We carried out a review of the data available to us about The Upper Hand Care Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Upper Hand Care Limited, you can give feedback on this service.
The Upper Hand Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people. At the time of this review, the service was providing personal care for 5 people.
Background to this report
At our previous comprehensive inspection at The Upper Hand Care Limited on 21 March 2019, we identified concerns relating to the key question, Well Led. We found there were a number of systemic issues due to a lack of management oversight and record keeping. Although there was no impact for people who used the service, there were risks which could impact the quality of care provided. This included medicines records, supervision of staff, training quality, staff competency and induction.
These were a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities)
2014, for which we issued a requirement notice. The key question well-led was rated Requires Improvement and the overall location rating was Requires Improvement.
The full report of that inspection can be found by selecting the ‘all reports’ link for The Upper Hand Care Limited on our website at www.cqc.org.uk.
Why we carried out this review
We carried out a review on 27 May 2022 to follow-up on the requirement notice and assess whether the provider has addressed the improvements required at our previous inspection.
We did this using a ‘desk-based’ review process because evidence to demonstrate that the requirement notice had been met could be obtained and assessed remotely without needing an inspection site visit to the location. This was not an inspection: the scope of this review did not include a visit to the service or an assessment of the outcomes for people using the service.
What we found
Details of the findings from this remote assessment can be found under the Well-Led section of this report
This review assessed that The Upper Hand Care Limited has taken action to meet the requirement notice issued after the last inspection. They are therefore no longer in breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities).
Rating at last inspection and update
Following the last inspection, this location was rated requires improvement. Although only the well-led key question was rated requires improvement, if there is a breach of a regulation a location cannot be rated higher than requires improvement overall.
Evidence reviewed remotely provided assurance that improvements had been made to address the issues that resulted in the Well-Led key question being rated Requires Improvement. The rating for Well Led has therefore been updated to Good.
As the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities)
2014 has now been assessed as met and no longer limits the overall rating, this has been updated to Good.
People’s experience of using this service:
¿ There were systematic failings in the oversight and management of the service. During the inspection we identified records were not easily accessible nor completed in line with good practice.
¿ People’s medicines were not audited in a timely manner, meaning issues identified were not always acted on swiftly to minimise the impact on people.
¿ There was minimal evidence that staff had undergone a comprehensive induction process to familiarise themselves with people, the service and their roles and responsibilities. Staff members competencies were not regularly reviewed nor supervisions provided.
¿ Staff did not receive in-depth training to enhance their skills and knowledge. Records confirmed staff received 12 training topics over one day.
¿ People received support from sufficient numbers of staff to keep them safe. Records confirmed pre-employment checks were carried out to ensure only suitable staff were employed.
¿ People were protected against the risk of abuse as staff members could identify, respond to and escalate suspected abuse. Staff received safeguarding training.
¿ Risk management plans in place gave staff clear guidance on how to mitigate identified risks.
¿ People were protected against the risk of cross contamination as the provider had robust infection control measures in place.
¿ Staff were knowledgeable about and adhered to the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s consent to care and treatment was sought and respected.
¿ People were supported to access sufficient amounts of food and drink that met their dietary needs and preferences.
¿ People received care and support from staff that were kind, caring and compassionate. People’s privacy was respected and their equality and diversity embraced.
¿ People’s dependency levels were monitored and staff were aware of the importance of supporting people to remain as independent as possible, where safe to do so.
¿ People’s care plans were person-centred and tailored to their individual needs and requirements. Where possible, people and their relatives were encouraged to develop their care plans.
¿ People were aware of how to raise concerns and complaints and were confident these would be managed in line with the provider’s complaints policy.
¿ People’s views were sought through regular telephone monitoring. At the time of the inspection no issues had been identified that required any action.
¿ Relative’s and staff described the registered manager as approachable, supportive and professional.
¿ The registered manager stated she was keen to work in partnership with other healthcare professionals to drive improvements.
Rating at last inspection: The service was registered on 23 April 2018 and has therefore not previously been inspected.
Why we inspected: This was a planned inspection in line with our inspection programme.
Enforcement: At this inspection we identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance. Details of action we have asked the provider to take can be found at the end of this report.
Follow up: We rated this service requires improvement, we will therefore re visit the service within the next 12 months in line with our re-inspection programme. If any concerning information is received we may inspect the service sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk