We carried out a review of the data available to us about Caring Hands on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Caring Hands, you can give feedback on this service.
Caring Hands is a domiciliary care agency providing personal care to adults living with families or in their own homes in the community. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection the service was providing personal care to 21 people living with frailty of old age and other health related conditions.
People’s experience of using this service and what we found
People were encouraged to make decisions about the care they received and were treated with dignity and respect by compassionate, caring staff who promoted independence and choice. People told us they were asked what they wanted or needed before care was delivered. One person said, “They try to help with independence, and don’t do things I can do for myself.”
Care was delivered by staff who were trained and understood their roles and responsibilities. The registered manager and senior staff carried out spot checks on staff to monitor the quality of the service provided, and to seek people's views. People, relatives and staff were encouraged to offer feedback both formally and informally. Changes were made as a result of feedback.
Staff felt well supported and people were confident in the service they received. Quality assurance systems and practice identified potential issues, enabling prompt actions to be taken.
Staff were proactive in supporting people’s health and well-being and were responsive to changes in people’s needs. Care plans were detailed and person-centred and contained guidance for staff to support people’s known health conditions. Management and staff worked in partnership with other agencies and health care professionals.
There were systems and processes to effectively monitor the quality of care delivery; people’s records were clear, informative and securely maintained.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update The last rating for this service was requires improvement (published 26 February 2020) and there was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person had not established systems and processes to audit and monitor the safety and quality of the service provided. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.
Why we inspected
This was a planned inspection based on the previous rating.
We carried out an announced comprehensive inspection of this service on 10, 13 and 15 January 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve systems and processes to audit and monitor the safety and quality of the service provided.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions caring and well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caring Hands on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Caring Hands is a domiciliary care agency (DCA) providing personal care to older people and people with physical disabilities in their own homes. At the time of this inspection 27 people were supported with personal care. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Improvements had been made to the audits carried out by the registered manager; however, they did not always record how safety and quality was monitored. The provider's systems had not identified issues we found on inspection with records. Care records relating to people’s health did not always reflect the care being delivered. Improvements were required to ensure the information contained within people's care records was personalised, consistent and accurately reflected peoples current care and support needs. Staff were knowledgeable about people's needs and people's safety had not been impacted.
People could not be assured their personal information was being shared securely. Staff communicated information between themselves in real time through an electronic application on their personal mobile phones. The provider had not ensured this process was secure or considered people’s rights to confidentiality and data protection. The registered manager took immediate action to stop this practice at the time of the inspection.
Improvements were needed to ensure people were involved in all aspects of their care and were supported to express their views.
People said they felt safe and were protected from harm. A person said, "I feel very safe. They are very good at making sure you feel cared for. They are very helpful.” Staff had a good understanding of what safeguarding meant and the procedures for reporting any issues of harm to people. All the staff we spoke with were confident any concerns they raised would be followed up appropriately by the registered manager.
There were enough staff to care for people safely, with staff and people using the service telling us current staffing arrangements were sufficient. Staff said their rotas were well managed, with sufficient travel time between each care visit. A relative said, "They (staff) are always near to being on time, give a few minutes here or there. Very good at providing the same staff which is handy. It means we get to know them.” The staff recruitment procedures ensured appropriate pre-employment checks were completed to ensure only suitable staff worked at the service.
Medicines were managed safely by trained staff. Effective practices were in place to protect people from infection. Staff received supervision and appraisals to support them in their role and identify any learning needs and opportunities for professional development. A person said, “They (staff) are skilled. I feel comfortable with what they know. If there is any doubt they always ask the questions. They do, without sounding over the top, but they know what is expected and they know how to do it.”
Senior staff carried out spot checks to monitor the quality of the service provided and to seek the views of the people who were supported. A person said, “I am very happy with the service, it is difficult not to overstate the situation, whatever they do for me is very good.” People had a choice of meals and told us they had plenty to eat and drink.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People received appropriate healthcare support as and when needed and staff knew what to do to request assistance. Complaints were investigated and managed appropriately in line with the provider's policy.
The service worked in partnership with other agencies to ensure quality of care across all levels. People, relatives and staff were encouraged to provide feedback about the service. There was a culture of openness and transparency. Staff were positive about the management and leadership of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 18 January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified one continued breach in relation to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person had not established systems and processes to audit and monitor the safety and quality of the service provided.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Not everyone using Caring Hands received 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. At the time of this inspection the service provided personal care to 32 people.
The service was run by a single provider who was in day to day control of the service. It was therefore not required to have a registered manager. The provider is an individual 'registered person'. 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 provider was supported to run and lead the service by an office care manager and a community care manager.
At the last comprehensive inspection in April 2016 the service was rated Good for each key question. Was the service safe, effective, caring, responsive and well-led? This led to an overall rating of Good. At this inspection the provider had not maintained this standard and we have rated this service as Requires Improvement. This is the first time the service has been rated Requires Improvement.
We identified one breach of the Regulations of the Health and Social Care Act (2008). This related to the lack of governance and audits completed by the provider. The provider had no formal system to check if staff training equipped them for their role. There were no formal medicines or care record audits. This is discussed in more detail in the well-led section of the report.
We identified two breaches of the Care Quality Commission (Registration) Regulations 2009. The provider had not submitted statutory notifications to the CQC to notify us of the death of a person using the service or of an incident of alleged abuse as required. The provider acted to address these concerns during the inspection.
Staff supported some people with their medicines, as required. The provider gave assurances that they completed competency assessments to assess the ability of staff to deliver this care safely. However, these were not documented. This was not in line with the provider’s policy. Without exception, people and their relatives told us, medicines were administered safely. The provider gave assurances at the time of our visit they would ensure they formalised this process in the future. We have made a recommendation about medicines management.
Staff received training to provide them with the knowledge and skills required for their role. However, the training was limited to what the provider considered to be mandatory. A review was required to determine the appropriateness of the training and the potential impact this may have on staff and people using the service. We made a recommendation about the on-going management and recording of staff training and support.
People were protected from harm. Staff received training and understood how to recognise signs of abuse and who to report this to. Staffing levels were sufficient to provide safe care. The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting. When people were at risk, staff had access to assessments and understood the actions needed to minimise harm. The service was responsive when things went wrong, were open and reviewed practices and had a system in place to manage incidents. People were protected by the service's arrangements for the prevention and control of infection.
People were supported by staff, as needed, with meal preparation and the provision of drinks. People received appropriate healthcare support as and when needed from various professionals and services. There were good systems in place to ensure staff and the provider worked with health professionals to promote and monitor people's health needs. 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 their relatives described the staff as exceptionally caring, kind, and compassionate. People could express their views about their care and felt in control of their day to day lives. Staff and the provider showed very good knowledge of the people they supported and understood how to maintain people's privacy and dignity. It was clear they had developed positive relationships with people and encouraged their independence.
People were involved in developing their care plans which were detailed and personalised to ensure their individual preferences were known. If a person's needs changed, then their care plans were updated. Information about how to make a complaint was available and people told us they were confident to raise issues or concerns. The service actively encouraged feedback from people. No one was receiving end of life care at the time of the inspection.
The service had an open and positive culture. As well as the staff, the provider and community care manager also provided care to people in the community, which gave people the opportunity to highlight any issues through face to face contact. People, their relatives and staff all spoke very highly about the way the service was managed.
You can see what action we told the provider to take at the back of the full version of the report.
People were supported to remain safe. Staff had received training and understood how to recognise signs of abuse and how to report any concerns. Procedures for managing medicines were safe, staff had received training and understood how to support people to have their medicines safely. Risks to people were identified and managed and staff told us that having comprehensive risk assessments in place helped them to provide care safely and to support people to take positive risks. People told us they felt safe and that they had trust in the staff supporting them. There were sufficient staff to cover all the visits and people told us they had regular carers who came on time and stayed for the expected duration of the visit. One person said “They are always the same carers unless they are sick, they let me know if there are any changes.”
Staff were well supported and had received training to equip them with the knowledge and skills they needed to meet people’s needs. One staff member said “They really care about the staff, we are really well supported.” New staff received a thorough induction and all staff received observations of their practice to ensure they were delivering care effectively. A relative told us that they had confidence in the skills and abilities of the care workers saying “I was able to go away for a weekend for the first time in the knowledge that they would be content and unafraid.” Some staff had received training specific to the needs of people they were supporting, an example of this was for someone who required a specialist technique to receive their food, fluids and medication.
People were supported to have sufficient to eat and drink and staff were proactive in recognising risks or needs associated with nutrition. People told us they were happy with the support they received, one person said “The carer warms the meal for me and cooks fresh vegetables, they always set it out nicely, I’m fussy about that.” Staff supported people to access health care services and had developed good links with local services.
People’s consent was being sought in line with the Mental Capacity Act 2005 and staff were aware of their responsibilities with regard to this legislation. People told us they were very happy with the care they received and described the care workers as patient, caring and kind. Staff spoke about the people they were supporting in a caring and compassionate manner. People were treated with dignity and respect and felt their views were listened to. One person said “I am never made to feel a bother,” another person told us “They treat me with great respect and kindness.”
Care plans were developed with the involvement of people and their relatives and reflected their individual needs and preferences. Staff knew the people they were caring for well, one staff member said “It’s the detail that’s important, knowing that someone likes their bacon crispy and prefers bread and butter to toast, that’s not in their care plan but you just get to know them.” People told us that they felt confident that any concerns or complaints would be listened to and acted upon and that they knew how to raise such matters. One person said “Contacting the agency is always quite simple and easy, they do listen.”
The service was well led and the registered provider was regarded highly by people and staff, one person said that the provider was “Helpful, understanding and cheerful,” a staff member said “It’s the best agency I have worked for.” There were systems in place to monitor the quality of the service and there was clear commitment from the provider and staff to deliver the objectives set out in their statement of purpose, 'To enable people to live at home safely and independently with the best quality of life.' The provider maintained an oversight of all aspects of the service and was knowledgeable about people’s needs and risks associated with proving their care. Feedback from people and relatives was encouraged and valued and there was a robust complaints process in place. Staff described an open culture where learning from incidents and experiences were used to drive improvements. One staff member said, “We are a very happy, chirpy team, there’s no moans, only learning from each other.”
We considered all the evidence we had gathered under the outcomes 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?
This is a summary of what we found '
Is the service safe?
People told us that they felt their rights and dignity were respected. People told us, 'They always stay the correct length of time and do the things they are meant to. I wouldn't dream of changing to another agency. It's really lovely. I can't fault it.' The provider had a system in place to identify, assess and manage risks to the health and safety of people who use the service and others. We saw that the external environmental and access had been risk assessed prior to a care package being agreed. Recruitment practice was safe to ensure that only staff suitable to work with vulnerable people were employed by the service. All the people we spoke with were happy with the service's medication practices. People told us they felt safe and had no concerns regarding the service.
Is the service effective?
People told us that they were happy with the care they received and their needs had been met. It was clear from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One relative told us, 'They always send the same carers. It's always a familiar face, never anyone we don't know.' People told us that, 'The quality of staff is excellent.' Staff had received training to meet the needs of the people using the service. They told us, 'The training is very thorough. I started with an induction and then I did some 'shadowing' visits. Everyone is really helpful and supportive.'
Is the service caring?
People told us that they liked the staff. Comments included, 'They are very caring', 'Very kind', 'I'm very happy with it', and 'They are always prompt and very professional.' When we spoke with staff it was clear they enjoyed their role and they had a good relationship with the people they provided care to. Staff told us, 'It's the best agency I've ever worked for. I really enjoy my job. All the clients are lovely.'
Is the service responsive?
People's needs had been assessed before care had been provided. People said that they were involved in their care. People told us they could raise concerns or make suggestions to the staff if necessary. They told us they had confidence in the staff. 'I really am delighted. If not I'd tell them and they'd soon fix it.'
Is the service well-led?
People were very happy with the care and support they received. People told us they felt they were listened to and their views were taken seriously. The provider had a system to regularly assess and monitor the quality of service that people received against the requirements of the essential standards. This included assessing the quality of care people received. We saw evidence that direct observation of staff took place which monitored the quality of the care and support given. Staff were clear about their roles and responsibilities. We were told that the staff got on well together and worked as a team. Staff said that they were well supported by the manager and management team who were, 'Very supportive.' We were told that there were always, 'Three people on call, if I need to phone them.'
People we spoke with told us that they felt involved in making decisions about the support they received. They felt that the care workers always respected their privacy and dignity. People told us that they had confidence in the service and the care workers. They said that they felt safe and listened to. They said that the care workers were very good at communicating with them and were open to suggestions. One relative told us that, "It's lovely to find an agency where the care is consistent. They always send the same carer, at the correct time. They do exactly as they should. I really can't fault them."
We found that the provider did not have effective recruitment procedures to ensure that care workers were of good character and had the qualifications, skills and experience necessary for the work to be performed.
We found people's views were taken into account and each person care records were reviewed on a monthly basis. We found people's family and/or their representatives were involved in their care.
We found people needs were assessed and care and treatment planned and delivered to meet these needs. Care records we reviewed were detailed and we saw that risk assessments were linked to people's care plans.
Staff received training which was relevant to their roles and provided support staff needed to deliver treatment that was safe and appropriate to meet people's needs.
The provider had a system in place to monitor and assess the quality of the service they provided.