This inspection took place on 1 and 5 November 2018. We announced the inspection in advance because the service is small and we wanted to be certain the registered manager would be available to support with the inspection.

At the previous inspection in January 2018 the service was found to be in breach of the regulations in relation to fit and proper persons being employed. This was because necessary checks had not been completed prior to some people starting employment. The service had sent us an action plan which identified what they would do and by when to improve the key question 'safe' to at least good. At this inspection we found the service had completed the action plan and were no longer in breach of the regulations.

Extrahand Care Services Ltd is a domiciliary care agency. They provide personal care to people living in their own homes in the community for; older adults, including people with dementia, people with physical disabilities and people with learning disabilities. At the time of this inspection there were nine people receiving a regulated activity.

There was a registered manager. 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 continued to be protected from the risk of harm and abuse. Safeguarding policies and procedures were clear and had been followed when required. Staff were knowledgeable about what might be a safeguarding concern and how to report this.

There were enough staff to ensure people were supported safely. Staff told us they felt they had enough time on visits. People who received a service said they felt safe and did not feel rushed when receiving care and support.

Staff had been recruited safely. We reviewed three staff recruitment files which included people who had been employed since the last inspection. All necessary pre-employment checks had been completed. Recruitment files included the necessary documentation.

Risk assessments had been completed and management plans developed which ensured people were supported to manage the risks in their daily lives.

Medicines had been managed safely. Medication administration records (MAR) had been completed and checked to ensure medicines were administered as prescribed. People were supported with their medicines where it had been assessed as necessary.

People continued to be protected from the risk of infection and cross contamination. There was an infection control policy in place. Staff had received training and had access to gloves, aprons and hand gel, which had been provided by the agency.

People's needs had been assessed prior to them receiving a package of care. This ensured the service were confident they were able to meet their needs. The service had involved individuals in their assessments and consulted with others involved to ensure assessments were comprehensive.

Staff had received training appropriate to their role. New staff without a background in care were supported to complete the Care Certificate. Staff said they had received sufficient training. The training records were up to date with the dates people needed to complete refresher training identified.

People had been supported to maintain their nutrition and hydration. When we inspected there was no one who needed a modified diet recommended by speech and language therapists. However, the staff were aware of what might indicate a swallowing difficulty and how to refer people on to appropriate professionals.

The staff team were coordinated and kept each other up to date to ensure effective care was provided. The team liaised with other services and health staff effectively.

People were supported to maintain their health and wellbeing. We could see people had been supporte

This was an announced inspection which took place on 12 and 20 October 2017. The inspection was announced to ensure that the registered manager or other responsible person would be available to assist with the inspection visit. This was the first comprehensive rated inspection of the service following their registration with the Care Quality Commission in March 2016.

Extrahands Care Limited is registered with the Care Quality Commission (CQC) to provide personal care to people in their own homes in the community. At the time of our inspection visit, seven people were being supported and were all privately funding their care. The service is located in Hyde, Tameside and is situated close to transport links.

The service had a registered manager. 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.

At this inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to fit and proper persons employed. Recruitment processes required improvements to ensure only suitable staff were employed to work with vulnerable people.

We received positive comments from two relatives acting on behalf of their family members.

Staff were aware of their responsibilities in keeping people safe and had received training in safeguarding adults.

The provider refers to people they support as clients and we have used this reference throughout the report. We found there were enough staff to make sure clients received the care they needed. Clients and relatives told us staff generally arrived on time. The service had a monitoring system that continually checked the promptness of their visits and were able to take action, if staff were running late for any reason.

Staff were given appropriate support through a programme of training and on-going supervision, and an annual appraisal. Care staff said the training provided them with the skills and knowledge they needed to do their jobs.

Client's support plans contained up to date, detailed information about their care and support, including risk assessments and action plans. The registered provider and registered manager used a variety of methods to assess and monitor the quality of the service. They carried out a lot of checks and visits to each person to make sure the care and support was a good standard at all times.

The complaints procedure was explained in the 'service user guide.' This was provided to clients when they first choose the service to provide their care package.

Clear guidance for the management of medicines was in place. The manager carried out observation checks and records kept demonstrated people received their medicines safely and as prescribed. Staff responsible for supporting clients with their medicines had ¿received training to ensure they had the competency and skills required.