This inspection took place on 1, 2, 4 and 15 May 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. This was the first inspection since the service was registered at this location in March 2017.

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. At the time of our inspection 24 people were using the service, 11 of whom received personal care.

Not everyone using Hand 2 Hold receives 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 in place. 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.

People and their relatives told us staff at the service helped them to stay safe. Risks to people were assessed and plans put in place to reduce them. The provider had plans in place to support people in emergency situations that disrupted the service. Policies and procedures were in place to ensure good standards of infection control. People’s medicines were managed safely. Policies and procedures were in place to safeguard people from abuse. The provider and registered manager monitored staffing levels to ensure enough staff were employed to keep people safe. The provider’s recruitment policies minimised the risk of unsuitable staff being employed.

Staff received a range of mandatory training to help them provide effective support and received regular supervisions and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Some people using the service received support with food and nutrition. Where this was the case people’s dietary needs and preferences were supported. People were supported to access external professionals to monitor and promote their health.

People and their relatives spoke very positively about the support they received from the service. All of the relatives we spoke with said the health and wellbeing of people had improved as a result of the kind and dedicated support staff offered. People and their relatives said staff treated people with respect and helped them to maintain their dignity and independence. People were supported to access advocacy services.

People and their relatives said people received personalised care based on their support needs and preferences. Personalised care planning and delivery was evident. People and their relatives said communication with the service was good. Policies and procedures were in place to investigate and respond to complaints. The provider had policies in place to support people with end of life care if needed.

Staff spoke very positively about the culture, values and leadership of the service. The provider and registered manager carried out a number of quality assurance checks to monitor and improve standards at the service. Plans and procedures were in place to obtain feedback on the service from people, relatives and staff. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.