The inspection took place on 17 November 2016 and was an announced inspection.

The service provides personal care to people living either in their own home or the home of a family member. At the time of the inspection, approximately 150 people used the service and a registered manager was not 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 and associated Regulations about how the service is run. The registered provider told us the acting manager had recently completed additional training and would be applying to become the Registered Manager.

People told us they felt safe around staff and with staff in their homes. People were supported by staff they were familiar with and who attended their calls regularly. People had the correct number of staff they expected for their call and staff attended on time. Staff understood the health conditions people lived with and how they needed to be kept safe. Staff also understood what they should do if they suspected a person was at risk of abuse. Staff underwent recruitment processes that included background checks so that the registered provider could assure themselves of their suitability to work at the service. How people received their medicines was reviewed regularly to check that people received their medicine correctly and that staff understood how to help people.

People were supported by staff that had access to training and supervision so their performance was monitored. Staff had regular access to training that included training on ensuring staff understood the importance of obtaining a person’s consent. People were included in discussions about the meals staff prepared for them and staff sought additional medical help from other professionals such as the GP or district nurse where this was appropriate.

People knew the staff supporting them because the same staff regularly attended their calls. Staff involved people in making day to day decisions about their care. Staff understood what it means to care for someone with dignity and respect. People felt respected by care staff and that their home and possessions were also respected.

People understood how to make a complaint although they did not always choose to. People spoke with managerial staff to ensure their needs were known and regularly updated so that their care met their expectations. The registered provider had a complaints process should people decide to complain.

Although the registered provider did not have a registered provider managing the service, they had taken steps to appoint a manager and support them to initiate the formal registration process. The registered provider worked closely with the manager to review the quality of people’s care.

The registered manager and registered provider worked together on a daily basis to ensure staff understood the registered provider’s expectations of running the service. People understood how they could contact the admiration office to make changes to their care and felt assured that their care needs would be met.

During our inspection we spoke with the manager and three office based staff members.

After the inspection our expert-by-experience contacted 30 people who used the service by telephone, to capture their views about the service they received.

We sent out 30 questionnaires to people who used the service and their families. A total of 16 questionnaires were returned. Overall people seemed very satisfied with the service provided.

We also contacted three care assistants to find out their views about the service they worked for and the care they provided to people.

People we spoke with told us that they were happy with the standard of care provided and were involved in giving feedback to the service.

One relative told us: "We have a main carer who comes regularly and he is like a friend to my husband, well to both of us really. He treats him like a person not a number, with great dignity and respect, you know, nothing is too much trouble".

People told us they felt safe and the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff told us they were supported to deliver care safely and to an appropriate standard.

One member of staff told us: “They train us well here and appreciate what we do. I get regular supervisions and have spot checks to ensure I meet the right standards of care”.

We saw that the provider had an effective system for auditing the quality of care standards they provided.

During our inspection we spoke with the manager responsible for finances. The person responsible for the service was on annual leave. We were told that there was no registered manager at the service as two people previously recruited left the role within a short timeframe. The person responsible for the service was also the acting manager at the time of our inspection.

After the inspection we contacted three people who used the service and two members of staff to obtain their views about Caring Hands Limited.

People using the service told us they were very happy with the service they received and the staff who worked with them.

One person told us, “The carers are all very good. I can’t complain really”.

Another person told us,”I’ve got no complaints whatsoever. They enable me to be as independent as I can”.

We spoke to two members of staff who told us they felt supported by their manager and had the relevant training to undertake their work.

We looked at five outcomes to assess whether people were involved and participated in the service they received; whether care was provided appropriately; whether the service could adequately ensure people’s safety; whether correct procedures had been followed in the recruitment of staff and whether there was a system for ensuring ongoing quality assurance within the home.

We found that Caring Hands Limited was compliant in all five outcomes.

People told us that they were very happy with the service they receive. Everyone said they had been involved in discussing and agreeing their care. They told us they received information about the service and that staff support them in a way that respect their dignity.

People told us that they felt confident to make a complaint, although those we spoke to said they had no complaints. They told us that they had confident in the way staff supports them. They said if they were unwell staff would contact their doctor. Where people needed support with food preparation they told us that staff knew how to prepare their meals and would always offer them a choice. Everyone we spoke to said their care and support is reviewed and that they were asked if they were satisfied with the service they receive. Comments made by people who use the service included:

"There is a key safe but they always call out and say who is coming through the door. They help me to maintain my independence. When helping me with having a bath, they always make sure I wash the parts I am able to, and support me with the things I can't do."

"Someone came to visit and talk to me about the care. So yes, we agreed what I wanted. They do everything I want them to do and always asks what else I want doing. The service is good."

“I'm very happy with the service, I don't know what I would do without them”.