Caring Hands (Care Services) Limited provides personal care to people in their own homes. Care and support is provided to older people, some of whom have dementia, and also people with physical and other disabilities. As part of the inspection we spoke with the registered managers, care coordinator and staff working at the service. We also spoke with people receiving care and examined records relating to the service provided.We completed a responsive inspection of Caring Hands because of concerns we received about aspects of practice at the service. The CQC do not investigate individual complaints but we looked at whether effective systems were in place to protect the welfare and safety of people receiving care.
Below is a summary of what we found.
Is the service safe?
We found that enough staff were provided to meet people's care needs at the service.
Although assessments and care plans were in place, the provider was not fully ensuring risks to peoples' welfare and safety were identified and managed. Care plans did not always contain information about the care that staff were actually giving and risks were not always identified promptly and appropriate action taken for the planning and delivering safe care. Although a care coordinator was able to tell us how some incidents and concerns had been responded to, there were no effective systems to show whether this always happened; what had been done in response to incidents or how any risks had been reviewed or reduced.
Systems for managing people's medication were not protecting them from risks. This was because there were no detailed plans about what support people needed with medication and records were inaccurate and incomplete.
The registered managers were able to describe who they would contact with concerns about neglect or abuse. Although the training staff received included all relevant information, two staff we spoke with were not aware of the correct procedure for recording allegations or concerns about the safety of people receiving care.
We met with the provider on 21 August 2014 and one of the registered managers told us they had delivered more training to staff and reinforced the need to use correct procedures where there were concerns about abuse or neglect. We also saw that arrangements for the safe administration of people's medication were being improved.
Is the service effective?
Care plans were in place at the service that covered different areas of people's care needs. Some care plans included detailed assessments, including about moving and handling. Records about people's care needs did not contain sufficient guidance for staff about any diagnosed health conditions or disabilities to ensure they were alerted to risks and people's care effectively met their needs.
Is the service caring?
People told us that they were happy with the staff that provided their care. One person told us, 'I would employ all of the carers.'
Care plans were in place but were brief and focussed on care tasks that would be completed by staff. Care planning did not provide detailed information about how people's care was actually delivered to ensure they received personalised care that met their individual needs and preferences.
Is the service responsive?
Systems were in place for obtaining people's views about the service provided and people were contacted regularly to give feedback about their care. Staff we spoke with said team meetings were held to allow them to discuss the quality of practice at the service.
We found complaints and comments about the service were not properly recorded including a record of how they were responded to.
Is the service well-led?
The registered managers did not have an effective system for identifying and managing risks or provide an overview of current concerns or areas of development at the service. Although we saw on-call records that showed incidents had occurred that could cause harm to people using the service, there was no system for recording or analysing these.
Care plans we saw had not been updated to take account of incidents that had occurred in order that risks could be managed effectively.
We met with the provider on 21 August 2014 and saw that systems were being introduced to record and review incidents that occurred at the service.
The registered managers had not notified the CQC of three deaths that had occurred in the presence of staff from the service, as required by law.