About the service: Caring Hands Homecare aims to help people live an independent and fulfilling life, whatever challenges they face. They offer services from personal care and companionship to specialised services for people living with complex conditions. At the time of our inspection the service was supporting 15 people with personal care.

People’s experience of using this service:

People received personalised care which was responsive to their individual needs. Staff had a good understanding of the care and support people required and provided this with care and patience.

People’s care and support had been planned proactively and in partnership with them. People felt consulted and listened to about how their care would be delivered. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had been recruited safely, appropriately trained and supported. People told us their visits were well managed and staff who visited them knew and met their care needs.

People were supported to have access to healthcare professionals and their healthcare needs had been met. The service worked in partnership with other organisations to ensure they followed good practice and people in their care were safe.

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. People told us they had no concerns about their safety whilst in the care of staff supporting them.

The service had a complaints procedure which was made available to people and their family members. People told us they were happy with their service and had no complaints.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek people’s views about the service provided.

Rating at last inspection:

At the last inspection the service was rated requires improvement (report published 05 June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

At the last inspection on 17 and 18 April 2018 we asked the provider to take action to make improvements because we found a breach of legal requirements. This was in relation to the need for consent.

We received a provider action plan and the provider said they would meet the relevant legal requirement by 06 June 2018. At this inspection we found this action had been completed.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

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

The inspection of the service took place 17 and 18 April 2018. The service was given 24 hours' notice prior to the inspection this was done to ensure there would be someone available to speak with us.

Caring Hands Homecare (Fylde and Wyre) Limited is managed from well-equipped offices located in Preston. Services are provided to support people to live independently in the community. During this inspection there were 31 people who used the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing.

Not everyone using Caring Hands Homecare (Fylde and Wyre) Limited receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There is a registered manager at 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 2008 and associated Regulations about how the service is run.

At the last inspection of the service we found breaches of the regulations these were in relation to Regulation 11 HSCA RA Regulations 2014 (Need for consent), Regulation 12 HSCA RA Regulations 2014 (Safe care and treatment), Regulation 17 HSCA RA Regulations 2014 (Good Governance), and Regulation 18 HSCA RA Regulations 2014 (Staffing), and Regulation 19 HSCA RA Regulations 2014 (Fit and proper persons employed).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations. During this inspection we checked to see if there had been improvements at the service. We found all the breaches of regulation had been improved however we found a further breach of Regulation 11 HSCA RA Regulations 2014 (Need for consent) at this inspection.

At this inspection, we found mental capacity had been considered however in two care files we saw the next of kin had signed the consent documentation where the person’s mental capacity had not been considered. People were not always supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the systems in the service did not support this practice.

This resulted in a breach of Regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Need for consent). You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we found care planning and assessment around risk had been improved. We saw people had individualised risk assessments which covered areas such as mobility, nutrition, pressure areas and physical health. However, we found information to guide staff about how to lessen risks to people was not always recorded in detail. We discussed this with the registered manager and the provider during the inspection, who agreed with our findings. We have made a recommendation around this.

During this inspection we found the service had not always worked within best practice guidelines to identify record and meet communication and support needs of people with a disability, impairment or sensory loss. We have made a recommendation about this.

We found staff had received medicines training and felt confident to support people with their medicines regimes. People had support plans around medicines and audits were being completed. We found protocols for ‘as and when required’ medicines were in place for all but one person. We checked the record around the medicines for this person and spoke to staff. Staff were able to tell us how the medicines were to be given safely.

We found people we

Caring Hands Homecare (Fylde & Wyre) Limited is a domiciliary care service. Caring Hands Group aim to help people live an independent and fulfilling life, whatever challenges they face. They offer services from personal care and companionship, to specialised services for people living with complex conditions.

Caring Hands Homecare (Fylde & Wyre) Limited was newly registered on 27 April 2016. Consequently, this was their first inspection.

The service did not have a registered manager in place. 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.

During this inspection we looked at how the service managed medicines and found the provider's medicines policy and procedures were not being implemented. We spoke with four care workers who all told us there had been no medicines training provided to them by the provider. This meant there was a risk staff would not have the necessary skills, knowledge and competency to administer medicines safely.

We found the service did not take appropriate and effective action to risk assess service users safety and then follow plans to mitigate and reduce risks to service users.

We looked at how people were supported to eat and drink, in order to maintain good health. We found where concerns about people's abilities to eat and drink were identified; referrals had not always been made to external professionals for support and guidance.

The concerns with medicines management and risk management amounted to a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We reviewed personnel records of nine staff members. We found people were not always protected by suitable procedures for the recruitment of staff. We had concerns with all of the recruitment files we looked at. We were not confident the service had followed safe and legal recruitment processes. We raised this with the registered provider and requested they take immediate action to assure staff working at the service were safe.

The concerns we found with recruitment amounted to a breach of regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act 2005 (MCA). We found the principles of the MCA were not consistently embedded in practice. We found people’s capacity to consent to care had not been assessed and decisions had not always been recorded.

The above concerns amounted to a breach of regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

We found staff were not being supported by way of regular and effective supervision and appraisals

We found training was not considered for key areas such as dementia, mental health and sensory impairments. A relative we spoke with told us, “Some of the carers have not been trained; they don’t understand the needs of a blind person. They don’t put things back in the same place so my relative can find them.”

The concerns we found with supervision arrangements and training amounted to a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

We reviewed five care fil