This inspection took place on 10 February 2017. In Safe Hands provides domiciliary care to people living in their own homes. At the time of our inspection, 17 people were supported with personal care.

This agency was last inspected in January 2016 and was rated as ‘requires improvement’. We found a breach of the regulations relating to the governance of the service. At this inspection we found improvements had been made, although further improvements were still required to show what actions and learning had been identified from their own quality assurance systems.

The service had 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 felt safe with the staff who supported them. Staff received training to safeguard people from abuse. They were supported by the registered manager, who ensured staff followed safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were mostly identified and staff were aware of current risks and how they should be managed. The registered manager agreed to provide more detailed information where risks were known, so staff continued to provide consistent and safe care.

Some people were given their medicines by staff who were trained and assessed as competent to give medicines safely. Records showed people’s medicines were given in a timely way and as prescribed. Checks ensured medicines were managed safely and staff were observed by management to ensure they were competent to do so.

There were enough staff to meet people’s needs effectively, and people told us they had a consistent and small group of staff who supported them, which they appreciated. The registered manager completed pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in their own homes.

People told us staff asked for their consent before undertaking any personal care tasks. Where people were able to make their own decisions, staff respected their right to do so. Some people’s ability to make their own decisions fluctuated, but staff knew people’s individual reactions that showed them if people wanted to be supported or not. The staff team and the registered manager worked within the principles of the Mental Capacity Act.

People and relatives told us staff treated them with dignity, kindness and respect. People’s privacy was maintained and people felt comfortable when staff supported them with personal care needs.

The registered manager sought regular feedback from people and made improvements to ensure they were proactive in improving the service people received. For example, the registered manager was looking at ways to see if they could provide a day centre for people to improve people’s friendship with others and help reduce social isolation (Although this is not part of their regulated activity).

People saw health professionals when needed and the care and support provided was in line with what they had recommended. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. Some care plans were updated with the most recent information and were detailed, however, some improvements were required in risk assessments and in some care plans. The registered manager was aware of this and was working on ensuring all care records were updated. People were involved in how their care and support was delivered, as were their relatives.

People and relatives felt able to raise concerns with the registered manager. They felt these would be listened to an

In Safe Hands is a domiciliary care agency which provides personal care support to people in their own homes. At the time of our visit the agency supported 24 people with personal care and employed 16 care workers.

We visited the offices of In Safe Hands on 4 and 13 January 2016. We told the provider before the visit we were coming so they could arrange for people and staff to be available to talk with us about the service.

The provider for this service is an individual owner. Unlike a registered company, they are not required by law to have a separate registered manager, unless they do not have the skills and experience to manage the service themselves. The provider for In Safe Hands undertook all of the day to day management tasks.

People and their relatives told us they felt safe using the service and care workers understood how to protect people from abuse. Staff knew how to keep people safe. Processes that helped keep people safe required further improvements. This included checks on care workers to ensure their suitability to work with people who used the service and the completion of risk assessments. Risk assessments were not always recorded or detailed enough to ensure people received consistent and safe support. People assessed as requiring two care workers to provide safe care did not always receive this.

The provider and staff had limited understanding of the principles of the Mental Capacity Act (MCA), and how this affected some people’s decisions to consent. Care workers respected people’s decisions and gained people’s consent before they provided personal care or support.

There were enough suitably trained care workers to deliver care and support to people. Most people had care workers they were familiar with, who stayed the agreed length of time and these calls were made at the time they preferred.

Care workers received an induction and a programme of training to support them in meeting people’s needs effectively. People told us care workers were kind and caring and had the right skills and experience to provide the care and support they required. People were involved in how their care package was planned but some care records required more detailed information for care workers to help them provide consistent care for people.

People knew how to complain and were able to share their views and opinions about the service they received. Care workers were confident they could raise any concerns or issues with the office management, knowing they would be listened to and acted on.

The systems and processes to monitor the quality of the service provided were not always effective. Due to recent management changes, the systems were not thoroughly effective so regular checks on the quality of service people received had not been completed. Some management staff were not aware of their roles and responsibilities and delegated tasks were not always checked by the provider to ensure action had been taken.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.