Care at Hand Limited

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Care at Hand Limited is a domiciliary care service providing the regulated activity of personal care to people in their own homes. At the time of our inspection there were 21 people using the service.

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

Right Support:

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. Staff communicated with people in ways that met their needs. Staff supported people with their medicines.

Right Care:

Concerns raised implied there may not always be enough staff to support people to stay safe. We have made a recommendation about staffing. People received kind and compassionate care. Staff treated people with dignity and respect and understood and responded to their individual needs. Staff had training on how to recognise and report abuse. People’s support plans reflected their needs and the risks posed.

Right Culture:

Where concerns and complaints were raised, these were not responded to in a timely manner. We have made a recommendation about complaints management. People received good quality care and support. Staff knew and understood people well and were responsive to their care and support needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us in July 2023, and this is the first inspection.

The last rating for the service under the previous provider was Required Improvement, published in June 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified a breach in relation to the provider’s quality assurance and governance arrangements. We have made recommendations about staffing and complaints management.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Care at Hand Limited is a domiciliary care agency providing personal care to people living in their own houses and flats. At the time of the inspection 35 people were using the service.

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

Risks to people had not been assessed or managed appropriately. Staff did not have sufficient guidance in place to support people’s individual health needs safely.

People’s medicines were not managed effectively. People’s care plans and risk assessments were not up to date, and medicines administration charts did not always contain details relating to specific medicines and how these should be administered.

The provider did not have appropriate recruitment processes in place to ensure staff were safely employed. Staff did not always have up to date training and we received mixed feedback about the support staff received from the provider.

People’s end of life care wishes were not assessed or recorded in people’s care plans.

We have made a recommendation about the documentation of people’s end of life care wishes.

The provider did not have robust processes in place to ensure they had oversight of the safety and quality of the service. The concerns found at inspection had not been identified by the checks completed by the provider.

People told us they felt safe and staff were kind and caring. People said their regular care staff knew them well but they did not always receive consistent staff and staff did not always arrive at the agreed times. People told us they were not updated about changes to their care visits.

People’s capacity to make decisions had been assessed, however their consent to care had not always been clearly recorded. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had made improvements to the personalisation of people’s care records. People felt comfortable raising concerns; however, they did not always feel their concerns were acted upon.

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 28 August 2019) and there were five 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 enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-Led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, recruitment and the oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care at Hand Limited is a domiciliary care agency. This service provides personal care to people living in their own houses and flats. At the time of this inspection 57 people were using the service.

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

People's medicines were not always managed safely. People were cared for by staff who had an understanding of how to keep them safe, however not all individual risks had been identified or recorded to provide sufficient guidance to staff.

People reported they felt safe with staff and had developed positive relationships where they received a consistent service from regularly assigned staff. However, some people had experienced disruptions with the delivery of their care and support due to unforeseen changes to staff they were not advised about in advance, late visits, and changes to the timings of their calls.

We checked whether the service was working within the principles of the MCA. We found limited information regarding people's capacity to make decisions. Staff did not have all of their knowledge and skills refreshed regularly to provide people with support in line with national guidance.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care records were not consistently personalised, nor did they contain all the knowledge from staff working with them at each care call.

The service's internal systems were not up to date and had failed to identify the issues we found on our visit. People and their relatives had not been regularly asked for feedback on 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

The last rating for this service was Good (published 29 June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

Enforcement

At this inspection we rated the service as requires improvement. We identified five breaches of regulations, in relation to safe care and treatment, staffing, person-centred care and good governance. Please refer to the end of the report for action we have told the provider to take

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This report only covers our findings in relation to the location being safe and well-led. You can read the report from our comprehensive inspection carried out 10 November 2016 by selecting the ‘all reports’ link for Care at Hand Limited on our website at www.cqc.org.uk. In the comprehensive inspection Care at Hand was meeting the standards and had been rated as ‘Good’.

The service had a registered manager. 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.

Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Risk assessments were in place for people using the service. Risk assessments in place were reviewed and updated regularly. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

There were sufficient numbers of care staff available to meet people’s care needs and people received their medicine as prescribed. However, we did receive mixed feedback about reliability of timings of visits. We have made a recommendation about improving systems for recording late visits and last minute changes.

The provider had a robust recruitment process in place to protect people and staff had been recruited safely. Staff had the right skills and knowledge to provide care and support to people.

The registered manager was visible in the service and worked well together with the team. People were well cared for by staff who were supported and valued.

Management systems were in place to check and audit the quality of the service.

Care at Hand provides a domiciliary support service to enable people to continue living at home. The service predominantly supports older people although some adults with a range of support needs arising from physical or learning disabilities are also provided with a service. When we inspected the service provided support with personal care to upwards of 100 people living at home in and around the Harlow area.

A registered manager was in post. 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 were supported in their own home by staff that were able to meet their needs safely. Staff had the skills and knowledge they needed to provide people’s care. People said they felt cared for safely in their own home. There were risk assessments in place to reduce and manage the risks to people’s health and welfare. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns.

People benefited from receiving a service from a staff team that knew their job. Staff were supported by a registered manager that was receptive to ideas and committed to providing consistently good standards of care. People also benefitted from receiving personal care and support from trained staff that were caring, friendly, and responsive to people’s changing needs. People’s right to make day-to-day choices about how they preferred their care and support to be provided was respected and this was reflected in their agreed care plans.

People received a reliable service that was well-led. There were sufficient numbers of staff employed to meet people’s assessed needs. People were protected from the risks associated with the recruitment of staff unsuited to the role by the provider’s recruitment procedures.

People had the guidance they needed to raise concerns or make a complaint. There were procedures in place to ensure complaints were appropriately investigated and action was taken to make improvements to the service when necessary. There were systems in place to monitor the quality of the service provided on a day-to-day basis as well as longer term.

Is the service safe?

The management of medication falls into this category, we found the service had put systems in place to safely support people with their medication.

A majority of people we spoke with said that they consented to their plan of care and treatment. One person said, "I, and my [relative] were fully involved alongside Social Services and the hospital.' However, another person stated, 'Nobody asked me it was just put in place a long time ago. I am happy with the provision and I suppose I am happy with the times.'

We asked people if they were treated in a way that reflected their individual needs. One person replied, 'I am happy with most of my care, especially when they take me for my weekly shopping..." However, another person said, "No I am not. I have used this agency for a number of years now and things are getting worse."

We found that care plans were relevant to people's needs. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had regard to comments and complaints raised by people who used the service. One person told us, 'I feel safe now but had a problem in the past which was dealt with.'

They all said that they, or their relatives, were involved in the care. One relative explained, "They talk to [my relative]. [My relative] can't speak but [they've] got a sense of humour. They're always laughing and joking with [my relative] and I get on well with them as well."

A person who used the service said, "Although I'm disabled, I can still do things myself. We work together.' This reflected how people were involved in their care.

A relative said, "They are very good...very pleased with them. On Wednesdays I asked for an early morning call so that [my relative] can go to the Parkinson's club. All the carers are very helpful."