Extrahand Care Services Ltd

At the previous inspection in January 2018 the service was found to be in breach of the regulations in relation to fit and proper persons being employed. This was because necessary checks had not been completed prior to some people starting employment. The service had sent us an action plan which identified what they would do and by when to improve the key question 'safe' to at least good. At this inspection we found the service had completed the action plan and were no longer in breach of the regulations.

Extrahand Care Services Ltd is a domiciliary care agency. They provide personal care to people living in their own homes in the community for; older adults, including people with dementia, people with physical disabilities and people with learning disabilities. At the time of this inspection there were nine people receiving a regulated activity.

There was 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 continued to be protected from the risk of harm and abuse. Safeguarding policies and procedures were clear and had been followed when required. Staff were knowledgeable about what might be a safeguarding concern and how to report this.

There were enough staff to ensure people were supported safely. Staff told us they felt they had enough time on visits. People who received a service said they felt safe and did not feel rushed when receiving care and support.

Staff had been recruited safely. We reviewed three staff recruitment files which included people who had been employed since the last inspection. All necessary pre-employment checks had been completed. Recruitment files included the necessary documentation.

Risk assessments had been completed and management plans developed which ensured people were supported to manage the risks in their daily lives.

Medicines had been managed safely. Medication administration records (MAR) had been completed and checked to ensure medicines were administered as prescribed. People were supported with their medicines where it had been assessed as necessary.

People continued to be protected from the risk of infection and cross contamination. There was an infection control policy in place. Staff had received training and had access to gloves, aprons and hand gel, which had been provided by the agency.

People's needs had been assessed prior to them receiving a package of care. This ensured the service were confident they were able to meet their needs. The service had involved individuals in their assessments and consulted with others involved to ensure assessments were comprehensive.

Staff had received training appropriate to their role. New staff without a background in care were supported to complete the Care Certificate. Staff said they had received sufficient training. The training records were up to date with the dates people needed to complete refresher training identified.

People had been supported to maintain their nutrition and hydration. When we inspected there was no one who needed a modified diet recommended by speech and language therapists. However, the staff were aware of what might indicate a swallowing difficulty and how to refer people on to appropriate professionals.

The staff team were coordinated and kept each other up to date to ensure effective care was provided. The team liaised with other services and health staff effectively.

People were supported to maintain their health and wellbeing. We could see people had been supported to make and attend medical appointments when required.

The service continued to work within the principles of the Mental Capacity Act 2005 (MCA). Staff understood the importance of gaining people's consent prior to providing care and support.

People told us they felt well cared for and said staff were kind and caring. Staff understood how to support people to maintain their privacy and dignity and could describe how they supported people with respect. Written entries in care files were respectful.

People had been supported to communicate their views and wishes. Communication guides included in the care plans identified how best to support people to communicate. Information could be provided to people in different formats, such as, large print if necessary.

People were supported to maintain their independence and encouraged to complete tasks they had identified as goals.

Holistic assessments ensured people continued to receive personalised care that was responsive to their needs. All areas of the person's health and social care needs had been assessed. Care plans had been developed with the person which identified specifically how they preferred their needs to be met. The service ensured any changes to people's assessed needs had been responded to and referrals made to other professionals as required. Care plans had been regularly reviewed in consultation with the person and their families to ensure they remained up to date.

There was a complaints policy in place. Information about how to complain had been included in the information provided to people by the service. People we spoke with had not felt the need to raise a complaint, but told us they knew how to do this. In addition, quality assurance visits were completed to explore people's experience of the care provided. We could see improvements had been made in response to these visits.

There was a clear management structure in place. Staff were aware of their obligations in relation to the standards of care they provided and their own professional behaviour. Staff also said they felt the service was well managed and the management team were supportive and approachable.

Governance systems ensured the management had oversight of service delivery. Any issues identified had been addressed. Staff also told us they felt they had been involved in the development of the service and their views were considered.

The service had continued to work in partnership with other agencies and organisations including the local authority and local commissioners.

All necessary statutory notifications had been received by CQC. The service's CQC report and rating continued to be displayed in the office and on their website.

The five questions we ask about services and what we found