This inspection took place on the 14, 16 and 21 March 2018 and was announced. Following the previous inspection on 13 July 2017, this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.Handle With Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, including people living with dementia, younger adults and people with a physical disability. Not everyone using Handle With Care receives a service which is a regulated activity; CQC only inspects the service being 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.
There was a registered manager was in place who was also the provider. 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. Another manager had also been recruited and they were in the process of applying for registration. We have therefore referred to the ‘registered manager’ and the ‘manager’ in this report.
At our last inspection in July 2017, we found risks to the health and safety of people were not always assessed and were not always safely managed. At this inspection, whilst we found some improvements, we also found that information about people’s risks was not always clear, up to date and available to staff. This meant that staff may not have access to the information they needed to guide them to provide safe care and all the actions they could take to reduce risks as much as they could. The provider had not sustained the improvements they told us they had made to people’s risk assessments following the last inspection.
At our last inspection in July 2017, we found the provider had failed to operate effective systems and processes to monitor and mitigate risks to people and maintain an accurate, complete record in respect of each service user and staff member. At this inspection we found that some improvements had been made. However, we also found other concerns about the quality and safety monitoring of the service and the accuracy and completeness of records.
People’s rights under the Mental Capacity Act (2005) were not always fully supported through recorded mental capacity assessments to assess their ability to make decisions about their care and treatment. This is important to ensure people are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible.
Although the provider had a procedure for end of life care planning, people, their families or carers had not been involved in creating and recording a care plan which would support staff to know, understand and act on people’s end of life care needs and wishes. The lack of information and guidance could put people at the end of their life at risk of receiving inappropriate care and treatment.
At our last inspection in July 2017, we found the provider had failed to safely manage and dispose of people’s medicines. At this inspection, we found systems and processes had been improved and medicines were disposed of safely. Some improvements were still required in record keeping to support safe disposal and administration.
At our last inspection in July 2017, we found the provider had failed to establish and operate effective systems and processes to prevent abuse of people. At this inspection we found improvements had been made and safeguarding concerns had been raised with the Local Authority and investigated appropriately.
At our last inspection in July 2017, we found the provider had failed to operate an effective recruitment procedure. At this inspection we found improvements had been made and safe recruitment practice had been followed. However, records did not always evidence that plans in place to monitor risks associated with the employment of staff had been adhered to. We have made a recommendation about this.
Incidents and accidents were monitored to check action had been taken to address safety issues and prevent a reoccurrence.
People and their relatives reported some dissatisfaction with the timing of their calls, the duration of their call and communication from the office when care staff were running late. We discussed this with the provider who told us care was contracted to be delivered within a two hour window. However, from the feedback we received people were not always aware of these arrangements and said the service was not meeting their expectations. We have made a recommendation about this.
At our last inspection in July 2017, we found the provider had failed to provide appropriate supervision and training to enable staff to carry out their duties effectively. At this inspection we found a system was in use to check staff competencies through observed supervision. This system enabled senior staff to confirm people were cared for effectively.
People’s needs were assessed and these included information about people’s cultural and spiritual needs. Staff demonstrated an awareness of people’s diverse needs and a respect for people’s chosen lifestyles.
People’s dietary needs were assessed and people told us they were supported with these appropriately.
People were supported to access healthcare services as required. However, where there was a delay in the response from a healthcare service, this was not always robustly followed up to protect people from deterioration in their condition. The provider has assured us future delays will be reported to the local authority safeguarding team to protect people from this risk.
People and their relatives told us staff were kind and caring and their privacy and dignity were respected by staff.
Staff we spoke with knew about the interests of the people they supported and some people told us they were cared for by familiar staff who showed an interest in their lives and wellbeing. The provider checked staff were delivering kind and compassionate care through competency based supervisions, although not all of these were up to date.
At our last inspection in July 2017, we found the provider had failed to operate an effective and accessible system for dealing with people’s complaints. At this inspection, we found improvements had been made. However, records to evidence the outcomes and actions taken in response to complaints were not always fully completed to show the complaints system was operated effectively for people.
People told us the care they received met their needs, even when they expressed dissatisfaction with the timing and duration of their care calls. People’s care plans were not always up to date and this was being acted on by the manager to ensure care plan guidance for staff was accurate.
Peoples needs in relation to the protected characteristics under the Equalities Act 2010, were taken into account in the planning of their care. People’s communication needs were assessed and staff demonstrated an understanding of how to meet these.
At our last inspection in July 2017, we found the provider had failed to notify the Commission without delay of any abuse or allegation of abuse in relation to a person. At this inspection we found the provider had failed to notify us of one allegation of abuse. The provider had notified the
local authority and the appropriate action had been taken in response to this concern. We have
made a recommendation about this.
At our last inspection in July 2017, we found the provider had failed to display their current rating on their website. At this inspection we found there was a link on the provider’s website to the most recent report.
Staff spoke positively about changes in the service since our previous inspection. This included the appointment of a new manager, improved communication between managers and staff and an improved team culture.
We found four 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. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.