This inspection took place on 6 and 8 June 2018 and was announced. This service is a domiciliary care agency based in North Tyneside. It provides personal care to people living in their own homes throughout North Tyneside and Northumberland. Services were provided to adults with a wide range of health and social care needs. At the time of our inspection there were 19 people receiving a service.

Not everyone using Safe Hands receives a regulated activity; The Care Quality Commission (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.

The service had a registered manager in post. The registered manager had been in post since the service first registered in 2010. A registered manager is a person who has registered with the 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.

At the last inspection in April 2017, we asked the provider to take immediate action to make improvements to the governance of the service. We found these actions had been completed.

People told us they felt safe and were comfortable with the staff who supported them on a regular basis. Policies and procedures were in place to help staff safeguard people from harm and staff we spoke with understood their responsibilities in relation to protecting people. Incidents of a safeguarding nature had been appropriately recorded, investigated, reported and monitored. The local authorities told us that they had no current concerns about the service.

Staff supported people to maintain their health, safety and welfare within their own home. The registered manager had completed risk assessments where individual risks had been identified. We saw these were now regularly reviewed and updated to reflect the changes in people’s needs. Staff followed best practice in relation to the prevention and control of infection.

Staff felt there were enough of them employed to meet people’s needs and look after people safely. Care workers said they did not feel rushed with their duties. People and relatives told us that overall, they had regular care workers who arrived when expected.

Staff recruitment continued to be safe and robust. New staff had received a company induction but a comprehensive induction to meet national minimum standards had not been fully adopted. Staff training was up to date. Records showed and staff confirmed that they received regular supervision sessions, an annual appraisal and staff meetings took place to discuss any issues. Staff told us they felt valued by the office team and there was an open culture, which gave them the confidence to discuss anything with the registered manager and know it would be acted upon.

People and relatives told us medicines were received safely and when they expected it. Medicine administration records were accurate and up to date. Competency checks on care workers were now in place to ensure staff remained competent at administering medicines. Regular unannounced spot checks were also conducted to ensure high standards of care were delivered.

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.

People and relatives told us that staff encouraged a healthy and balanced diet. They told us care workers made meals they had chosen. External healthcare professionals were involved with people’s care to ensure their ongoing well-being.

People and relatives told us care workers were friendly and that they respected their home, their visitors and their belongings. People said care workers upheld their dignity and privacy. Al

Safe Hands Home Care Limited provides personal care to people living in their own homes in the Newcastle, Northumberland and North Tyneside areas. They also provide an enabling service to help support people to access the local community. At the time of the inspection there were 18 people using the service.

At our previous comprehensive inspection in June 2016, we identified two breaches of regulations relating to safe care and treatment regarding the management of medicines and good governance. We rated the service as requires improvement.

The inspection was announced. The provider was given 48 hours' notice because they are a domiciliary care agency and we wanted to make sure that key staff were available. We attended the provider’s head office and visited three people in Newcastle, Northumberland and North Tyneside on 30 and 31 March 2017 to find out how care and support was provided in these areas. Our expert by experience contacted people by phone from the 5 to the 10 April 2017.

There was 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.

People told us they felt safe with the staff who visited them at their homes. The provider had not notified CQC of several safeguarding allegations in line with legal requirements.

We looked at the management of medicines. We found that improvements had been made and care files contained an up to date list of medicines. There were some inconsistencies with the recording of medicines which the registered manager stated would be addressed.

People and relatives did not raise any concerns about staffing levels. The registered manager told us they were recruiting more staff. Recruitment checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS].

Training was carried out in safe working practices. Competency based assessments however, were not carried out to ensure that staff had the necessary skills in areas such as medicines management and moving and handling. In addition, ongoing documented checks to make sure staff were adhering to the correct procedures were not completed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We noted however, that records did not always evidence how staff followed the principles of the MCA.

People were supported to access to a range of healthcare services to ensure their health needs were met. This was confirmed by our observations and the health and social care professionals with whom we spoke.

People and relatives told us that staff were caring. We saw positive interactions between people and staff. People’s privacy and dignity was promoted. Care plans were person centred. We found that some care plans required updating to reflect changes in people’s preferences and needs.

The service provided enabling support where this was identified in people’s care assessment. Staff assisted people to access the local community to help meet their social needs.

There was a complaints process in place. We found however, that not all complaints were documented or monitored.

An effective quality monitoring system was not in place. Certain audits and checks were not carried out in areas such as medicines and care files. In addition, we f

The announced inspection took place on 7 and 9 June 2016. We last inspected the service in August 2014. At that inspection we found the service was meeting all the regulations that we inspected.

Safe Hands Home Care Limited provided home care and housing support to 18 adults living in their own homes living in the Northumberland, Newcastle and North Tyneside areas. People were provided with a variety of support times depending on their care package and needs, with some receiving 24 hour care. It should be noted that the numbers of people being supported and the number of hours they receive will fluctuate due to the nature of the service.

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.

We found shortfalls in the management of medicines. The terminology used in recordings by staff was not in line with best practice guidance and the process adopted when administering people's medicines process needed to be improved. Full details about needs related to ‘as required’ medicines, were not always available to staff.

Record keeping within the service was not always maintained to suitable standards. Care planning, medicines records, risk assessments, best interest decisions and quality assurance checks were not always documented thoroughly or not at all in some cases.

Quality assurance checks were completed in some areas of the service, for example finances and staff confirmed this. However, we saw very little documented evidence that either the registered manager or the provider had a full and clear oversight of the service to ensure people received good quality care and support. People, and their relatives confirmed, however, that they received good care from the staff team. Accidents and incidents were recorded but not fully monitored for emerging trends by the registered manager or provider.

People told us they felt safe with the staff team that supported them and their relatives confirmed those thoughts. Staff were confident and had been trained in safeguarding procedures. They confirmed they would have no doubts about reporting any issues to management or other appropriate bodies if the need arose.

Risk assessments in place needed to be tailored to individual need and not completed as a blanket approach. The provider had contingency plans in place and staff knew what to do in the event of an emergency.

Staffing levels were maintained by timely and safe recruitment procedures. The registered manager told us they tried to ensure people were visited by the same care staff but that was not always possible due to sickness or holidays.

Staff had received an induction into the service and completed appropriate training. Staff said they felt supported by management and supervisions and appraisals were completed, although these were behind schedule and the registered manager was in the process of bringing them up to date.

Some people received support with mealtimes as part of their care package. People were supported to prepare meals and eat meals they had chosen. Staff ensured drinks were left between visits for people if they required them.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. Although best interest decisions were made, these were not always documented fully.

Staff promoted people’s independence and treated people with warmth and kindness in a respectful and dignified manner. People were involved in the care planning process, alt

People said they felt well cared for and their carers were reliable, helpful and friendly.

They said they were asked about their views of the service they received and they knew how to make a complaint if there had any concerns and felt this would be taken seriously.

During this inspection we spoke with three people who used the service and one relative. We also spoke with the manager and three care workers.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care records contained risk assessments and instructions on how these risks should be managed. For example, infection control, accessing facilities in the community and assisting with cooking.

Systems were in place to make sure that managers and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

Staff had undergone training on safeguarding vulnerable adults and were aware of the procedure to follow if they observed any bad practice in the service.

The provider contracted a health and safety consultant and they were currently in the process of reviewing the health and safety policy. We saw that health and safety checks were carried out in one person's home where 24 hour care was provided.

Is the service effective?

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met.

People's health and care needs were assessed and the majority of care plans provided staff with information about how each person's care needs should be met. However, one person's care plan did not contain sufficient information on managing a medical condition although the staff on duty were fully aware of this.

Is the service caring?

We spoke with three people who used the service and their comments included, "I am highly satisfied with the service I receive. The carers have a nice attitude and they don't rush me." A relative told us they had no problems with the service and their relation was well cared for. People said they received regular carers unless a member of staff was off sick or on holidays. When this happened they were told who would be covering for them and they had the office telephone number if they were any problems.

People said the staff generally turned up on time and stayed the correct amount of time to complete the necessary tasks.

We observed the interactions between staff and a person they cared for. We saw staff interacted well with the person and were attentive and sensitive to their individual needs.

Is the service responsive?

There was a complaints procedure in place and each person who used the service was provided with a copy of this. A complaints book was maintained to record any complaints received in the home and the outcome of the investigation.

Records showed, and staff told us, that appropriate training was provided for the staff to help meet individual needs.

Is the service well-led?

The provider had systems in place to monitor the quality of the service people received. People were asked their opinion of the service and quality spot checks were carried out by the manager. One person said, "X (the manager) calls to see me about once a month so I would tell him if I wasn't happy." Regular staff meetings were held to discuss day to day issues in the service, for example, book keeping/recording, communication and responsibilities. Management meetings were held in the office to discuss day to day issues such as paperwork, recruitment, rotas, communication and fire drills.

Staff said they were well supported by the manager and he carried out regular spot checks and they had supervision meetings every six to eight weeks. Comments included, "They are a good company to work for," "If you have a problem the manager sorts it out," "If I have any concerns someone is always available" and "I'm very happy working here. They were absolutely marvellous when I came back from sick leave."

We saw evidence to show that the manager visited people who used the service to carry out quality spot checks and these had provided positive feedback about the service. We found people's care records, accidents and complaints were monitored regularly by the manager.

The people who used the service and the staff told us the manager was very approachable if they had any concerns or suggestions.