The inspection took place on 16 August 2016 and was announced. 39 Wick Farm Road is a small domiciliary care agency, providing personal care support to people in their own homes. At the time of our visit the service was supporting 53 people.

The service has 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.

At the last inspection in 22 June 2015, we asked the provider to make improvements to the management of medicines, assessing and monitoring the quality of service provision and record keeping. At this inspection we saw that the service had made the necessary improvements.

People were safe because the service monitored that staff had administered medicines appropriately and safely. Risk assessments were carried out and measures put in place to manage and minimise any risk identified.

There were sufficient staff to meet people’s needs and people received support from a consistent team of staff. Staff were recruited safely in line with current guidance. People received support and care from trained staff who were supported and supervised in their role.

The managers were aware of their responsibilities under the Mental Capacity Act (MCA) 2005. The staff understood the need to obtain consent when providing care, what constituted restrictions on people’s freedoms and their right to make decisions for themselves.

People were supported with meals and to make choices about the food and drink they received. Staff at the service worked alongside health professionals to support people to meet health care needs. Assessments had been carried out and care plans were developed which reflected people’s individual’s needs and preferences. People knew how to complain and the service responded well when concerns were raised and dealt with appropriately.

The management team were visible, open and empowering. Staff were very positive about working for the service and feedback from people who used the service and relatives was also very positive indeed. Effective systems were in place to manage, monitor and audit the quality of the service.

The inspection took place on 22 June 2015 and was announced.

39 Wick Farm Road is a small domiciliary care agency, providing personal care support to people in their own homes around the Southminster area. At the time of our visit the service was supporting 30 people.

The service has 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.

At the last inspection in July 2014, we asked the provider to make improvements to the management of medicines, assessing and monitoring the quality of service provision and record keeping. At this inspection we saw that the service had made improvements, however there were areas where the implementation of improvements was ongoing.

People were not always safe because the service could not monitor whether staff had safely dispensed and administered medicines. Risk assessments were carried out and measures put in place to manage and minimise any risk identified. Staff were recruited safely and there were sufficient staff to meet people’s needs.

People received support from trained staff who were well supervised . There were sufficient staff to meet peoples’ needs and people received support from a consistent team of staff.

The manager was aware of their responsibilities under the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their

freedom and liberty these are assessed and decided by appropriately trained professionals. Care staff understood the need to obtain consent when providing care.

People were supported with meals and to make choices about the food and drink they received. Staff at the service worked alongside health professionals to support people to meet health care needs.

Assessments had been carried out and care plans were developed which reflected individual’s needs and preferences. People knew how to complain and the service responded well when concerns were raised.

The service had a visible and approachable manager and staff were happy to work for the service. The manager knew the service well and people and their families felt able to contact the manager on an on-going basis. However the implementation of additional, more formal systems to monitor and audit the service remained in the infancy stages and needed further development.

36 Wick Farm Road provided a domiciliary care service for people living in their own homes in a rural area.

Our inspection on 31 July 2014 was to follow up non-compliance from the last inspection on 2 May 2014. We had asked the provider to send us an action plan telling us how they intended to address the shortcomings and what they would do to make the required improvements. They sent us an action plan on 10 June 2014 telling us that they had made improvements and were now compliant with the regulations.

As part of our follow up inspection we looked at the improvements made to care records for six people who used the service. We looked at improvements to the administration of medication, the recruitment of staff and quality assurance systems. As this inspection related primarily to systems for managing the service, we only spoke with the registered manager and deputy manager for the service during this inspection.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

Systems for the administration of medicines had been put in place although there was still room for improvement. Details of people’s medication, the amount prescribed, the recording and collection of medication had been improved. A system for the administration of medication had been developed to protect people from harm.

A review of the recruitment procedures had been completed and improved to ensure that new staff were recruited correctly. This process ensured people were given the right level of training and support which enabled them to care for people safely.

Some aspects of the service which still required further improvements were around policy, procedures and quality monitoring of the service. This included reviews of care planning and delivery, updating risk assessments and the recording of information relating to the safe care of people who used the service. People could not always be assured that information and records about them were being maintained to ensure their welfare and safety.

Is the service effective?

Some people's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met. People and/or their families were involved in their care arrangements. This made their care more effective as they had some control over its delivery.

Is the service caring?

The manager and deputy manager had a good knowledge of people’s care needs and circumstances, likes and dislikes. They were caring, kind and flexible and offered a personalised and individual service.

Is the service responsive?

The service was responsive to the needs of people who used the service. The staff worked flexibly to enable people to maintain their independence and to give family carers a break from caring. A range of health and social care professionals from the community were involved in people’s care. This showed that people received their care in a joined up way.

Is the service well-led?

The service had made some improvements in the monitoring and development of its quality assurance. However, further improvements were needed to ensure that the records it kept were maintained and accurate for the safety and welfare of people who used the service. Improvements were also needed to the way it which the service was managed and led.

We undertook an inspection on 2 May 2014. The service had eight staff who provided a service for 34 people living in their own homes in the community. People had a range of care and support needs. We spoke with four people who used the service and their relatives. We spoke with two staff as well as the manager and deputy manager who make up the eight staff.

We looked at a range of records which included four people's care plans and two daily records, medication administration, cooperation with other professionals, staff training, and quality monitoring checks.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

Not all of the care plans or risk assessments we looked at had been updated with current information. This meant that staff would not have the correct information to care for people safely.

The manager did not have a system in place to protect people from the risks associated with the unsafe use and management of medicines. The administration of medication was not being adequately recorded or monitored to ensure people were kept safe from harm.

Is the service effective?

People's needs were being met by staff who knew them very well. Staff had the relevant skills and experience to care for them effectively in their own homes in the community.

The assessment and monitoring of the quality of the service was not being undertaken and this could mean the service would not be effective in meeting people’s needs.

People told us that the staff helped them access health and social services where needed. Health professionals were involved in providing specialist advice to ensure people who used the service received care that was planned and coordinated.

Is the service caring?

People we spoke with told us that the staff including the management were kind, considerate and approachable. One person said, “They always go the extra mile, nothing is too much trouble for them."

We saw that information was written about people who used the service in a sensitive and respectful way.

Is the service responsive?

The service responded to people’s needs in a timely way and there was ongoing communication between staff, other professionals, the people who used the service and their relatives.

Staff worked closely with people’s relatives and supported them in their caring role. One relative said, “The manager keeps their eye on the ball.”

People were able to express their views directly. The manager responded individually to concerns and made the necessary changes as appropriate. This meant that people felt listened to and valued.

Is the service well-led?

The provider did not have a system in place to assess and monitor the quality of the service. Policy and procedures were not being reviewed or followed by staff. Staff supervision and training was not planned in order to support and develop the skills of staff. Therefore, the service was not well led or managed effectively.

People who used the service were happy with the care and support provided by the management and staff at 39 Wick Farm Road. We found that improvements had been made in all standards during our inspection.

One person told us: "I get on really well with the care worker and that is important to me. She really looks out for me and treats me with respect." A relative told us: "The manager always contacts us to ask if everything is OK, we couldn’t be happier with the service. They go that extra mile.”

People's care plans, risk assessments and their records had been reviewed and updated. Systems for the support and training of staff had been put in place with spot checks and training seen to be more consistent. Staff had also received training in safeguarding adults from abuse.

The management of the service had been improved with a better system for monitoring of the quality of the service which included records and complaint.

People could be assured that they received a personalised quality service.

Relatives and people who used the services of 39 Wick Farm Road told us that they thought the service was generally good. They told us staff were respectful, kind, polite and did their job well. One person said, "The carers help me stay independent, help me keep my dignity and my pride". People told us that staff usually turned up on time but did not always contact the person to say they were going to be late. Some people were not able to have a choice of staff member as it depended on where the person lived and what staff were available in that location. One person said, "I would prefer to know when they are coming, but I don’t mind fitting around them”.

The provider had told us that they would make improvements to the service. However, records about people who used the service and staff were disorganised, not up to date and did not contain the information required. Quality assurance and monitoring systems were not in place for the protection of people who used the service. Support systems for staff including supervision and training were very limited and inconsistent.

People who used the service could not be assured that they would be protected from the risks of harm and receive a quality service by skilled and experienced staff.

People with whom we spoke said that they were happy with the care and services provided by the agency. Comments included "I can't fault them" and "You won't find a finer agency."