Safe Hands Care & Support Services

Safe Hands Care and Support Services is domiciliary care service based in Levenshulme, Manchester and provides care and support to people living in their own homes. At the time of our inspection there were 60 people using the service.

People’s experience of using this service:

People told us they felt safe using the service and staff displayed good knowledge about how to protect people from the risk of harm. People told us they received their medicines as prescribed and staff were also recruited safely, with appropriate checks carried out when their employment commenced.

There were enough staff to care for people safely, with staff and people using the service telling us current staffing arrangements were sufficient and their rotas were well managed. Accidents and incidents were monitored and any actions taken to prevent future re-occurrence were recorded.

People received the support they needed to eat and drink. Staff told us they were happy with the level of training, support and supervision available to support them in their roles.

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 said they felt treated with dignity and respect and staff promoted their independence as required.

Complaints were handled appropriately and a number of compliments were also made about the service.

Audits and quality assurance systems were in place to monitor the quality of service and there were opportunities for staff to express their views at regular team meetings. Spot checks and competency assessments of staff carrying out their work were completed.

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

Rating at last inspection:

This last inspection was in September 2018 (published November 2018) and the overall rating was requires improvement.

Why we inspected:

This was a routine comprehensive inspection and in line with our timescales for Requires Improvement rated services which is approximately 12 months from the publication date of the last report.

Follow up:

We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for Good rated services, however if any information of concern is received, we may inspect sooner.

We last inspected Safe Hands Care and Support Services in October 2016 where the service was rated as Good overall and for each key question we inspected against.

This latest inspection took place on 12, 14 and 19 September 2018 and was announced. We contacted the service the day before the inspection to let them know of our intentions to visit on this day. The inspection was carried out in response to a recent inspection we had undertaken at another location operated by the same provider, Overton House in Longsight.

During this inspection we found service delivery had declined in areas such as the recording of people’s medication (particularly creams), spot checks/observations of moving and handling/medication, the MCA (mental capacity act) and governance arrangements. We have also made a recommendation regarding the further development of satisfaction surveys. You can see what action we have asked the service to take at the end of this report.

The address registered with CQC for this service is in Heald Green, however when we contacted the service to announce the inspection, we were informed the new office premises were at an address in Levenshulme. This hadn’t been done through the correct CQC registration procedures and we will follow this issue up outside of this inspection process.

The registered manager had recently left their role, therefore at the time of inspection a registered manager was not in post. However services are given approximately six months to recruit a suitable registered manager before CQC can pursue further action. 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 service had recently recruited a new manager, however they had only commenced their employment several days before our inspection.

Medication was handled safely and given to people as described. However records were not being maintained regarding cream charts and staff competency assessments when administering medicines.

We checked to see if the service were working within the requirements of the mental capacity act (MCA). We found information in people’s care plans was not always accurate regarding their level of capacity and found this was an area not all staff had received training in.

People told us staff generally communicated well with them, however two people told us they didn’t like it when staff spoke in a different language in front of them and couldn’t understand what was being said. We raised this concern with management and were informed this was something that been fed back to them in the past as part of their own survey and that they were currently looking to address the issue with staff to improve this area.

Further improvements were required to overall quality monitoring systems to ensure concerns such as a lack of cream charts, inaccurate information about people’s capacity and a lack of competency assessments for medication and moving and handling, were identified and acted upon in a timely manner.

Safeguarding policies and procedures were in place and the staff demonstrated a good understanding of safeguarding concerns and the process to follow if they suspected abuse had taken place.

The service had a robust recruitment process to help ensure people employed were suitable to work with vulnerable people.

Risk assessments were in place and support plans devised to mitigate any risks presented to people.

Staff told us they received the appropriate induction, training, supervision and appraisal to support them in their role.

People told us staff always sought their consent before delivering care.

The feedback we received was that staff were kind and caring towards people.

People told us they felt treated with dignity and respect and that staff promoted their independence where possible.

Each person who used the service had an appropriate care plan in place which provided person centred information about how they liked their care to be delivered.

There were systems in place to seek and respond to feedback about people’s views of the service, although we have made a recommendation about how these could be developed further.

There was a complaints policy in place, however at the time of the inspection, no complaints had been raised. This was confirmed by people we spoke with.

Team meetings were held so that staff could discuss their work and raise any concerns they may have.

A range of policies and procedures were in place to ensure appropriate guidance could be sought when needed.

This was an announced inspection which took place on 13 and 14 October 2016. In line with our current methodology we contacted the service two days before our inspection and told them of our plans to carry out a comprehensive inspection. This was because the location provides a domiciliary care service and we needed to be sure that the registered manager would be at the office.

The service had a registered manager in place. 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.

People told us they felt safe using Safe Hands Care and Support Services. Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service. They told us they were certain any concerns they raised would be taken seriously by the managers in the service.

Care records contained assessments that had been completed before people started to use the service. They were detailed and showed what support the person required and how the service planned to provide it. The assessment process ensured staff could meet people’s needs. The assessments were used to develop care plans and risk assessments.

Care records were person centred and contained very detailed care plans and risk assessments that guided staff on the support people needed to meet their health and social care needs. Care records were reviewed regularly to ensure they reflected people’s needs. There were also detailed risk assessment about risks around people’s homes.

Robust recruitment procedures were in place which ensured staff had been safely recruited. Staff received the training, support and supervision they needed to carry out their roles effectively.

The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control. Accident and incidents were recorded and action was taken to help prevent reoccurance.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). People told us they had been consulted about their care records and felt involved in how their care was provided. They said that staff always consulted them before providing support. Staff were able to tell us how they supported people to make their own decision. The registered manager and staff were aware of the process to follow should a person lack the capacity to consent to their care.

People told us that the service was reliable and that visits were never missed. People told us that the service was friendly and they were always supported by the same staff, who knew them well.

All the people we spoke with said the service was very caring. Everyone was positive about the attitude of staff and managers and how they were supported. They talked about the kindness and warmth of all the staff. One person said, “I am absolutely delighted. I have never seen such a level of warmth, care and compassion.” People spoke highly of the quality of the care and support they received. Everyone we spoke with said the service was well organised and well-led.

The service placed great importance on helping people to maintain their relationships and social contact. Care records we looked at contained information about people who were important to the person and social and recreational activities they took part in during the week. People were supported to maintain their social contacts, interests and hobbies.

We found that the registered manager, provider and all the staff we spoke with were able to tell us about the people who used the service. They knew their likes and dislikes and things that were important to them. They all spoke respectfully and with warmth about people who used the service.

During our inspection we found the registered manager and provider to be enthusiastic, caring and committed to providing a good quality person centred service. We found that the registered manager and provider worked closely together regularly and demonstrated that they had a shared vision for the service that they provided. The registered manager told us the service aimed, “To help people stay as independent as possible for as long as possible in their own home.”

Policies and procedures we reviewed included protecting people’s confidential information and showed the service placed importance on ensuring people’s rights, privacy and dignity were respected.

There was a robust system of weekly, monthly and annual quality monitoring and auditing in place to help improve the quality of the service provided. There was a complaints procedure for people to voice their concerns. People told us they had no complaints but were confident that they would be listened to and action would be taken to resolve any problems they had.

Staff were very positive about the registered manager, registered provider and working for the service.

The service had notified CQC of any accidents, serious incidents and safeguarding allegations as they are required to do.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw that people's needs were assessed before they started using the service to identify risks to their health and wellbeing and the support they required. Care plans provided staff with detailed guidance on how to meet people's needs.

The people we spoke with, who used the service or were the relative of a person who used the service, told us they felt safe with the care staff who visited. We saw that there were effective measures in place to identify and manage the risks of abuse.

We saw that there were systems in place to safely recruit staff. This included carrying out appropriate pre-employment checks when new staff were employed by the service.

Is the service effective?

Care plan records provided care staff with the information and direction they needed to enable them to deliver appropriate care.

The people we spoke with who used the service, or were a relative of a person who used the service, made positive comments about the service provided. One person described the support they received as 'absolutely super'. A relative of a person who used the service told us they were 'very pleased' with the staff who supported their relative. They also told us their relative liked the staff who visited them and that they were supported by regular care staff.

We saw that staff were supported in their role by the management team and were provided with training to enable them to carry out their role competently.

Is the service caring?

The people we spoke with who used the service, or were a relative of a person who used the service, told us staff were 'polite' and 'kind'. When we asked one person what the best thing about the service they received was, they told us it was 'the people [staff]'.

Is the service responsive?

We saw that people's care plans had been regularly reviewed and updated. Where issues had been identified during these reviews, they were responded to appropriately.

Is the service well led?

The provider had a range of up to date policies and procedures in place, which provided guidance to staff. There were systems in place to check and monitor the quality of the service people received. This included quality checks on paperwork, spot checks on care staff and feedback forms completed by people who used the service. There was a complaints procedure in place and the people we spoke with told us they felt able to raise concerns should they need to.