Care at Hand Limited is a care at home service providing support to adults of all ages, including people who may be living with dementia, have mental health needs or physical disabilities. This was the first assessment carried out under our single assessment framework. This assessment was announced. Assessment activity started on 01 September and ended on 15 October 2025. At the start of our assessment, the service was providing the regulated activity of personal care to 10 people. This responsive assessment was carried out as we had received concerns about aspects of the safety and management of the service. We looked at a total of 15 quality statements, all of which were in the Safe and Well Led key questions. At our last inspection we rated the service Good (published 27 Feb 2024), however we rated the Well Led key question as Requires Improvement and found the provider was in breach of the legal regulation in relation to governance. Improvements were not found at this assessment, and the provider remained in breach of this regulation. In addition, at this assessment, we also found the provider was in breach of the legal regulation relating to safe care, staffing and the submission of statutory notifications. The service did not have a registered manager. At the time of this assessment, the nominated individual was managing the service on a day-to-day basis, with the support of senior staff from another service where they were also registered. A nominated individual is a registered person whose name has been notified to CQC as being the person who is responsible for supervising the management of the carrying on of the regulated activity on behalf of the provider. The provider had failed to maintain effective oversight of the service. Quality assurance processes were not being operated effectively. Audits and checks completed did not identify all of the concerns found during this assessment. Whilst some issues had been identified, the provider had failed to ensure actions were put into place to mitigate risks, make improvements and monitor progress. Feedback from the local authority assessment undertaken in July 2025 had not been acted upon. Staff were consistently not providing timely care to people. Staff did not always arrive to care visits on time or stay for the required duration. The provider analysed completed call data but were unaware of the shortfalls in care delivery we found. Care plans and associated risks assessments were not in place for all of people’s needs. Where measures were in place to mitigate risk, staff did not always adhere to guidance provided. Changes to the management at the service had created instability. There was a disconnect between the provider organisation, staff and people in receipt of a service. Staff were not being supported via team meetings, supervision and spot checks and expressed concerns regarding the management arrangements. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.
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Care at Hand Limited is rated Good overall, with four key questions rated Good, but Well-led requires improvement due to a breach of Regulation 17 arising from insufficient governance, audit arrangements, complaints responsiveness and staff meeting structures. Recommendations were also made regarding staffing sufficiency and complaints management, though no evidence of harm to people was found.
Concerns (6)
criticalGovernance: “There were few quality assurance and governance arrangements in place, such as audits, to monitor the service.”
moderateComplaints handling: “people told us where they had raised a concern with the manager, their concern had not been responded to and they were still awaiting a response.”
moderateStaffing levels: “Concerns were raised with us by 1 person to imply there may not always be enough staff to support their family member to stay safe.”
moderateSupervision / appraisal: “There was no evidence to demonstrate the previous provider had completed formal supervisions and 'spot visits' for staff.”
moderateRecord keeping: “Recruitment practices were not as robust as they should be, and improvements were required. The provider could not demonstrate all records relating to staff's employment had been sought.”
minorStaff training: “action was required to ensure staff received appropriate training relating to people with a learning disability and autistic people.”
Strengths
· People felt safe and well cared for, with no safeguarding concerns raised with the Local Authority or CQC.
· Medicine Administration Records demonstrated people received their medicines as required, with staff competency assessed.
· Staff supported people with dignity, respect and person-centred care; permanent staff ensured continuity and rapport.
· People were supported to maintain independence and make choices about their care and daily life.
· Care plans comprehensively covered individual needs, risks, communication and support requirements.
Care at Hand Limited received an overall rating of Requires Improvement at its May 2021 inspection, with continued regulatory breaches in safe care and treatment (Reg 12), good governance (Reg 17), and a new breach in fit and proper persons employed (Reg 19). The service remained rated Requires Improvement for a second consecutive inspection, though caring improved to Good, with people consistently reporting kind, respectful staff.
Concerns (13)
criticalMedication management: “one person needed to sit upright for 30 minutes following administration of their medicine. This information was not on their most recent MAR chart”
criticalCare planning: “one person's assessment stated they had epilepsy; however, no epilepsy guidelines or risk assessment was in place for staff to follow in case the person had a seizure.”
criticalGovernance: “systems in place to monitor the quality and safety of the service were not effective. This placed people at risk of harm. This was a continued breach of regulation 17”
moderateStaff training: “Training records evidenced staff had not had refresher training in key areas including medicines management, safeguarding and moving and handling.”
moderateStaffing levels: “They are not always on time and there's no consistency. I keep getting agency workers and they are always rushing.”
moderateEnd-of-life care: “The provider's assessment process did not consider whether people had any specific wishes for their future end of life care.”
moderateConsent / capacity: “People's consent to care had not always been clearly recorded in their care plans. A number of care plans contained blank or incomplete consent forms.”
moderateComplaints handling: “it was not always clear what actions had been taken in response. For example, where a concern had been raised about one carer's use of PPE, no action was recorded.”
moderateRecord keeping: “Risk assessments were not always in place to ensure staff had guidance to support people safely and care plans were not always up to date or reviewed”
moderateStaff competency: “The provider's system for monitoring staff knowledge and competency was not robust and had not highlighted the gaps in staff training.”
minorMissed or late visits: “people were not always notified of changes to staff or visit times.”
minorCommunication with families: “They don't let me know of any changes, they don't phone me at all.”
minorInfection control: “The provider had not ensured all staff had up to date infection prevention and control training... this was not in place for all staff.”
Strengths
· People told us staff were kind and caring and knew them well, with care plans personalised to individual preferences and routines.
· The provider had implemented a comprehensive induction for staff including completion of the Care Certificate.
· Staff had appropriately identified changes in people's needs and made timely referrals to health professionals.
· The provider responded appropriately to safeguarding concerns and maintained records of investigations and outcomes.
· A system to monitor missed and late visits with lessons learnt summaries was introduced.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experience
This focused KLOE inspection of Care at Hand Limited, covering only Safe and Well-Led domains, found the service rated Good overall, with effective safeguarding, risk management, and medicines practices in place. Minor concerns were noted around inconsistent visit timing, a missed CQC statutory notification, and insufficiently robust recording systems for late calls and staffing changes.
Concerns (4)
moderateMissed or late visits: “It's their timing of arrivals that I have the problem with. I'm often sitting around past my time slot waiting for them to arrive.”
moderateGovernance: “During the inspection we found the notification had not been sent to CQC. We spoke with the registered manager, they assured us that this was an oversight due to a recent period of absence.”
minorRecord keeping: “The registered manager recorded all communications from people in a bound book; this meant it was not always easy to assess different communications in relation to late visits.”
minorCommunication with families: “I did have a regular carer, but she has recently been off ill and I'm getting a little messed around at the moment with different carers – I wish they'd phone me to tell me who is coming.”
Strengths
· All staff completed safeguarding training and demonstrated good understanding of abuse types and reporting processes
· Risk assessments were in place, reviewed regularly, and provided clear guidance to staff on least restrictive risk management
· Medicines were managed safely with records showing administration as prescribed
· Robust recruitment process in place to protect people
· Registered manager was visible, held open door sessions, and staff felt supported and valued
Care at Hand Limited received a Good rating across all five key questions at its November 2016 inspection, with no regulatory breaches identified. The service demonstrated safe staffing, person-centred care planning, effective staff training and supervision, and well-functioning governance systems.
Strengths
· People felt safe and staff understood safeguarding responsibilities and whistleblowing procedures
· Consistent staffing with same carers allocated, supporting familiarity and trust with people using the service
· Staff received thorough induction, regular supervision, and appraisals throughout the year
· Care plans were person-centred, regularly reviewed, and kept up-to-date at both home and office
· Staff demonstrated understanding of the Mental Capacity Act 2005 and supported people's decision-making
Care at Hand Limited was rated Requires Improvement across all five key questions following a June 2019 inspection, representing a deterioration from its previous Good rating (2017), with five regulatory breaches identified covering safe care and treatment, staffing, person-centred care, consent, and good governance. Key failures included unsafe medicines management, insufficient staffing causing missed and late visits, care plans lacking personalisation, non-compliance with the Mental Capacity Act, and ineffective governance systems that failed to identify or address these issues.
Concerns (10)
criticalMedication management: “We found numerous gaps on the MAR's and some of the records went back to 2018. When we asked for the audits to identify if the gaps had been investigated we were told there were no recent audits.”
criticalStaffing levels: “The provider had failed to ensure sufficient staff were deployed to meet people's needs. This demonstrated a breach of Regulation 18 of the Health and Social Care Act 2008.”
criticalCare planning: “People's care plans did not give information to staff about their personalised care needs such as dementia, diabetes or mental health. Care plans we reviewed had limited information.”
criticalConsent / capacity: “The registered manager was not working within the principles of the MCA... had not considered what decisions people could make for themselves and had asked family to consent.”
criticalGovernance: “The checks of the safety and quality of the service had not highlighted all the issues we found during this inspection. Effective arrangements were not in place to assess and monitor quality.”
moderateMissed or late visits: “Fifty percent of people we spoke with had experienced changes to the timings of their visits... there was not a robust system in place to monitor missed and late visits effectively.”
moderateStaff training: “24 staff out of 30 staff had not received a safeguarding refresher in the last three years. Other subjects such as MCA and DoLS and dementia had not been refreshed for staff since their start date.”
moderateRecord keeping: “Care records were not consistently personalised, nor did they contain all the knowledge from staff working with them at each care call.”
moderatePerson-centred care: “People's care plans held either little or no information about people's likes, dislikes and preferences. There was no information in people's care plans about their life history.”
moderateIncident learning: “The registered manager told us the usual process for missed calls would be to complete an incident form, but this had not happened.”
Strengths
· Staff had good knowledge of the people they supported and were described as friendly, professional and caring by people using the service.
· Pre-employment checks were undertaken to ensure people's safety.
· Staff supported people to access healthcare services when needed and liaised with relatives and professionals.
· People felt safe with staff and had developed positive relationships with regularly assigned carers.
· Staff supported people to maintain their independence and respected their privacy and dignity.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experience
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: End of life care and supportRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersGood
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement