Helping Hands Harrow

Helping Hands Harrow is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. At the time of inspection the service provided care to 25 people, five of whom received personal care. CQC only inspect the service 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.

Our previous inspection in August 2017 found that there was no registered manager in post. The service took action in respect of this and this inspection in September 2018 found that there was a registered manager in post. 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 previous inspection on 17 August 2017 found two breaches of regulation. We rated the service as "requires improvement". During this inspection on 25 September 2018, we found that the service had made improvements in respect of risk assessments, medicines management, quality checks and audits.

Feedback indicated that people and relatives were satisfied with the care and services provided. One person we spoke with told us they were treated with respect and felt safe in the presence of care workers. Relatives we spoke with confirmed this.

Our previous inspection found a breach of regulation in respect of risk assessments. We found that the service did not always identify all potential risks and there was limited information contained in risk assessments. During this inspection in September 2018, we found that the service had taken appropriate action and made improvements in respect of this. We found appropriate risk assessments were in place and were personalised and included information specific to each person and their needs. Where people had specific health issues, there were appropriate risk assessments which included a summary of protective and preventative measures. These were also accompanied by an information fact sheet which provided details of specific health issues, warning signs and treatment.

Appropriate arrangements were in place in respect of medicines management. Records indicated that staff had received training on the administration of medicines and their competency was assessed. We noted that there were some gaps in medicine administration records (MARs). The service had a comprehensive system for auditing medicines. All the gaps in MARs had been clearly identified by these audits.

One person and relatives told us there were no issues with regards to care worker's punctuality and attendance. They told us that care workers were usually on time and if they were running late, the office contacted them to inform them of the delay. They told us that people experienced consistency in the care they received and had regular care workers.

At the time of the previous inspection in August 2017, the service did not have an electronic system for monitoring care worker's timekeeping and duration of their visit. During this inspection in September 2018, the service had a tele-logging system in place which flagged up if a care worker had not logged a call to indicate they had arrived at the person's home or that they were running late.

We looked at the recruitment records and found background checks for safer recruitment had been carried out to ensure staff were suitable to care for people.

One person we spoke with and relatives told us that care workers were caring and helpful. Staff were able to give us examples of how they ensured that they were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care.

Systems and processes were in place to help protect people from the risk of harm and care workers demonstrated that they were aware of these. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

One person and relatives told us that they were confident that care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers spoke positively about their experiences working for the service. They told us that they received continuous support from management and morale amongst staff was good. Spot checks were in place to assess care worker's competency.

Our previous inspection found that there was a lack of consistency and the quality of care documentation varied. During this inspection in September 2018, we noted that the service had made improvements and ensured that care records were consistent.

Care support plans were individualised and addressed areas such as people’s personal care, what tasks needed to be done each day, time of visits, people’s needs and how these needs were to be met. They also included details of people’s preferences.

The service had a formal complaints procedure in place.

One person, relatives and care workers we spoke with were satisfied with the management at the service. They said that management were approachable and supportive.

Our previous inspection found the service did not have effective systems and processes in place to assess, monitor and improve the quality of the services provided. We previously found a breach of regulation in respect of this. During this inspection in September 2018, we found that the service had taken appropriate action and made improvements. The service had comprehensive MARs audits and checked care plans and risk assessments. The service also carried out regular staff spot checks and supervisions to monitor care workers. We also noted that the service had introduced an electronic tele-logging system to monitor staff punctuality and attendance.

At the time of the inspection there was not a registered manager in post. 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. We discussed this with the head of service and she confirmed that the registered manager had left the service in April 2017 and a manager had been in post since April 2017. We were provided with evidence after the inspection to confirm that the manager had submitted their registered manager application on 18 August 2017.

The service was registered with the CQC in November 2016. This inspection on 17 August 2017 was the first inspection for the service.

People who used the service spoke positively about the care provided. They told us they felt safe around care workers and were happy with the care provided by care workers and management. This was confirmed by relatives we spoke with who told us that they were satisfied with the level of care and raised no concerns.

Individual risk assessments were completed for people. However, some assessments contained limited information and failed to identify areas of potential risks to people. We also found that some risk assessments were incomplete. This could result in people receiving unsafe care and we found a breach of regulation in respect of this.

We checked the medicines arrangements. Care workers received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that there were no unexplained gaps in these in the majority of these.

There were comprehensive and effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff who were unsuitable.

People told us their care workers mostly turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received. Management at the service explained that consistency of care was an important aspect of the care they provided.

Care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers were provided with an extensive induction which provided practical training. Care workers spoke positively about the training they had received.

Care workers were aware of the importance of treating people with respect and dignity. Feedback from people indicated that positive and close relationships had developed between people using the service and their care worker.

Care plans provided information about people’s life history and medical background. There was a support plan outlining the support people needed with various aspects of their daily life such as personal care, continence, eating and drinking, communication, mobility, medicines, religious and cultural needs. Care plans detailed people’s care preferences, daily routine likes and dislikes and people that were important to them.

Daily communication records were in place which recorded visit notes, daily outcomes achieved, meal log and medication support. The manager explained that these assisted the service to monitor people’s progress.

A complaints procedure was in place. People and relatives spoke positively about the service and told us they thought it was well managed and raised no concerns.

There was a management structure in place with a team of care workers, office staff, the manager and head of service. The majority of care workers spoke positively about the management and culture of the service and told us the management were approachable if they needed to raise any concerns.

We spoke with management about the aims of the service. The head of service explained that the service was new and that the aim was for the service to grow in a responsible manner whilst also providing a high level of care.

The last staff meeting took place in February 2017 and this was confirmed by management. The provider aimed to carry out meetings on a monthly basis. The service acknowledged that they needed to ensure such meetings took place and explained that due to the change of manager this meeting had not taken place. The manager confirmed that the next staff meeting was scheduled for September 2017.

The service did not have an effective system in place to monitor the quality of the service being provided to people using the service and to manage risk effectively. The service had failed to effectively check essential aspects of the care provided in respect of risk assessments, MARs and punctuality. We found a breach of regulations in respect of this.

During the inspection, management explained to us that they would make the necessary improvements to aspects of the care. However we needed to be sure that these processes had been implemented consistently over a significant period of time.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.