This was an announced inspection, carried out on 14 and 17 October 2016. We gave 48 hours’ notice of the inspection because the manager is often out of the office supporting staff or providing care. We needed to be sure that the registered manager or someone who could act on their behalf would be available to support our inspection.

Hand in Hand is a domiciliary care agency, providing personal care and support to people living in their own homes. The service operates from an office based in St Helens Merseyside.

The service has a manager who was registered with CQC. 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 told us they felt safe using the service. They said staff were careful and treated them well. Staff had completed training about safeguarding people and they had access to information and guidance as a reminder of their responsibilities should they have any safeguarding concerns. Staff knew about the different types of abuse and indicators of abuse.

Staff were confident about dealing with an emergency situation should one arise. People, family members and staff were provided with information about who they could contact for advice, guidance or support at any time of the day or night.

The registered provider had a policy and procedure relating to medicine management. Staff responsible for administering medication completed the relevant training and had their competency checked regularly to ensure they were managing people’s medicines safely.

Staff received the training and support they needed. New staff completed an induction programme and all staff received on-going training relevant to their role, responsibilities and the needs of the people they supported. One to one and group meetings offered staff with an opportunity to discuss their work and training and development needs. Staff felt well supported in their roles and had no concerns about approaching the registered manager or any other member of the management team should they need advice or support.

An assessment of people’s needs was carried out and appropriate care plans were developed. Care plans detailed people’s preferences with regards to how they wished their care and support to be provided. Care plans were regularly reviewed with the involvement of the person and other significant people such as family members.

The registered manager understood what their responsibilities were for ensuring decisions were made in people’s best interests. Staff were aware of the need to obtain people’s consent prior to providing people with care and support.

People told us that the staff were kind, caring and polite and that the staff respected their privacy, dignity and independence. People told us they enjoyed the company of staff because they cheered up their day and shared laughter and banter with them.

People told us that staff arrived at their homes on time and always stayed for the right amount of time. People were happy that wherever possible the same staff who knew them well visited them.

People’s wishes and preferences were accurately reflected in the care plans and contact records were maintained to show people received the right care and support. Contact records were also used as a way of communicating important information to relevant others about people’s needs.

People who used the service, family members and staff told us they thought the service was well managed. They described the registered manager and other members of the management team as being approachable and supportive.

Systems were in place to monitor the safety and quality of the service and to gather the views and experiences of people and their family members. The service was flexi