This inspection took place on the 14, 16 and 21 March 2018 and was announced. Following the previous inspection on 13 July 2017, this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the service demonstrated to us that improvements have been made and is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Handle With Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, including people living with dementia, younger adults and people with a physical disability. Not everyone using Handle With Care receives a service which is a 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 was in place who was also the provider. 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. Another manager had also been recruited and they were in the process of applying for registration. We have therefore referred to the ‘registered manager’ and the ‘manager’ in this report.

At our last inspection in July 2017, we found risks to the health and safety of people were not always assessed and were not always safely managed. At this inspection, whilst we found some improvements, we also found that information about people’s risks was not always clear, up to date and available to staff. This meant that staff may not have access to the information they needed to guide them to provide safe care and all the actions they could take to reduce risks as much as they could. The provider had not sustained the improvements they told us they had made to people’s risk assessments following the last inspection.

At our last inspection in July 2017, we found the provider had failed to operate effective systems and processes to monitor and mitigate risks to people and maintain an accurate, complete record in respect of each service user and staff member. At this inspection we found that some improvements had been made. However, we also found other concerns about the quality and safety monitoring of the service and the accuracy and completeness of records.

People’s rights under the Mental Capacity Act (2005) were not always fully supported through recorded mental capacity assessments to assess their ability to make decisions about their care and treatment. This is important to ensure people are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible.

Although the provider had a procedure for end of life care planning, people, their families or carers had not been involved in creating and recording a care plan which would support staff to know, understand and act on people’s end of life care needs and wishes. The lack of information and guidance could put people at the end of their life at risk of receiving inappropriate care and treatment.

At our last inspection in July 2017, we found the provider had failed to safely manage and dispose of people’s medicines. At this inspection, we found systems and processes had been improved and medicines were disposed of safely. Some improvements were still required in record keeping to support safe disposal and administration.

At our last inspection in July 2017, we found the provider

We carried out this unannounced inspection on 13 July 2017.

Handle With Care provides personal care services to people living in their own home. At the time of our inspection there were 167 people receiving this service. There were 56 staff members who provided personal care to people which included two senior managers, one trainee manager, three senior care assistants, five risk assessors, and two co-ordinators.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection in November 2016 we found safe medicine practices were not followed. At this inspection we found safe medicines practice continued to not be followed.

At our last inspection in November 2016 we found risk assessments were completed but not always dated and did not contain all the information on how risks to people could be minimised. At this inspection we did not find an improvement with this concern.

At our last inspection in November 2016 we found safe recruitment processes were not followed. At this inspection we found safe recruitment practices continued to not be followed.

At our last inspection in November 2016 we found staff training was not always effective. Staff competencies were not checked and staff did not receive an effective supervision to support them to carry out their duties. At this inspection we found training and supervisions did not always equip staff with the skills and knowledge to support people effectively because their competencies were not checked.

At our last inspection in November 2016 we found consent was not always sought when people were considered to lack capacity. At this inspection we found staff and the registered manager demonstrated an improved knowledge of how to support people who lacked capacity to consent to their care.

At our last inspection in November 2016 we found assessments of need were not always completed prior to the commencement of care. Care plans contained insufficient detail regarding people’s preferences, choice, wishes and risks and the in

We carried out this announced inspection on 21, 22 and 23 November 2016.

Handle with care provides personal care services to people living in their own home. At the time of our inspection there were 162 people receiving this service. There were 62 staff members who provided personal care to people which included, two senior managers, one trainee manager, three senior care assistants, three risk assessors, and two co-ordinators.

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 said they or their relative received safe care. However this was not our overall findings.

People’s medicines were not managed or disposed of in a safe way and risks to people were not appropriately identified, assessed or action taken to minimise the risk to people and others. Staff’s fitness for work had not been assessed. Missed visits had occurred but was currently being managed. Safeguarding concerns had been received into the service and was dealt with in line with the provider’s policy; however the Commission had not been notified of these safeguarding concerns.

People said staff were sufficiently skilled and experienced to care for them because they had regular staff who knew them well. However we found staff training was not always effective because the registered manager’s knowledge of the subjects they trained staff on was lacking. Staff received an induction programme but their understanding and competency was not checked.

Although staff received a yearly appraisal; staff did not receive an effective supervision to support them to carry out their duties.

Consent was not always sought when people were considered to lack capacity, though staff did confirm they asked people for consent when providing personal care. Capacity assessments had not been completed for people who were considered to lack capacity and people were not involved in the development of their care plan when they were considered to lack capacity. Staff and the registered manager could not demonstrate a good understanding of how the Mental Capacity Act was used in their role.

People were not always supported sufficiently to have enough to eat and drink because records did not accurately detail the support people required and the risks associated with this.

People were unable to recall if they had been involved in their assessment of care and their care plans did not include their preferences, how they would like to receive their support and what they were able to complete themselves. However staff said they asked people how they would like their support to be provided on a daily basis and ensured people were involved in carrying out care for themselves.

Assessments of need were not always completed prior to the commencement of care. Care plans contained insufficient detail regarding people’s preferences, choice, wishes and risks and the information in the care plans were not always accurate. People were not always involved in their care planning

There was a registered manager who was supported by two senior managers with the day to day running of the service, although staff said they could speak with the registered manager when required they mostly spoke with the senior managers to discuss their concerns. The registered manager failed to complete a Provider Information Return when requested and did not have systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of the service user and others who may be at risk.

Audits had not been completed of people’s care plans and risk assessments and as a result we found people’s care records did not contain all the information required

The inspection was carried out by a single inspector. As part of the inspection process we also used an Expert by Experience to obtain the views of people who used the service and to understand the service from their point of view. The expert spoke by phone to 18 people who used the agency and one relative. We also spoke with a member of staff from the local social services department who contracted with the provider and to the manager, the provider and six members of staff.

We used this inspection to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led?

This is a summary of what people told us and what we found. If you wish to see the evidence supporting our summary please read the full report

Is the Service Safe?

People we spoke with and their relatives said they were satisfied the standard of care provided by agency. Everyone told us they felt safe with the people who provided care to them. One person who used the service told us, “I am happy with the staff who come to support me”. Another person said” I am always treated with dignity and respect”.

We saw risk assessments were in place. We found the service had systems in place to ensure people were protected from abuse, or the risk of abuse. Staff had an understanding of safeguarding issues and how to report abuse or allegations of abuse.

CQC monitors the operation of the Mental Capacity Act 2005. The provider and manager at Handle With Care had a good understanding of the Mental Capacity Act 2005 and their responsibilities.

Is the service effective?

People who used the service told us that they were satisfied with the care and support they received.

Staff told us that the management were very supportive and that there was always someone available to offer advice and support.

Is the Service Caring?

People who used the service and their relatives told us support was provided in a caring way. They said that staff were kind and caring and treated them with dignity and respect.

Staff we spoke with said they were motivated to provide high quality care. They were aware of people’s needs and how they preferred to have their care delivered.

Is the service Responsive?

People’s care plans took into account information about people’s needs and preferences. Where people were not able to communicate, information from family members or others was used. Care plans were reviewed regularly and we found the service had systems in place to ensure the care and treatment provided was appropriate to people’s changing needs.

Is the service well- led?

Systems were in place to regularly assess and monitor the quality of the service provided. There were processes in place to review and learn from incidents, accidents and complaints.

People who used the service, their relatives and staff were asked for their views about how the agency was meeting people’s needs. One person told us “The management have asked me and my relatives if everything is OK and asked me if there was anything extra they could do - I said no because I am very content with my carers”.

Staff told us that there were regular staff meetings and that they received spot checks to evidence they were supporting people effectively.

The manager said staff received regular supervision and also had annual appraisals. Staff confirmed this.

As part of the inspection process we used an expert by experience to obtain the views of people who used the service. The expert spoke to 20 people who used the agency or their relatives. People were generally happy with the care and support the agency provided. People told us that that the staff who supported them were normally punctual and stayed the correct length of time. They said staff were friendly and cheerful and treated them with dignity and respect.

One person told us. “They talk to me, never rush me and always ask me what I want them to do. I try to be independent and they encourage me.” Other comments from people included: “I can’t fault them in any way. I am very happy with the care service I get.” “I am perfectly happy with the service and they provide a great service.” And “I am quite satisfied.”

We spoke with the manager and nine members of staff. They all told us they were well supported by Handle With Care. They told us training was good and they were provided with the information they needed to support people effectively.

We spoke to five people who used the agency and two relatives of people who used the agency. All of the people we spoke to were happy with the service that the agency provided. People told us that that the staff who supported them were normally punctual and stayed the correct length of time. They said staff were friendly and cheerful and always treated them with dignity and respect.

One person told us, “The staff are wonderful”. Other comments from people included: “I am happy with the carers who call,” and, “I can not fault the staff, I have not had any problems”.

Each person we spoke with told us that they had an information pack in their home and this had details about the care and support they needed as well as importance contact telephone numbers. Relatives of people told us that their family members were well supported by staff to receive the care they needed.

We were told by people who used the service that they felt safe and had no concerns about the staff who supported them. They said that staff treated them well. Relatives of the people we spoke with were all happy with the support their relatives received.

We spoke with eight members of staff. They said that they were well supported by the agency and confirmed that the recruitment process was thorough. They told us that management were very supportive and approachable.

We telephoned people who use the agency and also some relatives of people who use the service. They were all happy with the service that Handle with Care provides.

People stated that the care workers provided by the agency appeared to know what was expected of them and had the necesssary skills to meet their needs. People stated care staff were normally punctual and stayed the correct length of time. The said that staff are friendly and cheerful and always treat them with dignity and respect.

One person told us staff were excellent and said “they are my life line I could not do without them”

None of the people we spoke with had made any complaints but they said that they were aware of how to complain and were confident that any complaints would be dealt with appropriately.