Background to this inspection
Updated
28 March 2024
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by an inspector, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
This service also provides care and support to a person living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
The inspection was announced.
Inspection activity started on 21 November 2023 and ended on 11 December 2023. We visited the location’s office on 21 and 23 November and 5 December 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with the registered manager, trainee team leader and 6 support workers. We reviewed records relating to people’s care and support, medicines management, staff recruitment, training and support and the management of the service, including policies and procedures. We visited 4 people at their home, spoke with 3 relatives by phone and contacted a health and social care professional for their feedback.
Updated
28 March 2024
About the service
Safe Hands Home Care Limited is a domiciliary care agency providing personal care to older people, those with a physical disability, people living with dementia and people with a learning disability who are living in their own homes. At the time of our inspection there were 8 people using the service who received the regulated service of personal care.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
The registered manager had not read this guidance and therefore they were not fully able to demonstrate how the service was meeting the underpinning principles of ‘Right support, right care, right culture.’
Right Support
An effective system to assess, monitor and manage risk was not in place. Risks relating to people’s care and support and medicines had not been fully assessed.
Relatives told us that people were generally supported by the same staff and there had been no missed calls. One relative said, “There is more or less the same carers, they have been there a long time, more than 14 years. She is quite happy with them.”
Right Care
Care plans did not fully reflect people’s needs. The registered manager told us these were being updated.
People were supported to access the local community and take part in activities, where this was part of their plan of care.
People and relatives we spoke with talked positively about the caring nature of staff. One relative told us, “When [name of staff member] goes in, she will put bird food out for her, she likes to see the birds.”
Right Culture
An effective system was not in place to monitor and manage the quality and safety of the service and ensure regulatory requirements were met. We identified shortfalls across many areas of the service including the assessment of risk, medicines management, the maintenance of records relating to people, staff and the management of the service. These had not been identified by the provider’s monitoring systems.
Whilst we did not identify any impact on people, there was the potential for people to come to harm, as risks were not adequately assessed and records were not well maintained. The registered manager told us they were reviewing their whole governance system to ensure it effectively monitored the quality and safety of the service.
People and relatives spoke positively about the service. One relative said, “I’m happy with it all - I would recommend it. I would say that they are good at their jobs, know what they are doing and are nice and kind people.” Staff also spoke enthusiastically about working at the service and the people they supported.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 1 June 2023).
At our last inspection there were 3 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Safe care and treatment; Staffing [in relation to training] and Good governance. We issued a warning notice in relation to Regulation 17 [Good governance] and told the provider and registered manager, action needed to be taken to improve. The provider completed an action plan to show what they would do and by when to improve. We also met with the provider and registered manager to discuss how they would make changes to ensure they improve their rating to at least good.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We have found evidence that the provider needs to make improvements. Please see the full report below for further details.
Enforcement and Recommendations
We identified 3 continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Safe care and treatment, Staffing [in relation to training] and Good governance. 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.
Follow up
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.