This inspection took place on 28 June 2018 and 29 June 2018. On both days, the inspection was announced due to the amount of people this agency supported. The provider was given five days’ notice of our inspection visit to ensure senior management, registered managers, care staff and associated records were available when we visited the office.

Helping Hands Live-in National is a domiciliary care agency which provides personal care and support to people in their own homes nationwide as a ‘live in’ service, which supports people who may have complex care needs. Care staff would usually be on site in the person’s home up to 24 hours per day.

At the time of our inspection visit, the agency supported more than 750 people. This was the first time the service had been inspected under its current registration. However, the service was inspected previously in June 2016 under a different registration, when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We rated the service as ‘Good’ in all areas.

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. Helping Hands employed several registered managers at this location. There were three registered managers in post, and two registered manager posts were being filled at the time of our visit, both of these registered manager posts had been recruited to. Both new appointees were progressing their registration with CQC, and one was due to commence their employment. Each regional area, North, South, East and Central had a manager (or registered manager) responsible for the staff and the delivery of care to people using the service, within those regions. In addition, there was a registered manager appointed to manage clinical support and clinical training for staff.

People felt safe using the service and staff understood how to protect people from abuse and keep people safe. There were procedures to manage identified risks with people’s care and for managing people’s medicines safely. Checks were carried out on staff during the recruitment process to make sure they were suitable to work with people who used the service.

There were enough staff to deliver the care and support people required and people usually received care from a consistent staff team. People told us staff were friendly, respectful and caring and had the right care skills to provide the care and support they required. Staff received an induction when they started working for the service and completed training to support them in meeting people’s needs. Staff felt the training provided them with the right skills and knowledge to support people safely and effectively.

The provider understood the principles of the Mental Capacity Act (MCA), and staff respected people’s decisions and gained people’s consent before they provided personal care. People were protected from the spread of infection, as staff were trained in how to use preventative measures such as protective gloves and clothing to prevent cross contamination.

Care plans contained relevant information for staff to help them provide the personalised care people required. People knew how to complain and information about making a complaint was available to them. Staff said they could raise any concerns or issues with the provider, registered managers, and their immediate line manager knowing they would be listened to and acted on.

There were processes in place to monitor the quality of the service provided and to understand the experiences of people who used the service. This was through regular communication with people and staff, returned satisfaction surveys, staff meetings,