This inspection was completed on 9 May 2018 and was announced.

Helping Hands Care Company Ltd. 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 and younger disabled adults.

Not everyone using Helping Hands Care Company Ltd 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.

At the time of our inspection there was not a registered manager in post. A new manager had been appointed and was in the process of applying to be registered. 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.

We last inspected Helping Hands Care Company Ltd. in August 2017. We found significant shortfalls and the service was rated inadequate and placed into special measures. Staff were not deployed effectively. Medicines were not managed safely. Care and treatment was not always provided in a safe way for people. There was a lack of sufficient guidance for staff regarding how to manage risks to people and not all potential risks had been assessed. There was a lack of guidance in place to ensure people were supported appropriately with their health care needs. The provider and registered manager failed to ensure that systems were established and operated effectively to ensure compliance with the regulations. The systems and procedures in place to assess, monitor and drive improvement in the quality and safety of people were not effective. CQC had not been notified of important event that happened within the service. People’s care plans did not reflect their needs and preferences. Complaints were not documented, investigated and responded to.

We took enforcement action and issued warning notices relating to ‘Safe Care and Treatment’ and ‘Good Governance.’ We required the provider to make improvements and the service was placed 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. At this inspection we found that improvements had been made and there were no breaches of the fundamental standards and regulations.

Since our last inspection the previous registered manager had left and a new manager had been appointed. The provider had greater oversight of the service, and was working there each day. They completed a range of checks and audits to ensure that improvements were continuing to be made and people received safe, effective, compassionate care. Medicines were now managed safely and the provider checked medicines administration records (MARs) to ensure they were accurate and fully completed.

A new call handling system had been introduced, which automatically allocated travel time to staff and did not allow staff to be scheduled in multiple places at once. People told us that staff were now on time, and they were not rushed.

Staff had met with each person since our last inspection, and completed a full assessment. Risks had been identified and assessed. There was guidance in place for staff regarding how to respond to risks, such as the breakdown of skin or if people fell. There was still generic information in place regarding people’s healthcare conditions, however, this sat alongside personalised information when there was specific action that staff should take. The provider told us that they wanted to continue to make this information more person-centred going forward. People’s end of life wishes were not consistently recorded and

This inspection took place on 16 and 17 August 2017 and was announced. Helping Hands Care Company Ltd provides care and support to a wide range of people living in their own homes including, older people, people living with dementia, and people with physical disabilities. The support hours varied from one half an hour call a day to four calls a day, with some people requiring two members of staff at each call. At the time of the inspection, 59 people were receiving care and support from the service.

The service had a registered manager in post. A registered manager is a person who is 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.

We last inspected Helping Hands Care Company Ltd in June 2016 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, need for consent, person centred care and good governance.

At our inspection in June 2016, the service was rated ‘Requires Improvement’. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had not met the previous breaches of regulations and further breaches were found.

Staff were not given enough travel time between people’s calls and sometimes they were scheduled to be in two places at once. Staff told us this placed them under pressure, and caused them anxiety and people told us this affected the level of care they received. The registered manager told us they were in the process of implementing a new call logging system that would automatically assign travel time for staff, which they hoped would improve this situation. Staff were not always introduced to people before providing support. They told us that they felt this was uncaring.

The registered manager and provider had made changes to the service without consulting with people or involving staff. Both staff and people we spoke with expressed concerns about the new electronic call monitoring system, and the fact they had been unable to feedback their concerns. Staff told us they did not feel as though they had been supported during its introduction.

People’s care plans contained generic information regarding their health care needs such as diabetes and catheter care. Other guidance for staff, such as how to recognise pressure areas was also generic rather than individualised and there was no information regarding how to respond to any concerns. Some people had developed pressure areas and there had been a delay in seeking medical advice. Risk assessments regarding people falling had not been completed. When people fell, staff did not always inform the office or ensure people received appropriate support.

Medicines were not always managed safely. Staff had not recorded individual medicines they were supporting people to take. One person consistently run out of medicine and no action had been taken to support them with the ordering or delivering of their medicine.

Complaints were not always documented or analysed to look at ways of reducing the risk of reoccurrence. The registered manager did not review and analyse accidents or incidents to look for any trends or ways to prevent them from happening again. People had been asked their views on the service but feedback was not acted on consistently. There was no formal system of review to ensure the service was providing safe, effective care. The registered manager did check medicine records and people’s care plans but had not identified

The inspection took place on 23 and 24 June 2016, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. At the time of the inspection 57 people were receiving the regulated activity of personal care.

Helping Hand Company Limited provides care and support to people in their own homes. The service is provided to older people and older people living with dementia. Staff undertake visits to provide care and support to people in Dover, Deal and surrounding areas.

The service is run by 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 told us they felt safe using the service. Staff were trained in how to protect people from abuse and harm. However, records showed that there had been a minor incident in one person’s home and staff had not reported the event to the registered manager. This was an area for improvement. There were safeguarding procedures in place and staff had received training about abuse. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe. Staff were aware of the whistleblowing policy and told us they would not hesitate to report any concerns to the registered manager who would take appropriate action.

People told us they felt safe when staff were supporting them with their care. However, not all risks associated with people’s care had been identified and assessed. There were no risk assessments in place to support people with their behaviour, how to use the bathing equipment safely or how to reduce the risk of people developing pressures sores. There was not always sufficient guidance in place for staff to ensure people remained safe. There was very limited information in the moving and handling risk assessments to guide staff about how to move people safely and what staff should be doing to keep people safe. Some people were living with diabetes and the care plans lacked detail of the signs and symptoms to watch out for if their condition became unstable. There was a risk that staff may not recognise the signs if a person was becoming unwell and may not seek the necessary medical help.

Some people needed equipment to support them with their mobility. There was no system in place to ensure that this equipment, such as hoists and bath hoists, had been regularly serviced and were safe to use. Accidents and incidents had not been analysed to look for patterns and trends to reduce the risk of further events.

Contingency plans were in place in the event of an emergency, such as bad weather or a breakdown in technical equipment. There was an on call system operating to ensure that people and staff had support outside or normal office hours

People told us they received their medicines when they should and felt their medicines were handled safely. However, care plans were not clear about people’s medicine needs. There were shortfalls in the medicine records and a lack of guidance about some areas of medicine, including topical medicine management.

The registered manager visited people to assess their care needs before the service was commenced. The information gathered did not detail the full guidelines of what care was needed and therefore it was not recorded in the care plan. The care plans were brief and it was difficult to ascertain what had been discussed at the assessment. The care plans were not personalised, they did not have clear and detailed guidance for staff to follow to make sure people received their care and support consistently and safely. People told us their independence was encouraged wherever possible, but this was not always supported by the care plans. Some p

One inspector undertook the inspection. We spoke with twenty of the people who used the service or their relatives as appropriate, the management and care staff.

We set out to answer our five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Prior to the inspection various people in the community and the local social services adult protection team had contacted us. They had raised concerns about whether the care and support people were receiving was safe. Our inspection found the service was safe.

Risk assessments had been carried out concerning the management of medication, mobility, moving and handling and environmental hazards. When risks were identified management plans were in place to minimise the risks. Identified risks were managed to protect people’s safety.

Systems were in place to make sure that the manager and staff learned from accidents and incidents, concerns, complaints, and investigations.

The company had safeguarding policies and procedures available for the staff. The adult protection policy included a clear breakdown of what constituted signs and symptoms of abuse and covered all types of abuse. Two staff members confirmed that they had read and understood the policies and procedures. They were able to demonstrate this by outlining their actions in a hypothetical safeguarding scenario. Staff had received training in safeguarding and mental capacity

A policy was in place to protect people’s money. It clearly stated the obligations of any care staff in relation to the handling of any monies belonging to anyone who used the service. Audits and checks were in place.

Overall, appropriate checks were undertaken before staff began work. Recruitment checks were in place which included completing application forms, checking that references were satisfactory and police checks were in place.

We found that the provider had a ’Criminal Records Policy‘ which stated that the service would, comply with the law and the disclosure and barring service (DBS). The policy was not followed in all cases. When negative information had been received, the manager had not recorded that they had discussed this with the potential staff member to make sure they were safe to work with vulnerable people. Subsequent to the inspection the manager provided evidence that they had reviewed all staff files and ensured that such evidence was available

Staff demonstrated, through discussion that they had the skills and knowledge to carry out their role safely. They felt supported by the management of the service.

Is the service effective?

The service was effective. People told us that they were happy with the care that they received and that their care needs were met. People’s health and care needs were assessed with them and /or their representatives where appropriate. We found that care plans were regularly reviewed to reflect any changes in a person’s needs.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. People said they felt staff respected their privacy and dignity and staff were polite and caring.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care records of six people who received a service. These had detail and guidelines about the support needed to meet the people's needs. Staff had an awareness of the detail in the care plans and of people’s needs.

Is the service responsive?

The service was responsive. Most people and relatives felt that the management were very responsive when they had any concerns. One person said, that when they raised a concern it was dealt with swiftly and thoroughly

People's care plans and risk assessments were reviewed regularly to check they were still meeting people's needs. Spot checks were carried out that ensured that changes of needs were re-assessed and care plans were adjusted to reflect any changes. The manager told us, ’We listen to the staff who report any changes and we go and re-assess if needed‘. People told us that they were involved in developing their own plans of care.

Is the service well-led?

The service was well-led. We saw evidence and discussions with staff confirmed that systems and processes were in place to monitor the quality of the care. A variety of audits and checks contributed to the services assessment of the quality of care given. Where shortfalls were found the manager took the appropriate action to address them

The majority of people spoken with said that it was a good service and well run. They said the office/management team were 'approachable'. Some people said that the manager came to see them when they had expressed concerns and they felt that they were being listened to.

We saw that regular surveys were undertaken to inform the service of any areas of concern and improvement.

Our inspection of 31 July 2013 found that improvements were needed to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not being maintained.

During this inspection we found that improvements had been made and the provider was now compliant.

We visited the office and spoke with the Registered Manager and one member of staff. We also spoke by telephone with three people using the service.

We found that records, including care plans and risk assessments were fit for purpose, and gave staff written guidelines to ensure that people received the care they needed.

People told us they were satisfied with the service. They said: "The service is reliable”. “I am happy with the service”. “The staff are good at helping me with my personal care”. “Overall the staff do a good job”. “The staff are nice and helpful”.

We visited the office and spoke with the Registered Manager and two staff. We later spoke on the telephone to seventeen people who used the service, two relatives and four members of staff.

People and relatives confirmed that they had given their consent and been involved in discussions about their care. They said they were satisfied with the service they received and that their care was personalised to their needs. We saw records to show that people had signed their care plans to show they agreed with the care to be provided.

We found that people needs were assessed before a service was provided and people were involved in planning their care and support. People told us they were supported to take their medicines safely.

People felt that the service recruited the right calibre of staff. The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

People spoken with told us they had been asked for their feedback on the service they received. They said they did not have any complaints and were confident that when issues were raised they would be listened to and acted upon.

We viewed records and found that in some care plans the detail recorded to confirm that people were receiving the care they needed was varied and in some cases there was a lack of information to show how risks were being managed.

People said that they had discussed their support and preferred routines with staff. They received the help they needed and that they were encouraged to do things for themselves. People spoken with confirmed that they had given consent to their care and felt in control of the care they received. Overall people spoken with had no concern with regard to the quality of care and were very complimentary about the quality of the staff and the support offered. People told us they felt safe receiving a service from the agency.

When asked people who use the service stated that they felt that staff that supported them had the skills and experience required and that the agency took time to introduce a new member of staff to them and ensured they were suitable.

People said that they had an active say on ways to improve their care. The management are very receptive to comments and concerns and strive to resolve any issues as soon as possible. People said that they would feel free to make a complaint if necessary.