48 hours’ notice of the inspection.

The service is a home care agency providing personal care to people living in their own homes. At the time of our inspection 367 people were using 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

People using the service were safe because staff understood their responsibilities to protect people from avoidable harm and abuse. Staff received training to use equipment safely and how to support people with their medicines.

People’s care plans included risk assessments of risks associated with their personal care routines.

The provider had effective recruitment procedures and ensured that all legally required pre-employment checks were carried out. New staff were not allowed to work unsupervised. Enough suitably skilled and experienced staff were deployed to meet the needs of people using the service. This included trying to ensure that people received home care visits at times they expected by care workers that were known to them.

The provider implemented disciplinary procedures when care worker’s conduct fell below the standards expected of them.

Care workers received training that was relevant to the needs of the people they supported. Care workers and other staff were supported through induction, training, appraisal and supervision.

Care workers sought people’s consent before they provided care and support. They understood their responsibilities under the Mental Capacity Act 2005.

People were supported with their meals. Care workers either helped people prepare meals or heated prepared meals for people. People were supported to access health and social care services when they needed them.

The service sought to ensure that people were cared for and supported by a team of core care workers. This enabled people using the service and care workers to develop caring relationships. It also helped care workers develop a better understanding of people’s needs and preferences.

People were involved in decisions about their care and support, including decisions about times of home care visits, which care workers, supported them and how they were supported.

People’s care plans were person centred and focused on their individual needs. People were involved in reviews of their care plans.

The provider sought people’s feedback about their experience of the service. Complaints were investigated and responded to. The provider took action in response to people’s feedback and complaints.

The provider had a `mission statement’ that was shared with people using the service and understood by staff. They had procedures for monitoring that staff practiced the standards expected of them.

The service was well-led and organised. Teams with specific responsibilities coordinated their efforts towards ensuring that the needs of the people using the service were met.

The provider had effective procedures for monitoring and assessing the quality of the service. When areas requiring improvement were identified action was taken to bring about improvement.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was announced which meant we gave the provider notice that the visit would take place.

Caring Hands provides care and support to people in their own homes. At the time of our inspection there were 298 people using the service.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they were happy with, and felt safe with, the care and support provided. They said staff knew about their support needs, treated them with respect and kindness, and maintained their privacy and dignity.

Staff recruitment procedures were robust and ensured that only staff with suitable skills and character were employed. Staff received induction and on-going training to ensure they had up to date knowledge and skills to provide the right support for people. They also received regular supervision and appraisals in line with the provider’s policies.

People’s needs were assessed and plans were in place to meet those needs. People’s wishes and preferences were taken into account and recorded in support plans. Risks to people’s health and wellbeing were identified and plans were in place to manage those risks. People were supported to access healthcare professionals whenever they needed to.

Systems were in place to ensure that there were no missed calls. We were informed that there had been no missed calls in the last 12 months and people we spoke with confirmed this.

The provider had a complaints procedure and we saw that appropriate action had been taken in response to complaints.

There were systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service, their relatives, and staff.

We telephoned ten people to gather their thoughts of the service being provided. All ten were receiving direct care from the service. We were also able to talk to eight support workers and six members of the management team during our visit to the service.

People told us that they had been involved in deciding what help and support they received and that a member of the management team visited them to check that they remained happy with the service provided. One person explained: “A coordinator came and got all the details.”

Care plans and risk assessments had been completed. These showed support workers the actions to be taken to meet each person’s individual needs and the actions to take, to minimise any possible risks associated with the care and support they provide.

People told us that they felt safe with the support workers who cared for them and they knew who to talk to if they were unhappy about the service they received. One person explained: “I do feel safe with them and it’s nice to think that someone is coming in at night.”

An appropriate recruitment process was in place and support workers were not allowed to work alone in the community, until the appropriate checks had been carried out.

Monitoring systems were in place including the use of quality surveys. This provided people with the opportunity to share their thoughts on the support they received and enabled the management team to monitor the quality of service being provided.

As part of this follow up to the review of compliance carried out on 5 December 2012, we visited Caring Hands EM Limited and looked at the records for four people new to the service. This was to see whether improvements had been made to the risk assessment process. We were also able to speak with two people who were using the service over the telephone. This enabled us to find out whether they were happy with the service they were being provided with.

Records checked showed us that the appropriate processes were being followed to ensure that whenever possible, people were kept safe. Risk assessments had been completed in a timely manner and actions had been taken to minimise any risk to both the person using the service and the support worker providing the service.

People spoken with confirmed that someone from the service had visited them at the start of their care package commencing, to carry out the appropriate risk assessments and they told us that they were satisfied with the care and support that they had received so far. One person told us: "The carers are very good, they treat me very well:” Another explained: “They come at a time that suits me, it is going very well.”

We telephoned four people to gather their thoughts of the service being provided. Two were receiving direct care from the service and two were relatives of a person receiving care. We were also able to talk to six members of the staff team during our visit to the service and two care workers were spoken with over the telephone.

We were told that people were involved in deciding what care and support they needed and we found that initial assessments of their care needs had taken place. One person told us, “Someone visited me to see what I needed.” Another person explained, “They came and asked me questions and we discussed what I could and couldn’t do for myself.”

People told us that they were very satisfied with the support they received and that the care workers who visited them, treated them with dignity and respect at all times. One person explained, “The carers always treat her with respect, they are lovely.” Another told us, “I am absolutely satisfied, they put him at ease, you should have seen them this morning, they were both singing away!”

We were told that people felt safe with the care workers who supported them and the care workers had all received training in the safeguarding of adults. One person told us, “I feel safe with them, I have the same ones four times a day.” Another explained, “I trust her completely, in every way, I feel safe and secure with her.”

We telephoned six people to gather their thoughts of the service being provided. Two were receiving direct care from the service and four were relatives of people receiving care. We were also able to talk to three support workers and two care coordinators during our visit to the services’ office and a further three support workers were spoken to on the telephone.

People told us that they were treated with respect and their care and support was provided in a personalised and dignified manner. One person explained, “They are very good, they know he can’t move very well, they talk to him and take their time and they sense when he’s not so well.” Another person told us, “They understand his dementia and he responds to them well.”

We were told that people felt safe with the support workers who supported them. One person told us, “I trust them 100%; I don’t worry at all when I’m not there.” Another person explained, “I feel safe, they treat me very well.”

We were told that on the whole, people received regular support workers. One person explained, “We get regular carers most of the time, I know them all now.” Another person told us, “We get regular carers, about four different ones, but one in particular comes quite a lot. “ One person spoken with did feel that they didn’t always receive regular carers, they explained, “You get all sorts, it does bother you sometimes, because they don’t know how to make a bed.”

People told us that, on the whole they were satisfied with the care and support they were receiving. One person told us, “We are satisfied with the support they are getting, they are helping mum, because they are helping dad.” Another person explained, “I am very satisfied, they do everything I need and more.”

Support workers told us that they very much enjoyed working for the service. One support worker explained, “At the end of the day, I feel I have done something good, I enjoy caring.” Another support worker told us, “I love it, I love my job.”