We visited this service on 3 and 4 December 2018. We gave notice of the visit to ensure that the registered manager was available to assist us during our visit.

This domiciliary care service is owned by Archangel Enterprises Limited and is registered to provide personal care to adults within their own homes. The agency offers support primarily to people with a learning disability mainly within the Winsford and Northwich areas of Cheshire. The service is run from an office situated on the outskirts of Winsford within an established industrial estate.

The service provides care and support to both people living in ‘supported living’ settings and people living in their own home. Supported living settings are designed so that people can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living or in people’s own homes; this inspection looked at people’s personal care and support. At the time of our visit 90 people were being supported by the service.

There was a registered manager employed to work at the service. 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

People told us they felt safe using the service and felt safe with the staff team. Staff demonstrated an understanding of the types of abuse that could occur and had confidence in systems in place to report these.

Medication management was safe with people able to manage their own medication independently.

There were sufficient staff in place to meet the needs of people who used the service. Recruitment of new staff was robust with appropriate checks in place to ensure that they were suitable to support vulnerable people.

The risks faced by people in their support and in their living environments were taken into account. The registered provider sought to enable people to take risks in a safe manner in order to increase independence in their daily lives.

Staff received the training and supervision they needed to perform their role. People told us that the staff knew their needs and preferences.

The registered provider was aware of the principles of the Mental Capacity Act 2005 but was not routinely involved in assessing whether people should be the subject of deprivation of liberty safeguards. People were consulted about the support they received, agreed with it and had the opportunity to become more independent through discussions with staff through positive risk taking.

People’s nutritional needs were met and people were supported to be involved in the preparation of food in line with their abilities.

People always received support in accessing medical services when needed.

People and relatives felt that the staff team were caring and took their privacy into account at all times. People’s personal information was kept secure and confidential.

Staff interactions were respectful and positive.

People had their communication needs taken into account with staff able to effectively communicate with those with limited verbal communication.

Care plans were person centred and people who used the service were involved in their creation.

The registered provider supported people in leisure activities as well

We inspected this service on 26 and 27 January 2016 and gave short notice to the registered provider prior to our visit.

This domiciliary care service is owned by Archangel Enterprises Limited and is registered to provide personal care to adults within their own homes. The agency offers support to older people and people with learning disabilities, sensory impairments, physical disabilities and dementia. The service is situated on the outskirts of Winsford within an established industrial estate.

The service is provided to people living in their own accommodation, rented through a partner landlord. This arrangement is often known as ‘supported living’. At the time of our inspection there were 24 people who received a service in this way. A further 41 people were supported by staff in their own homes. At the time of this inspection 65 people were being supported by the agency and they employed 53 staff members.

There was a registered manager employed to work at the service. 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 and relatives told us that the staff were “Caring” and “Really nice”. They said they usually had the same group of staff supporting them and they were always made aware of who this would be prior to the visit. People said they were comfortable with their staff team and enjoyed getting out and about in the community and keeping in touch with family and friends.

Systems were in place to keep people safe. These systems included safe medicines management procedures and assessing and minimising risks to people and in and around their homes.

People were protected by safe recruitment practices that ensured appropriate checks were carried out prior to a member of staff starting their role. This also helped ensure that only suitable staff were employed by the service.

People were supported by staff who received regular training and support for their role. This helped to ensure that people received safe and effective care and support from a well-trained staff team.

Plans of how people needed to be cared for were available. The plans contained specific information which was person-centred about individuals’ that staff needed to know when they were delivering care and support to people.

Staff supported people to access the services of health care professionals, when requested to do so. Details of the visits were recorded in the care plan file.

A complaints procedure was in place and people told us that if they needed to complain they felt they would be listened to. Complaints had been well documented and dealt with in a timely manner.

We saw that there was an open and honest culture within the agency and staff confirmed this. Staff said that the registered manager was approachable and caring and that she “Went the extra mile” when necessary. People and relatives made positive comments about the registered manager, which included “She is brilliant” and “She cares about the people”. One person commented about the agency that “They are the best”.

Policies and procedures were available to the staff team. Having access to this information helped ensure that people received the care and support they required as staff had up to date knowledge of best practice available to them.

We spoke directly to seven people who used the service. Their comments included:

"Staff are really nice and really kind"

"I feel safe there"

"They are always there to help me"

"I decided to retire and they helped me with this decision"

"I have no worries"

"I do voluntary work, it was my decision and staff helped me with this"

"I have a support plan and I can get it changed"

"Staff listen to me"

"I have a support plan and it is changed when I want it to"

"If I have any problems I can go to the staff, they will listen to me"

"Staff are very approachable"

"I have a support plan and I can look at it anytime I want"

"They respect my privacy"

"They listen to me, everything is going well. Sometimes I go out on my own and other times it is nice to have someone with me and they always help with this"

"They listen to me and give me opportunities I never had before"

"They are honest and I can trust them"

"They are really supportive"

Our visit found that the agency was compliant with all the outcome areas that we looked at. People who used the service were supported in their daily lives and were protected from harm. They were supported by staff who had been recruited robustly and were supported in their role. All people who used the service had their opinions about their support taken into account and the agency checked the quality of the service it provided on a regular basis.

We found people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We spoke with people who used the service and their relatives and found they experienced care, treatment and support that met their needs and protected their rights. Comments from people who used the service included "My carer always keeps me active. I feel involved” and “My carers always turn up on time. They are very good”.

We found people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with staff and found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Comments from staff included "I feel the company recognise the good work that we do”.

We saw the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We spoke to people who use the service and asked their views about how they and their relatives are involved in making decisions about their care and treatment and how the service is run.

People told us they have information about the service which they keep in their home and they told us they are kept up to date with any new information since the new office manager started working at the office in December 2010. They told us of problems they had encountered before the new office manager started and they felt that things in the agency were starting to improve. People told us they had mixed experiences over the last 12 months about the care received. They felt the standard of care provided by the staff was good. However some people felt they experienced several problems such as, staff not turning up, staff being changed at the last minute and turning up late.

People using the service and their relatives/next of kin told us they mostly decide how they are supported and cared for and that staff who support them treat them well and with respect. However 3 people felt one thing that could be improved was to have the same staff team as they found that sometimes they have different staff and felt that if they have the stability of the same staff it would help with the care and support needed for their relative. They suggested they should have the rotas of staff being supplied so they always knew in advance who was coming on duty.

Most people commented they were happy with the care they receive and would tell someone if they were not. Everybody told us they would ask to talk to somebody in the office if they were not sure about the care and treatment received. They felt that since the new office manager started she listened to their comments and suggestions and acted on them to help improve the care.

People who use the service made the following comments about the staff who support them:

One person said the staff are very good and know what they are doing. Another person told us the care they get is second to none.

People said they are supported by the right amount of staff. They also told us that staff usually arrive at their homes on time. They felt that on occasions they were a little late but not for long.

“.. the staff are top dollar…”

‘The staff are good at their jobs they work hard for what they have to do’. ‘I have no problems whatsoever about the staff ’.

‘The staff are good and know what they have to do, one staff went the extra mile when I was ill and even did shopping and phoned the doctors’.

“they are not a bad bunch, there’s nothing I'm not happy with really,,,, no gripes at all, we don’t always see the same staff but we are always quite satisfied,,,”

‘If we have the same staff sent it makes it a lot easier and avoids too many changes and disruptions but sometimes when the staff are off sick or on holiday we do get different staff and this can effect the care and the stability we’ve built up.”

“The manager is very good, I have every confidence in her now she is at the office, I know she will try her best to improve things because she listens and has already changed some things’.

“when the manager took over she had a chat with us in the December then we had regular telephone calls, we’ve not had any recent visits but previously we had some visits because we had problems and concerns raised but this has all resolved…”

“…previously the care was a bit hit and miss, the manager is really on the ball, she keeps an eye on everything and it is much better ….”