About the service: Safehands Homecare is a 'domiciliary care agency' providing personal care and support to people in their own homes. The service was providing a regulated activity of personal care to 26 older people at the time of the inspection.

People’s experience of using this service: Issues found under the safe and well-led domains at the last inspection, relating to staff recruitment checks, recording of medicines administration and governance of the service had been addressed.

Recruitment processes had been improved and checks were in place to ensure staff were suitable to work in a care environment. People's medicines were administered as prescribed and recorded appropriately. The registered manager demonstrated an open and honest approach which supported staff to understand the values of high quality person-centred caring. Some audits to monitor the quality and safety of the service to drive improvements, were being developed and enhanced.

People were protected from avoidable harm and abuse by staff who could identify and report safeguarding concerns. People received assessments and support and staff followed guidance where risks were evident to keep people safe.

People told us they received their services on time and that staff were appropriately trained to meet their needs. An induction was completed by new staff and annual training supported staff to enable them to carry out their role effectively. Some specialist training specific to people’s individual needs had been sourced through the local hospice and the community district nursing team.

Staff could tell us how they built trusting relationships with people. Comments from people confirmed that staff maintained their dignity, privacy and promoted their independent living skills.

Staff understood their responsibilities in relation to the mental capacity legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans had been reviewed and updated to contain more person-centred information. The registered manager advised this was a ‘work in progress’ to ensure all personalised information was captured. Staff could identify when people required additional input from health professionals and followed any advice to meet people's specific needs.

People were supported by staff to attend health care appointments and encouraged to participate in activities and events in their local community. Not all people had end of life care plans in place to ensure their wishes were respected. This was an area the provider had identified for further development and had arranged end of life care training for all staff with the local hospice.

Complaints had been addressed in line with the providers policies and procedures. People told us they knew how to make a complaint and would be confident any concerns would be addressed.

Rating at last inspection: Requires Improvement (Published 13 April 2018).

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 15 and 19 March 2018 and is the first inspection of the service. The inspection was announced; we gave the registered provider two days' notice because the location provides a domiciliary care service and we wanted to make sure there was someone at the agency office to assist us with the inspection.

This service provides personal care and support to people living in their own houses and flats in the community. It provides a service to older people and younger adults. At the time of the inspection there were 20 people receiving a service and 12 care workers employed by the service, including a senior care worker who assisted with the management of the service.

The service has a manager in place who is registered with the Care Quality Commission (CQC). 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.

This is the first time the service has been rated Requires Improvement.

Staff received training on the management of medicines and care plans recorded that some people required prompting to take their prescribed medicines. Although people told us they received their medicines as prescribed, we noted that there were a small number of gaps on medication administration records (MARs). The registered manager assured us they would reiterate the importance of accurate recording with care workers.

The registered persons were aware of improvements that needed to be made to the recording of employment references and dates of staff shadowing. They had made good progress towards completing this task to ensure that only people considered to be suitable to work with vulnerable people had been employed.

People were protected from the risk of harm or abuse because the provider had effective systems in place to manage any safeguarding issues. Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. There had been one safeguarding incident and this had been managed appropriately by the registered manager. However, a notification had not been submitted to CQC in respect of this incident as required; we identified that this was an isolated event.

People had care plans in place that described their lifestyle choices and day to day needs. These were personalised and people told us they received support in a way that suited them. Care plans were reviewed and updated every three months to ensure they were a reflection of the person’s current care wishes and needs.

We saw there were sufficient numbers of care workers employed to meet people's individual needs, and that people received the level of support they required to meet their agreed support needs.

Staff understood their responsibilities under the Mental Capacity Act and people confirmed they were consulted about their care and gave consent to the support they received from staff. They told us they were encouraged to make decisions about their day to day lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

We received positive feedback from everyone we spoke with about the support they received from care workers. Our discussions with people and their relatives confirmed that there were positive relationships between people who used the service, their family carers and staff. People felt care workers genuinely cared about them.

Care workers told us they were well supported by the registered provider and manager. They received an induction to their post that included shadowing experienced care workers, and had refresher trainin