We undertook an unannounced inspection of Helping Hands Watford, 173 St Albans Road, Hertfordshire. The service provides care and support to people living in their own homes; at the time of our inspection 35 people were being supported by Helping Hands.

The service had a registered manager 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.

There were systems in place to keep people safe from harm. People we spoke with felt that that staff knew how to keep them safe. The provider had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service. There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. However, some people felt that staff were sometimes late attending their visits because of traffic.

Staff we spoke with were aware of people’s needs, and provided people with person centred care, however, some staff for whom English was not their first language had some difficulty understanding information.

Peoples care records were regularly updated to reflect changes to their circumstances and the provider kept abreast of those changes to ensure that any further support people may require was acted on. People were supported and encouraged to eat and drink well and where required the service supported people to make appointments with or attend health care services.

People confirmed that their privacy and dignity was respected by staff and that they were encouraged to so as much as possible for themselves in order for them to retain their independence and life skills. People were supported to make decisions for themselves. Where people were not able to make decisions for themselves, the provider had a system in place to ensure that, best interest decisions were made on their behalf which involved advocates and other professionals; this was recorded in peoples care plans.

The provider had a recruitment process in place which ensured that staff were qualified and suitable to work in people’s homes. Staff had undertaken appropriate training and had received regular supervision and an annual appraisal, which enabled them to meet people’s needs. Medicines were administered safely by staff who had received training.

The provider had a system in place to ensure that complaints were recorded and responded to in a timely manner as well as an effective system to monitor the quality of the service they provided.

Helping Hands Watford provides care and support to people living in their own home. At the time of our inspection 26 people were being supported by at Helping Hands Watford.

The inspection took place on 9, 11 and 16 November 2015. This inspection was announced. We previously inspected Helping Hands Watford in September 2014 and found they were not meeting the standards in relation to safeguarding people and staffing. During this inspection we found they had not made the required improvements and were still not meeting the required standards.

At this inspection we found the service to be in breach of regulations 17, and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 did not always feel safe receiving a service from Helping Hands Watford. Staff were not always aware of how to keep people safe and risks to people’s safety and well-being were not always identified and managed. People’s care records were not always updated to reflect the change in their needs. There were sufficient numbers of staff deployed to support people. People kept their medicines in their own homes and were prompted and or supported by staff to take them. However, the support with medicines was not always managed and recorded appropriately.

People were not routinely asked for their permission before staff assisted them with care or support. Staff received intermittent supervision from management which helped them to feel supported and valued. They told us they felt able to seek assistance when they needed to. People received support to eat and drink regularly. People were assisted to access healthcare appointments as needed.

People’s privacy and dignity was not always respected and promoted. People told us they were mostly treated with kindness and compassion by staff but a lack of continuity impacted on the ability to develop meaningful relationships with care staff.

People’s care records were not always regularly updated to provide a detailed account of their needs and care. People told us they did not always feel confident to raise anything that concerned them with staff or management, as the issues were not addressed and resolved. Arrangements were in place to obtain feedback from people who used the service; however this work was incomplete and had not been evaluated to put actions in place to improve the quality of the service.