We carried out a review of the data available to us about Hand in 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 Hand in Hands, you can give feedback on this service.
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.
Not everyone using Hand in Hands 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.
This service provides care and support to people living in five supported living homes, 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.
At our last inspection we rated the service good in safe, effective, caring and well-led. We rated the service as outstanding in responsive. At this inspection we found the evidence continued to support the rating of good and outstanding there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Settings. At this inspection we found that well-led had achieved outstanding.
There was a manager in post who had registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.
The registered manager is also the provider for this location.
The service was safe. Sufficient staff were in post and the recruitment process for new staff had helped ensure that only suitable staff were employed. People were kept safe by staff that were knowledgeable about safeguarding and knew how to report concerns appropriately. Accidents and incidents were monitored to identify any trends or patterns to ensure appropriate actions could be taken. Identified risks to people were reviewed regularly to ensure people’s changing needs and risks were managed well. Medicines were managed safely by staff that received appropriate training. People were protected from the risk of infections by staff who followed correct infection control procedures.
The service was effective. Staff had the right training and skills to meet people’s needs effectively. The registered manager ensured staff were able to develop and put in place adaptive learning systems to support staff learning. People were given choice and control over their lives and staff supported them in the least restrictive way possible. People were supported with a varied and healthy diet, support from staff promoted people’s healthy choices. People were supported to access health care services. Other professionals were positive about the service provided by Hand in Hands.
The service was caring. Staff knew people well and staff cared for them in a compassionate way. Staff respected people’s privacy and dignity and supported people to maintain relationships. Staff delivered care that was supportive, kind and caring. People were involved in deciding how their care was provided and staff promoted their choice.
The service was very responsive. People received person-centred care. People`s needs were assessed to ensure people received the support they required. People were supported to grow and achieve their goals. People were involved in creating and reviewing their care plan and they were supported to develop their independence. The registered manager and staff promoted people's independent and supported people with their relationships. People were given the opportunity to think about what was important to them regarding end of life care. People had a voice and the opportunity to discuss and raise concerns.
The service was well-led. The registered manager led by example and ensured staff had the right skills and values. Staff understood their roles and responsibilities and worked well as a team. The registered manager was passionate and actively involved in work to improve and develop the training and qualifications of staff working in adult social care received across England. They developed close working relationships with the local authority, the Department of Health and other professional partnerships to help ensure that they were up to date with changes to best practice. The registered manager attended professional meetings and shared their knowledge and their expertise of effectively supporting people with other providers. They were clear about their vision and values for the service and what they wanted to achieve, staff worked in line with these values. The registered manager promoted an open culture. There were effective systems to monitor the quality of the service, identified issues were actioned and lessons learned. The registered manager arranged fundraising events for local charities to promote their ethos, giving back to the community and improving people’s lives.
The inspection took place on 11 September 2015 and was unannounced. Hand in Hands is a supported living service for up to eight younger adults who live with learning disabilities. At the time of our inspection seven people were using the service.
There was a manager in post who had registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.
The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that no DoLS authorities had been required or obtained because it had not been necessary to restrict anybody’s liberty in accordance with the MCA 2005.
People told us they felt safe and secure. Staff had received training in how to safeguard people against the risks of abuse and knew how to report concerns both internally and externally. Safe and effective recruitment practices were followed. Flexible arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.
Plans and guidance had been put in place to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. People were supported to take their medicines by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.
People were positive about the skills, experience and abilities of the staff who supported them. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.
People told us they were supported to maintain good health and they had access to health and social care professionals when necessary. They were provided with appropriate levels of support to help them plan a healthy balanced diet that met their individual needs.
Staff obtained people’s consent and permission before providing support which they did in a kind and compassionate way. Information about local advocacy services had been made available for people who wished to obtain independent advice or guidance.
Staff developed positive and caring relationships with the people they supported. People and their relatives were fully involved in the planning, delivery and reviews of the support provided. The confidentiality of information held about people’s medical and personal histories had been securely maintained.
Support was provided in a way that promoted people’s dignity and respected their privacy. People told us they received personalised support that met their needs and took account of their preferences. Staff had taken time to get to know the people they supported and were knowledgeable about their background histories, preferences, routines, goals and personal circumstances.
Opportunities were available for people to pursue social interests and take part in meaningful activities relevant to their needs, both at the service and in the wider community. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded properly and investigated promptly.
People, their relatives, staff and professional stakeholders very were complimentary about the managers and how the service operated. Measures were in place to monitor the quality of services provided, reduce potential risks and drive improvement.