This comprehensive inspection took place on 13 and 14 December 2018 and was announced. This service 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 adults.

Not everyone using Caring Hands received regulated activity. The Care Quality Commission (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. At the time of this inspection the service provided personal care to 32 people.

The service was run by a single provider who was in day to day control of the service. It was therefore not required to have a registered manager. The provider is an individual 'registered person'. 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. The provider was supported to run and lead the service by an office care manager and a community care manager.

At the last comprehensive inspection in April 2016 the service was rated Good for each key question. Was the service safe, effective, caring, responsive and well-led? This led to an overall rating of Good. At this inspection the provider had not maintained this standard and we have rated this service as Requires Improvement. This is the first time the service has been rated Requires Improvement.

We identified one breach of the Regulations of the Health and Social Care Act (2008). This related to the lack of governance and audits completed by the provider. The provider had no formal system to check if staff training equipped them for their role. There were no formal medicines or care record audits. This is discussed in more detail in the well-led section of the report.

We identified two breaches of the Care Quality Commission (Registration) Regulations 2009. The provider had not submitted statutory notifications to the CQC to notify us of the death of a person using the service or of an incident of alleged abuse as required. The provider acted to address these concerns during the inspection.

Staff supported some people with their medicines, as required. The provider gave assurances that they completed competency assessments to assess the ability of staff to deliver this care safely. However, these were not documented. This was not in line with the provider’s policy. Without exception, people and their relatives told us, medicines were administered safely. The provider gave assurances at the time of our visit they would ensure they formalised this process in the future. We have made a recommendation about medicines management.

Staff received training to provide them with the knowledge and skills required for their role. However, the training was limited to what the provider considered to be mandatory. A review was required to determine the appropriateness of the training and the potential impact this may have on staff and people using the service. We made a recommendation about the on-going management and recording of staff training and support.

People were protected from harm. Staff received training and understood how to recognise signs of abuse and who to report this to. Staffing levels were sufficient to provide safe care. The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting. When people were at risk, staff had access to assessments and understood the actions needed to minimise harm. The service was responsive when things went wrong, were open and reviewed practices and had a system in place to manage incidents. People were protected by the service's arrangements for the prevention and control of infection.

People were supported by staff, as needed, with meal preparation and the provision of drinks. People received appropriate healthcare sup

This inspection took place on 27 April 2016 and was announced 48 hours prior to the inspection taking place. Caring Hands is a domiciliary care agency providing personal care and support to people living in their own homes in and around the Horsham area of West Sussex. At the time of the inspection approximately 35 people were receiving a service. The service was provided to adults and the majority of people using the service were older people. The service also supported some younger people with physical disabilities. The registered provider was managing the service on a day to day basis. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported to remain safe. Staff had received training and understood how to recognise signs of abuse and how to report any concerns. Procedures for managing medicines were safe, staff had received training and understood how to support people to have their medicines safely. Risks to people were identified and managed and staff told us that having comprehensive risk assessments in place helped them to provide care safely and to support people to take positive risks. People told us they felt safe and that they had trust in the staff supporting them. There were sufficient staff to cover all the visits and people told us they had regular carers who came on time and stayed for the expected duration of the visit. One person said “They are always the same carers unless they are sick, they let me know if there are any changes.”

Staff were well supported and had received training to equip them with the knowledge and skills they needed to meet people’s needs. One staff member said “They really care about the staff, we are really well supported.” New staff received a thorough induction and all staff received observations of their practice to ensure they were delivering care effectively. A relative told us that they had confidence in the skills and abilities of the care workers saying “I was able to go away for a weekend for the first time in the knowledge that they would be content and unafraid.” Some staff had received training specific to the needs of people they were supporting, an example of this was for someone who required a specialist technique to receive their food, fluids and medication.

People were supported to have sufficient to eat and drink and staff were proactive in recognising risks or needs associated with nutrition. People told us they were happy with the support they received, one person said “The carer warms the meal for me and cooks fresh vegetables, they always set it out nicely, I’m fussy about that.” Staff supported people to access health care services and had developed good links with local services.

People’s consent was being sought in line with the Mental Capacity Act 2005 and staff were aware of their responsibilities with regard to this legislation. People told us they were very happy with the care they received and described the care workers as patient, caring and kind. Staff spoke about the people they were supporting in a caring and compassionate manner. People were treated with dignity and respect and felt their views were listened to. One person said “I am never made to feel a bother,” another person told us “They treat me with great respect and kindness.”

Care plans were developed with the involvement of people and their relatives and reflected their individual needs and preferences. Staff knew the people they were caring for well, one staff member said “It’s the detail that’s important, knowing that someone likes their bacon crispy and prefers bread and butter to toast, that’s not in their care plan but you just get to know them.” People told us that they felt confident that any concerns or complaints would be listened to and acted upon and that they knew how to raise such matters. One person said “Contacting the agency is al

We carried out this inspection as part of our schedule of inspections to check the care and welfare of people who used this service. As part of our inspection we spoke with two of the people who used the service, four relatives and three care workers.

People we spoke with told us that they felt involved in making decisions about the support they received. They felt that the care workers always respected their privacy and dignity. People told us that they had confidence in the service and the care workers. They said that they felt safe and listened to. They said that the care workers were very good at communicating with them and were open to suggestions. One relative told us that, "It's lovely to find an agency where the care is consistent. They always send the same carer, at the correct time. They do exactly as they should. I really can't fault them."

We found that the provider did not have effective recruitment procedures to ensure that care workers were of good character and had the qualifications, skills and experience necessary for the work to be performed.

People told us they were happy with the care they received from the service.

We found people's views were taken into account and each person care records were reviewed on a monthly basis. We found people's family and/or their representatives were involved in their care.

We found people needs were assessed and care and treatment planned and delivered to meet these needs. Care records we reviewed were detailed and we saw that risk assessments were linked to people’s care plans.

Staff received training which was relevant to their roles and provided support staff needed to deliver treatment that was safe and appropriate to meet people’s needs.

The provider had a system in place to monitor and assess the quality of the service they provided.

A single inspector carried out this inspection. As part of our inspection we visited the agency’s office. We spoke with two people using the service, four relatives and three staff about their role and responsibilities.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

- Is the service safe?

- Is the service effective?

- Is the service caring?

- Is the service responsive?

- Is the service well-led?

This is a summary of what we found –

Is the service safe?

People told us that they felt their rights and dignity were respected. People told us, “They always stay the correct length of time and do the things they are meant to. I wouldn’t dream of changing to another agency. It’s really lovely. I can’t fault it.” The provider had a system in place to identify, assess and manage risks to the health and safety of people who use the service and others. We saw that the external environmental and access had been risk assessed prior to a care package being agreed. Recruitment practice was safe to ensure that only staff suitable to work with vulnerable people were employed by the service. All the people we spoke with were happy with the service’s medication practices. People told us they felt safe and had no concerns regarding the service.

Is the service effective?

People told us that they were happy with the care they received and their needs had been met. It was clear from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. One relative told us, “They always send the same carers. It’s always a familiar face, never anyone we don’t know.” People told us that, “The quality of staff is excellent.” Staff had received training to meet the needs of the people using the service. They told us, “The training is very thorough. I started with an induction and then I did some ‘shadowing’ visits. Everyone is really helpful and supportive.”

Is the service caring?

People told us that they liked the staff. Comments included, “They are very caring”, “Very kind”, “I’m very happy with it”, and “They are always prompt and very professional.” When we spoke with staff it was clear they enjoyed their role and they had a good relationship with the people they provided care to. Staff told us, “It’s the best agency I’ve ever worked for. I really enjoy my job. All the clients are lovely.”

Is the service responsive?

People’s needs had been assessed before care had been provided. People said that they were involved in their care. People told us they could raise concerns or make suggestions to the staff if necessary. They told us they had confidence in the staff. “I really am delighted. If not I’d tell them and they’d soon fix it.”

Is the service well-led?

People were very happy with the care and support they received. People told us they felt they were listened to and their views were taken seriously. The provider had a system to regularly assess and monitor the quality of service that people received against the requirements of the essential standards. This included assessing the quality of care people received. We saw evidence that direct observation of staff took place which monitored the quality of the care and support given. Staff were clear about their roles and responsibilities. We were told that the staff got on well together and worked as a team. Staff said that they were well supported by the manager and management team who were, “Very supportive.” We were told that there were always, “Three people on call, if I need to phone them.”