Helping Hands Nursing Agency is a domiciliary care agency. It currently provides personal care to people living in their own houses. It provides a service to older adults living in the Lincolnshire area and younger adults living in Essex.

There was a registered manager in post at the time of our inspection. 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.

The registered manager confirmed services will no longer be offered in Essex.

This is the first inspection under Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection was announced and took place on 8 and 14 August 2018. At the time of our inspection two people were receiving personal care.

People's needs were assessed, but records to evidence this were not always available. Risks associated with personal care were not adequately identified. Appropriate protective measures were in place to minimise the risk of avoidable harm. Not all care plans were completed fully and updated regularly to reflect people's changing needs.

The provider could not assure themselves that medicines were being managed in accordance with current regulations and guidance. Care plans were unclear about the level of support people needed with medicines, and there was no system in place to ensure that people received medicines as prescribed.

Staff had not received all the training required to ensure they had up to date skills and knowledge to provide effective care. Staff felt supported by the registered manager but they had not received regular supervision with their manager. Staff had received training in the Mental Capacity Act 2005 (MCA), but not all care staff understood what this meant for people.

The provider had some systems in place to monitor and review the quality of care people received. However, these were not always recorded clearly.

Safe recruitment procedures were followed. Pre-employment checks were made but evidence confirming this was not available for one staff member.

People were able to make their own choices about their personal care and were involved in planning and reviewing their care. There were sufficient staff to meet people's personal care needs at the time when they needed support. People’s nutritional needs were met. Staff worked within the principles of the Equality Act 2010 to make sure their work practice did not discriminate against people. There was no information about independent advocacy services for people to contact.

People were safe. Some staff understood their responsibilities in relation to safeguarding but not all were confident in how to raise concerns. Staff had received training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities but staff were not always aware of these.

There was a complaints process in place, and people were encouraged to express their views about the service. People and relatives felt confident to make suggestions for improvement of care or raise concerns. People and relatives spoke positively about the support they received from care staff. Relatives shared that communication could be improved by the registered manager.