Our inspection of Safehands Services Ltd commenced on 17 - 22 November 2017 with phone calls to staff. We visited the office from which the service was managed. We spoke with three relatives and six people who used the service on 21 November 2017. The inspection was announced and the service was given 48 hours' notice to ensure someone would be in the office.

We last inspected this service in September 2016 and found a breach of Regulation 12 and Regulation 17. During this inspection we found improvements had been made to completion of medication administration records and the auditing of the quality and safety of the service.

Safehands Service Ltd is a domiciliary care agency. The service is situated close to the centre of Bradford. At the time of our inspection the service was providing care and support to 38 people. Safehands provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Safehands 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.

The service did not have a registered manager in place. The previous registered manager left June 2017. 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 business manager, who was present during the inspection, had day to day responsibility for the running of the service. They were in the process of completing an application to become the registered manager.

Most people we spoke with told us they felt safe and did not raise concerns about the way they were treated. One person raised concerns about different staff visiting. Staff were aware of the actions they would take to keep people safe if they were concerned someone was at risk of abuse. Appropriate systems were in place to protect people from the risk of harm.

Overall risks to people’s health, safety and welfare were identified and action taken to manage the risk. Staff demonstrated a sound awareness of infection control procedures.

Medicines were managed safely. However, some improvements were needed to ensure a consistent approach. We recommended the provider reviews their medicines policies and procedures in line current guidance.

Recruitment processes were in place although we found on one occasion these had not been followed. Checks to show staff were safe to work with vulnerable adults were undertaken prior to staff working at the service.

People were provided with care and support by staff who were trained. Staff told us they had received induction and training relevant to their roles. This was followed up by competency checks. Staff received regular supervision. One staff member thought more group meetings would be beneficial.

People told us they were supported to had choice and control of their lives and staff supported them in the least restrictive way possible.

People told us staff usually turned up within the allotted time, or they phoned and let them know they were running late.

Staff were spoken of highly by most people who told us they were caring, kind, compassionate and respected their dignity and privacy.

Care records contained sufficient detail so staff knew what support to offer people. People felt they participated in planning their care. Care records included information about preferences, likes and dislikes.

People were supported with their nutritional needs. People had access to a wide range of healthcare professionals and we saw evidence people’s healthcare needs were met.

A complaints procedure was in place which enable

Our inspection of Safehands Services Ltd commenced on 13 September 2016 with a visit to the office from which the service was managed and visits to two people who used the service in the community. We carried out telephone interviews with staff on 15 and 16 September and spoke with seven relatives and five people who used the service on 20 September 2016. The inspection was announced and the service was given 48 hours' notice to ensure someone would be in the office.

The last inspection had taken place on 4 June 2014 when the service was compliant with all legal requirements inspected at that time.

Safehands Services Ltd is a home care provider offering care and support services to people living in their own home. The service is situated close to the centre of Bradford. At the time of our inspection the service was providing care and support for 49 people, with a further four people in hospital.

The service had a registered manager in place although they were absent on the day of the 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 business manager, who was present during the inspection, had day to day responsibility for the running of the service.

People who used the service told us they felt safe with the care they received. Appropriate systems were in place to protect people from risk of harm.

Policies and procedures were in place regarding the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS). This helped to make sure people’s rights were protected.

People were provided with care and support by staff who had the appropriate knowledge and training to safely and effectively meet their needs. We saw the skill mix and staffing arrangements were generally sufficient for the current needs of the service although staffing levels had been recently stretched due to staff absence.

People told us staff usually turned up within the allotted time agreed with the management team but were sometimes later.

Recruitment processes were in place although these were not always followed. Checks to show staff were safe to work with vulnerable adults were undertaken prior to staff working at the service. However we saw some people had commenced employment before satisfactory references from the person's previous employer had been obtained.

Staff told us they had received induction and training relevant to their role and were offered opportunities for on-going development. Some supervisions and spot checks had taken place although some of these were not formalised or documented.

Staff were able to tell us about people who used the service, their care and support needs and how they treated people with dignity and respect. People we spoke with told us staff were kind, caring and respected their dignity and privacy.

We saw care and support was delivered in line with people's care plans and people were consulted about the care and support required. Care records were generally updated to reflect people's changing needs although we saw some person specific charts had not been fully completed. we saw care records contained basic information about people's likes, dislikes and preferences.

Medicines were not always safely managed, with poor documentation and a lack of medicines audits.

People were supported to access a wide range of healthcare professionals and we saw evidence people's healthcare needs were met.

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Where the service provided nutritional support, people's individual dislikes and needs were supported to enable people to consume a well balanced and healthy diet.

A complaints procedure was in place which enabled people to raise any concerns or complaints about the care or support they received. Howe

The inspection was carried out by a pharmacist inspector. We set out to answer three key questions; Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with the manager and other staff and looking at records.

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with use and management of medicines.

People received their medicines at the times they needed them and in a safe way. Medicines were administered appropriately and, where necessary were kept safely in people’s homes.

Is the service effective?

We found that care plans for managing medicines were up to date and care workers had clear information to follow to ensure that people were supported to take their medicines safely and in a way that met their individual needs and preferences.

Is the service well led?

We saw that audits, or checks of medicines, were carried out regularly to assess the way medicines were managed and to ensure that people continued to receive the support they needed.

We inspected the agency office and spoke on the telephone with three people who used the service.

We found people were given appropriated information and were involved in making decisions about their care and treatment. People who used the service told us staff treated them with respect and were polite. One person said, “The carers are smashing.” And “They are polite and treat my relative with dignity.” Another told us, “One or two are not so brilliant.”

People told us that they were well cared for. One person said, “I feel that I get an exceptionally good service” and “They are efficient and on time.” We found that care was planned and delivered in a way that ensured people’s safety and welfare. Two relatives of people who used the service told us there were not enough staff. We noted that the provider had plans in place to recruit new staff.

People told us that they felt safe with staff in their home. We saw that the provider had systems and processes in place to ensure that people were protected from the risk of abuse. One person who used the service told us, “I feel in safe hands.” Another told us, “I speak to the manager and she listens.”

We saw the provider had systems and processes in place to gather feedback from people who used the service. Report writing in the care records was up to date and reflected the changes in care and treatment that people received. We also found that staff were supported and monitored in their working practice.

We spoke with people about the support they receive from the service and people were complimentary about the support they receive and stated that staff were caring and looked after them well.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

We saw personalised risk assessments linked with peoples care plans. These assessments were up to date. We looked at a rota and found appropriate staffing levels for the needs of the service users. There were two out of hours contact numbers for emergency.

Is the service caring?

People told us they were treated with dignity and respect. One person told us, "The staff are great." We spoke with some family members who told us that Safehands will always ask if there is anything they would like before they leave. We found care plans were up to date and person centered.

Is the service responsive?

People told us they knew about their care plans and get invited to review meetings. Where some people lacked capacity to make a decision, we saw dates and signatures from family members to say they were involved in the care planning process. We looked at some daily notes which followed the care identified in the care plans. A recent survey had gone to people who used the service and recommendations were acted on and changed.

Is the service effective?

We saw needs assessments when people started with the service and care plans built from the initial assessment. We saw evidence that when people’s needs had changed, the care plan was reviewed. People told us they felt their needs were met. We saw in the daily notes evidence of other professionals involved in peoples care.

Is the service well led?

On an annual basis a questionnaire is sent out from the management to ask for any comments or improvements and these are taken into account. Staff appeared clear about their roles and responsibilities. The manager told us they do random spot checks on staff to ensure a quality service. This information can be passed to staff during staff meetings which are held.