About the service:

This service is a domiciliary care agency. It provides personal care to people living in their own houses. People who use the service are older adults and younger adults who have a learning and/or physical disability. This is the only location operated by CTRC CIC which is a not-for-profit Community Interest Company

There were 14 people using the service at the time of this inspection and two of those people were receiving 24 hours live in support from the service. The service also offered outreach support to people in the community but not all those people required the regulated activity of personal care support and therefore did not fall within the remit of this inspection.

People’s experience of using this service:

Relatives told us the service was, “excellent,” “good,” and “reliable.” All comments made by the relatives we spoke with were positive about both the care received from staff and the management team.

The provider did not always work in line with the Mental Capacity Act 2005 and did not always check that relatives had Lasting Power of Attorney that gave them the legal right to consent to people's care and treatment.

Most risks to people were assessed and measures were put in place for people’s safety. However, we brought to the registered manager’s notice that one person’s risk assessment did not contain adequate measures to alert staff in the event of a fire. The registered manager addressed this following the inspection to make the measures in place more robust.

The registered manager and staff demonstrated they would recognise and report safeguarding adult concerns to the appropriate bodies. The manager demonstrated that they learnt from mistakes and ensure learning was shared with the staff team to prevent a reoccurrence.

Staff who administered medicines received training and their competency was assessed to ensure they undertook this in a safe manner. The management team undertook thorough audits of medicines administration to monitor the way medicines were managed.

Staff received support and training to equip them to undertake their role.

The management team and staff worked with both health and social care professionals for the wellbeing of people using the service.

People had person centred care plans that were reviewed on a regular basis and in response to changing circumstances. The plans contained information about people’s personal history so staff could understand them in the context of their lives. People’s preferences were stated and plans informed staff how best to support people to make choices.

The registered manager and management team undertook a number of audits and checks to ensure the quality of the service provided.

Rating at this inspection:

The service has been rated good in safe, caring, responsive and well-led and requires improvement in effective. The service is rated good overall.

Rating at last inspection:

This service was rated requires improvement. There was a breach of the regulations in good governance. This was because the registered manager did not have arrangements in place to monitor and improve the service provided and did not always ensure accurate records were maintained for each person. The report was published on 1 February 2018.

Why we inspected:

This was a scheduled inspection planned around our guidelines for the previous rating of requires improvement.

Follow up:

We will continue to monitor the service and re inspect in line with our inspection guidance.

The inspection took place on 23 and 24 November 2017 and was announced. We gave the provider 2 days' notice of the inspection as the service provides care and support to people living in their own homes and we needed to make sure the registered manager would be available to assist with the inspection.

The service was last inspected on 18 November 2016 when it was rated Good.

CTRC CIC is a not-for-profit Community Interest Company. This service is a domiciliary care agency. It provides personal care to people living in their own houses. It provides a service to older adults and younger adults who have a learning and/or physical disability. There were 18 people using the service at the time of this inspection. There were two people receiving 24 hour live in support from the service and three people funded their own care. The service also offered outreach support to people in the community but the majority of people using that part of the service did not require personal care support and therefore did not fall within the remit of this inspection.

There was a registered manager in post. 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.

There were checks on a range of areas of the service provision to ensure people received safe and appropriate care. However, not all of the quality checks were effective in recognising where improvements needed to be made. Some information in people’s care records was not up to date and records had not always shown when information had been reviewed. Spot checks had not identified when a care worker had been administering medicines to a person without the necessary paperwork in place to record this task being carried out.

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.

Feedback from people using the service and their relatives was mixed. People were happy with the care workers and the support provided to them. However, they felt the communication was poor from the office staff when visits were running late or if they had raised a complaint. People told us they knew how to make a complaint and there were systems in place to manage and respond to complaints.

The care workers we received feedback from, with the exception of one, were positive about the service and the support they received.

People received the medicines they needed safely.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place.

People's needs had been assessed in line with good practice guidance and they had been able to express their views and preferences. People’s care records included people's needs and preferences and were individualised in some areas but in some care records the information was not individualised enough in describing how to support the person safely.

Staff received support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged on various subjects that were relevant to staff member's roles and responsibilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People were happy with the support they received at mealtimes. The staff worked with other healthcare professionals to support people with their

CTRC CIC provides a range of services for people in their own home including personal care. People using the service had a range of needs such as learning and/or physical disabilities and dementia. The service offered support to people over the age of 18 years old. At the time of our inspection 23 people were receiving personal care in their home. The care had either been funded by their local authority, direct payments or people were paying for their own care.

We carried out an announced comprehensive inspection of this service on 23 and 24 November 2015. A breach of a legal requirement was found as the quality monitoring systems did not effectively identify where improvements needed to be made.

After the inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach.

We undertook this announced focused inspection to check that the provider had followed their plan and to confirm that they now met the legal requirement. We gave the provider notice the day before the visit so that we could be sure someone would be available. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for CTRC CIC on our website at www.cqc.org.uk

There was a registered manager in post. 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 focused inspection on the 18 November 2016, we found that the provider had followed their plan of action which they had told us would be completed by 6 January 2016 and the legal requirement had been met.

There were two new staff members who amongst other tasks would be checking the information and records held on people who use the service and staff. When checks were carried out on staff performance and on reviews of people’s needs the records were viewed to ensure they contained the necessary information.

We saw there was an annual audit in place to check all of the information on people’s files and on staff files. There were regular spot checks on obtaining feedback on the service from the people who used the service and checks on the staff supporting people. This was to ensure people were happy with the service they received and that staff were carrying out the duties they should be doing at the correct times.

The service had signed up to an organisation that also provided them with various templates so that different aspects of the service could be checked to ensure it was running effectively, for example the records held in the service and recruitment practices.

There were regular staff meetings and management meetings so that ideas and issues were discussed and addressed.

The registered manager could demonstrate that there had been improvements made to how the quality of the service was monitored for the benefit of the people using the service.

We undertook an announced inspection of CRTC CIC on 23 and 24 November 2015. We told the provider two working days before our visit that we would be coming because the location provided a domiciliary care service for people in their own homes and the registered manager and staff might not be available to assist with the inspection if they were out visiting people.

CRTC CIC provides a range of services for people in their own home including personal care. People using the service had a range of needs such as learning and/or physical disabilities and dementia. The service offered support to people over the age of 18 years old. At the time of our inspection 14 people were receiving personal care in their home. The care had either been funded by their local authority, direct payments or people were paying for their own care.

This was CRTC CIC’s first inspection at this location since registering in 2014.

There was a registered manager in post. 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.

There were processes in place to monitor quality and understand the experiences of people who used the service. However some of these had not been effective in identifying where improvements needed to be made to areas such as information obtained during the recruitment process and some of the details in people’s care records.

There were appropriate procedures for safeguarding adults. The staff had regular training in these and knew what to do if they suspected someone was being abused.

There were systems in place to ensure risks to people’s safety and wellbeing were identified and addressed. Staff received an induction and ongoing training to ensure people benefitted from receiving care from suitable staff who had the skills and knowledge to meet people’s assessed needs.

Staff received training in the safe administration of medicines and medicine risk assessments were in place where staff administered medicines to people.

Assessments were carried out to identify each person’s care needs before they started to receive care in their home and their care was planned to meet these needs.

Staff considered if people had the capacity to make daily decisions for themselves. The registered manager was aware they had to work with the local authority if a person needed to be formally assessed using the Mental Capacity Act 2005.

Those people we spoke with who used the service expressed satisfaction and spoke highly of the registered manager and staff. Relative’s feedback on the service was positive. They said the staff were caring and respectful. Where possible, people received consistent support from staff who knew them well.

Staff supported people using the service to be involved in a range of activities.

The service was flexible and responded positively to people’s requests. People and their relatives who used the service felt able to make requests and express their views. Relatives said they knew who to talk to if they had any concerns but had not needed to.

People who used the service, their relatives and the staff felt the service was well managed. They felt able to contribute their views and were listened to.

The provider worked with other agencies and the local authority to make sure the care given reflected people’s needs.

We found a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to quality assurance.

You can see what action we told the provider to take at the back of the full version of the report.