We undertook an announced inspection of Helping Hands Harrow on 25 September 2018.

Helping Hands Harrow is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. At the time of inspection the service provided care to 25 people, five of whom received personal care. CQC only inspect the service 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.

Our previous inspection in August 2017 found that there was no registered manager in post. The service took action in respect of this and this inspection in September 2018 found that there was a registered manager in post. 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 previous inspection on 17 August 2017 found two breaches of regulation. We rated the service as "requires improvement". During this inspection on 25 September 2018, we found that the service had made improvements in respect of risk assessments, medicines management, quality checks and audits.

Feedback indicated that people and relatives were satisfied with the care and services provided. One person we spoke with told us they were treated with respect and felt safe in the presence of care workers. Relatives we spoke with confirmed this.

Our previous inspection found a breach of regulation in respect of risk assessments. We found that the service did not always identify all potential risks and there was limited information contained in risk assessments. During this inspection in September 2018, we found that the service had taken appropriate action and made improvements in respect of this. We found appropriate risk assessments were in place and were personalised and included information specific to each person and their needs. Where people had specific health issues, there were appropriate risk assessments which included a summary of protective and preventative measures. These were also accompanied by an information fact sheet which provided details of specific health issues, warning signs and treatment.

Appropriate arrangements were in place in respect of medicines management. Records indicated that staff had received training on the administration of medicines and their competency was assessed. We noted that there were some gaps in medicine administration records (MARs). The service had a comprehensive system for auditing medicines. All the gaps in MARs had been clearly identified by these audits.

One person and relatives told us there were no issues with regards to care worker's punctuality and attendance. They told us that care workers were usually on time and if they were running late, the office contacted them to inform them of the delay. They told us that people experienced consistency in the care they received and had regular care workers.

At the time of the previous inspection in August 2017, the service did not have an electronic system for monitoring care worker's timekeeping and duration of their visit. During this inspection in September 2018, the service had a tele-logging system in place which flagged up if a care worker had not logged a call to indicate they had arrived at the person's home or that they were running late.

We looked at the recruitment records and found background checks for safer recruitment had been carried out to ensure staff were suitable to care for people.

One person we spoke with and relatives told us that care workers were caring and helpful. Staff were able to give us examples of how they ensured that they were respectful of people’s privacy

We undertook an announced inspection of Helping Hands Harrow on 17 August 2017. Helping Hands Harrow is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. At the time of inspection the service provided care to 23 people, eight of whom received personal care. The inspection focused on the care received by the eight people who received personal care.

At the time of the inspection there was not a registered manager in post. 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 discussed this with the head of service and she confirmed that the registered manager had left the service in April 2017 and a manager had been in post since April 2017. We were provided with evidence after the inspection to confirm that the manager had submitted their registered manager application on 18 August 2017.

The service was registered with the CQC in November 2016. This inspection on 17 August 2017 was the first inspection for the service.

People who used the service spoke positively about the care provided. They told us they felt safe around care workers and were happy with the care provided by care workers and management. This was confirmed by relatives we spoke with who told us that they were satisfied with the level of care and raised no concerns.

Individual risk assessments were completed for people. However, some assessments contained limited information and failed to identify areas of potential risks to people. We also found that some risk assessments were incomplete. This could result in people receiving unsafe care and we found a breach of regulation in respect of this.

We checked the medicines arrangements. Care workers received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that there were no unexplained gaps in these in the majority of these.

There were comprehensive and effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff who were unsuitable.

People told us their care workers mostly turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received. Management at the service explained that consistency of care was an important aspect of the care they provided.

Care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers were provided with an extensive induction which provided practical training. Care workers spoke positively about the training they had received.

Care workers were aware of the importance of treating people with respect and dignity. Feedback from people indicated that positive and close relationships had developed between people using the service and their care worker.

Care plans provided information about people’s life history and medical background. There was a support plan outlining the support people needed with various aspects of their daily life such as personal care, continence, eating and drinking, communication, mobility, medicines, religious and cultural needs. Care plans detailed people’s care preferences, daily routine likes and dislikes and people that were important to them.

Daily communication records were in place which recorded visit notes, daily outcomes achieved, meal log and medication support. The manager explained that these assisted the service to monitor people’s progress.

A complaints procedure was in place. People and relatives spoke positively about the service and told us they thought it