This inspection took place on 10 May 2016 and 3 June 2016. On both days, the inspection was announced. Due to the amount of people this agency supported, the provider was given seven days’ notice of our inspection visit to ensure senior management, registered managers, care staff and associated records were available when we visited the agency’s office.

Helping Hands is a domiciliary care agency which provides personal care and support to people in their own homes within the local geographical area of Alcester. In the report, this is referred to as the hourly service. Helping Hands also provides a nationwide ‘live in’ service to support people living in their own homes who may have more complex care needs and therefore, require additional levels of support.

At the time of our inspection visit, the agency supported in excess of 1000 people across the live in service and the hourly service (hourly service calls range from 15 minutes to 10 hours in duration).

This service was last inspected on 22 April 2013, when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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. Helping Hands employed several registered managers at this location. Each regional area, North, South, East and Central had a registered manager responsible for the staff and the delivery of care to people using the service, within those regions. Where required, we have split certain sections of our report into these geographic areas to report on our findings.

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 received care from a consistent staff team. People told us staff were friendly, respectful and caring and had the right 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.

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 and registered manager, knowing they would be listened to and acted on.

There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. This was through regular communication with people and staff, returned surveys, operational board meetings, spot checks on care staff and a programme of other checks and audits.

In the report we have reported the hourly service and live in service separately where we want to make people’s experiences of those services reflective of the service they received.

Helping Hands provided hourly care and support to people using their service. A live-in care service was also provided for people. The live-in care service covered England and parts of Wales.

During our visit we spoke with one of the company directors, the registered manager, quality assurance manager and the director for hourly care.

We spoke with two relatives and two people who received a service from Helping Hands to obtain their views. We also spoke with three members of the care staff.

People and relatives we spoke with told us they were happy with the care provided. One relative told us the service was recommended to them and said “The care worker is absolutely wonderful.”

People who received daily care said “I am happy with what they do.”

People told us they felt their relative was safe and would make a complaint if it was necessary.

Staff told us about the induction programme they had followed before working with people. This was confirmed when we looked at their personal records. Staff had received mandatory training and they told us they had regular opportunities to update their skills and knowledge so that they could meet and understand people’s needs.

The agency had undertaken regular quality checks to ensure they provided a good service and we saw changes they had made to improve their service.

We visited Helping Hands on 26 September 2012. Helping Hands provided hourly care and support to people using their service. A live-in care service was also provided for people. The live-in care service covered England and parts of Wales.

During our visit we spoke with three people who used the service and three members of staff. We also spoke with the training manager, the quality assurance manager and registered manager for Helping Hands.

People we spoke with told us the staff delivering their care were respectful and appeared well trained. People receiving daily care told us that staff generally arrived at the expected time.

People told us they felt safe and would make a complaint if it was necessary. Staff told us that the training they undertook about safeguarding was "informative" and they would report any suspicion of abuse.

Care staff told us they liked working for the agency and they had regular opportunities to update their skills and knowledge so that they could understand and meet people's needs.

The agency had undertaken a review of their care planning documentation and was in the process of producing the new and improved care plan records for people using the service.

At this review we specifically looked at the care delivery for people using the Live In Care service. This is care delivered by the agency to people wanting care support for 24 hours a day each day of the week. The care worker delivering this care lives in the person’s home with them.

We spoke with one person who was receiving Live In Care and the family representatives for five people receiving Live In care as their family member was unable to tell us about the care delivered to them.

People we spoke with told us that they had been consulted with about the type of care worker they wanted to live in their home and deliver their care. One person told us that they had met the care worker before they came to deliver care. Another person told us, ‘We did not meet them first, they came straight to the house’.

One person we spoke with was having a temporary care worker whilst their permanent care worker took annual leave. They told us, ‘I know who is coming for the next three weeks. My usual care worker is very good and coming back to me after her holiday.’

People we spoke with told us that care workers had usually met their requirements. One person told us, ‘We have had a wide range of carers. Some have been good, others not so good.’ Another person told us, ‘We only had one to choose from, we did meet them first and they have been perfect’.

We asked people if care workers administered their medication to them safely and at the right time. People were happy, they told us, with how care workers gave them their tablets and did not have any concerns. People told us, ‘It’s done fine’ and ‘No problems’ and that care workers always signed the care record to say they had given the medication. People we spoke with commented that care workers kept very good records about the care delivered and why it was given.

When we asked people if they felt their care worker had the skills necessary to meet their care needs they told us that generally they did. One person using the Live In Care service told us that when they first began to use the service they had a few problems, which ‘ all got sorted and it’s fine now.’ Another person told us, ‘My mother has vascular dementia and the carer is very understanding of her dementia care needs.’