Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Helping Hand Care Company Ltd Office 5, 23-25 Worthington Street, Dover, CT17 9AG Tel: 01304242981 Date of Inspection: 13 August 2014 Date of Publication: September 2014 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Safeguarding people who use services from abuse Requirements relating to workers Supporting workers Assessing and monitoring the quality of service provision Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Helping Hand Care Company Limited Miss Clare Sutton Helping Hand is a domiciliary care agency registered to provide personal care. Domiciliary care service Personal care Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 6 Our judgements for each standard inspected: Care and welfare of people who use services 7 Safeguarding people who use services from abuse 9 Requirements relating to workers 10 Supporting workers 11 Assessing and monitoring the quality of service provision 12 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 13 August 2014, checked how people were cared for at each stage of their treatment and care and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and reviewed information sent to us by commissioners of services. We talked with commissioners of services. We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. What people told us and what we found One inspector undertook the inspection. We spoke with twenty of the people who used the service or their relatives as appropriate, the management and care staff. We set out to answer our five key 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. The summary is based on our observations during the inspection, speaking with people using the service, the staff and from looking at records. If you want to see the evidence supporting our summary please read the full report. Is the service safe? Prior to the inspection various people in the community and the local social services adult protection team had contacted us. They had raised concerns about whether the care and support people were receiving was safe. Our inspection found the service was safe. Risk assessments had been carried out concerning the management of medication, Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 4
mobility, moving and handling and environmental hazards. When risks were identified management plans were in place to minimise the risks. Identified risks were managed to protect people's safety. Systems were in place to make sure that the manager and staff learned from accidents and incidents, concerns, complaints, and investigations. The company had safeguarding policies and procedures available for the staff. The adult protection policy included a clear breakdown of what constituted signs and symptoms of abuse and covered all types of abuse. Two staff members confirmed that they had read and understood the policies and procedures. They were able to demonstrate this by outlining their actions in a hypothetical safeguarding scenario. Staff had received training in safeguarding and mental capacity A policy was in place to protect people's money. It clearly stated the obligations of any care staff in relation to the handling of any monies belonging to anyone who used the service. Audits and checks were in place. Overall, appropriate checks were undertaken before staff began work. Recruitment checks were in place which included completing application forms, checking that references were satisfactory and police checks were in place. We found that the provider had a 'Criminal Records Policy' which stated that the service would, comply with the law and the disclosure and barring service (DBS). The policy was not followed in all cases. When negative information had been received, the manager had not recorded that they had discussed this with the potential staff member to make sure they were safe to work with vulnerable people. Subsequent to the inspection the manager provided evidence that they had reviewed all staff files and ensured that such evidence was available Staff demonstrated, through discussion that they had the skills and knowledge to carry out their role safely. They felt supported by the management of the service. Is the service effective? The service was effective. People told us that they were happy with the care that they received and that their care needs were met. People's health and care needs were assessed with them and /or their representatives where appropriate. We found that care plans were regularly reviewed to reflect any changes in a person's needs. Is the service caring? The service was caring. People were supported by kind and attentive staff. People said they felt staff respected their privacy and dignity and staff were polite and caring. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care records of six people who received a service. These had detail and guidelines about the support needed to meet the people's needs. Staff had an awareness of the detail in the care plans and of people's needs. Is the service responsive? Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 5
The service was responsive. Most people and relatives felt that the management were very responsive when they had any concerns. One person said, that when they raised a concern it was dealt with swiftly and thoroughly People's care plans and risk assessments were reviewed regularly to check they were still meeting people's needs. Spot checks were carried out that ensured that changes of needs were re-assessed and care plans were adjusted to reflect any changes. The manager told us, 'We listen to the staff who report any changes and we go and re-assess if needed'. People told us that they were involved in developing their own plans of care. Is the service well-led? The service was well-led. We saw evidence and discussions with staff confirmed that systems and processes were in place to monitor the quality of the care. A variety of audits and checks contributed to the services assessment of the quality of care given. Where shortfalls were found the manager took the appropriate action to address them The majority of people spoken with said that it was a good service and well run. They said the office/management team were 'approachable'. Some people said that the manager came to see them when they had expressed concerns and they felt that they were being listened to. We saw that regular surveys were undertaken to inform the service of any areas of concern and improvement. You can see our judgements on the front page of this report. More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 6
Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People had their care needs assessed before care began. Staff had identified needs and risks in all areas of people's care and treatment and these were appropriately described and recorded. From documentation viewed we found that assessments of needs were comprehensive, individualised and included personal care, nutrition, mobility, skin integrity and communication. We looked at six people's care plans. Each person was provided with a plan of care and support documentation in their own home with a copy retained in the office. Care plans included how to meet people's care needs such as helping people to wash and dress; managing meal preparation; managing medication; and assisting people with increasing their mobility or dexterity. We spoke with 20 people who used the service. People said that their staff were polite, kind and respectful. One person said 'They are lovely people. They all listen to me and we have some really nice little chats'. Another person said, 'They usually send the same people and I've got to know them really well. It's nice that they send the ones that I like. That makes me happy'. Two people said it was important that they got the same carers as far as possible because they were not comfortable with change. Other people said, 'I've got to know the staff really well and they feel more like friends. I have had a few falls and it shakes me up for a few days. They always know when I'm a bit down and they cheer me up'. A relative said, 'There's always a bit of banter which he really enjoys. He's very fond of one of the carers that he has and looks forward to seeing her'. This person also said that the length of visits had been increased in recognition of them needing a higher level of support, which they were very pleased about. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 7
The service tried to accommodate people at their preferred times during the day, and the people spoken with and those surveyed by the service on the whole said that staff arrived at the agreed time. Staff confirmed that the service strived to provide a personalised service tailored to the needs of the people using the service. Staff spoken with discussed how care was delivered and how they ensured the care was personalised and individual. Risk assessments had been carried out concerning the management of medication, mobility, moving and handling and environmental hazards. When risks were identified management plans were in place to minimise the risks. The service had provided two staff members to care for some people who were at risk of falling during transfers and had ensured appropriate equipment was obtained to support safe moving and handling. People's care plans and risk assessments were reviewed regularly to check they were still up to date. Reviews were carried out by the manager that ensured that changes of needs were re-assessed and care plans were adjusted to reflect any changes. The manager told us, 'We listen to the care staff who report any changes and we go and re-assess if needed'. Daily logs were kept about people and the findings were communicated to health care professionals appropriately if needed. People were referred to GPs and district nurses when needed. We saw examples within care plans where the service had worked with other agencies in supporting people with their healthcare needs. The service had an out of hours service that meant people's calls were answered without delay if they needed support in an emergency situation. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 8
Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People felt safe with the staff from the service. One person said, 'I feel safe because I know them well'. One person told us that the staff were able to let themselves in to their home by accessing the key from the key safe. They said this meant that they knew only approved staff could enter their home to provide care, and that made them feel safer. Another person said that they knew when the staff were due to arrive at their home, so they always felt safe, and they trusted the carers. The service had made safeguarding policies available for the staff. The adult protection policy included a clear breakdown of the signs and symptoms of abuse and covered all types of abuse. The policy stated who staff were required to inform of any suspicions of abuse and detailed what the safeguarding procedures were. Two staff members confirmed that they had read and understood the policies, and was able to demonstrate this by outlining their actions in a hypothetical safeguarding scenario. A staff member told us that they had attended safeguarding training, and we saw training records which confirmed this. There was a finance policy in place that clearly stated the obligations of any care staff in relation to the handling of any monies belonging to anyone who used the service. Audits and checks were in place to ensure staff followed the policy. We saw evidence of regular supervisions and spot checks that minimised risks to people who used the service. All staff had a criminal record check from the Disclosure and Barring Service (DBS) carried out prior to commencing work. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 9
Requirements relating to workers People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. People were cared for, or supported by, suitably qualified, skilled and experienced staff. However improvement was needed with regard to evidencing that discussions had taken place for any staff with information on their police check or criminal background check. Reasons for our judgement There were effective recruitment and selection processes in place. Recruitment checks were in place which included completing application forms, checking that references were satisfactory. New staff had been subjected to a police check before they started working with the people who used the service. Records showed that people's identity and qualifications had been verified and that the interview process had included checking the gaps in people's employment history. Staff we spoke with confirmed they had a formal interview and relevant checks. We saw on the staff files that staff had been given a copy of their job descriptions and contracts so they were aware of their role and responsibilities. The manager told us that when staff started working they received induction training and shadowed experienced staff before they were deemed competent to work on their own. Staff told us they had received training and shadowed senior staff as part of the induction process. The manager said that staff worked through a probationary period to make sure they had the right skills to carry out their duties. We found that the provider had a 'Criminal Records Policy' which stated that the service would, comply with the law and the disclosure and barring service (DBS). This policy stated, "The registered provider must always be consulted in the event of a conviction or relevant caution being revealed on a disclosure, and where it may be proposed to employ the applicant. The decision to employ must rest with the registered provider and be explicitly recorded as such". The provider may find it useful to note that we found that the policy was not followed in all cases. The manager stated that discussions had already taken place with staff where information about previous convictions and cautions but there was no written evidence of this on staff files. Subsequent to the inspection the manager provided evidence that they had reviewed all staff files and ensured that such evidence was available. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 10
Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement Staff received appropriate professional development. Seventeen out of the twenty people said that staff were well trained and that their needs were always met. One person said, "I have had to change to this service because I need two carers but I am more than happy. They are reliable and are properly trained - which is the main thing". Another said that 'staff exceeded expectations' and 'nothing was too much bother', 'they have lots of patience' and make them feel "human". Three people said that there was a difference in levels of experience across different staff. Two staff spoken with at the time of the inspection demonstrated that they had the skills to carry out their role. Records also showed that staff had received training in essential courses including, safeguarding adults, manual handling, medication, dementia and mental capacity. Staff said they felt supported by the training to carry out their role. Staff said they had a good understanding of the different policies and procedures. They knew where to access them and where they would get further advice from. Staff said that they received support from the manager. They said that they had a number of opportunities to discuss any issues arising from their training or in general and received regular supervision. Evidence of supervision was found within the staff files. Staff said that the training and support they received helped them improve the care and support they provided. We saw evidence that staff had an in house induction when they started working at the service which covered health and safety and fire evacuation procedures. A foundation induction programme that followed the elements of national guidance issued by Skills for Care (a government backed training agency) was also in place for new staff. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 11
Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement People who use the service and their representatives were asked for their views about their care and they were acted on. The majority of people said that it was a good service and well run. They said the office/management team were 'approachable'. Some people said that the manager came to see them when they had expressed concerns and they felt that they were being listened to. One relative said although they were out of the area, 'That's been part of the deal really - that we keep the same company because they are so well organised and efficient. I can't praise the management highly enough'. People and relatives felt that the management were responsive when they had any concerns. One person said, 'There was one staff who upset us very much. The manager and the owner both came to see us at home and were very kind and understanding. They made lots of notes. Another person said that they were in hospital two months ago and, on discharge, their needs had changed. They told us that the manager came out straight away to assess what extra care and support they needed and this was provided. People told us the care and support they received had been reviewed. Evidence of reviews was seen within the care plans. People were involved in deciding if and when changes were required and how the service would be provided. The service had a number of systems in place to make sure that they assessed and monitored its' delivery of care. The manager checked the daily record sheets that were returned to the office each month to ensure staff were supporting people the way they had agreed. The manager also monitored the times staff were visiting people and the length of time spent at the visit. The manager explained and we saw examples of medication records that were checked when they were returned to the office. The service had a process in place to manage risk to people and staff. Individual's records contained risk assessments, including instructions to staff on action to reduce risks to people using the service and themselves. These included environmental and individual Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 12
risks. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We saw evidence that the service had taken action when they found that some staff were not completing attendance records accurately. The service had a process in place to complete 'spot checks' on staff to ensure that they were performing their duties to the required standard. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 13
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 14
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 15
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 16
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 17
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 18
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Helping Hand Care Company Ltd September 2014 www.cqc.org.uk 19