Hand in Hands

Updated 6 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by one inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service provides care and support to people living in four ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there were two registered managers in post.

Notice of inspection

This inspection was announced. We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 17 May 2022 and ended on 14 June 2022. We visited the location’s office/service 14 June 2022.

Between 17 May and 14 June 2022, we received feedback from people, relatives, professionals and reviewed information the service sent us.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used information gathered as part of monitoring activity that took place on 17 March 2022 to help plan the inspection and inform our judgements. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with five people using the service, received feedback from five relatives, five staff members and both registered managers. One of the registered managers was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed four people’s care and support plans with additional care records for medicine management, risk assessments and other documents relevant to the management of the service.

Updated 6 August 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Hand in Hands is a supported living service providing personal care to people living with a learning disability and/or autism. At the time of the inspection the service supported 13 people across four supported living services and 15 people 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 11 people using the service received the regulated activity of personal care.

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 worked tirelessly to support people to make decisions even if initially, decisions had to be taken by others involved in people’s care. The support provided by staff enabled people to develop an understanding and to take the decisions, leading to positive changes in their health and well-being.

People were supported to overcome their anxieties and fears. The support they received focused on their strengths and promoted their independence. With support from staff people lived fulfilling lives, took positive risks and accomplished their dreams and aspirations.

Right Care

People were in control of their life and the care they received. Staff treated people as equal partners in their care. This increased people’s self-esteem and made them confident in enjoying life to the full.

People, professionals and family members we spoke with told us about the significant positive changes people experienced due to the care received from staff. Staff understood how to provide care to people with protected characteristics to help them break down the barriers of their disability and live a life like any ordinary citizen.

The care and support people received was shaped to their individual needs. Staff were skilled getting people interested to learn new skills and develop their knowledge and understanding about what was important to them and how they wanted to live their life.

People learnt about how to stay safe from abuse, about confidentiality and being safe when using social media. They also learnt how to be more resilient, control their anxieties, fears and behaviours to enable them to have a good time when going out, going on holiday or to work. These achievements were celebrated and acknowledged by everyone involved in their care.

Right Culture

The registered managers promoted a positive, inclusive culture amongst the staff team and people. Staff morale was good, they felt equal and essential part of the service. They were motivated and supported to progress in their career and develop their knowledge and understanding about best practice when supporting people with a learning disability and/or autism.

The inclusive culture promoted by the registered managers led to a long-standing permanent staff team. This gave people continuity of care and an opportunity to build strong, trusting relationships with staff who supported them for several years. Professionals and family members, we spoke with attributed the positive outcomes people achieved to the managers and staff who placed people in the centre of the service.

Recruitment had not been difficult for the provider due to the good reputation they built on the market. They received applications without the need for advertising and on the rare occasion when a staff member left, their position was quickly filled.

The registered managers and the provider used a range of audits and governance systems to quality assure the service provided. Systems in place were designed around people and their input and feedback was directly impacting on how the service was changed and shaped to meet their needs. People felt accomplished and happy living in the service.

The registered managers and staff demonstrated an excellent understanding about Right Support Right Care Right Culture guidance. The service enabled people to live their life like ordinary citizens.

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 outstanding (published 03 November 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding. We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remained outstanding. 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 https://www.cqc.org.uk/location/1-1724411627 on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.