About the service: A&M Bewdley Care Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, younger adults, physical disability, sensory impairment, mental health and dementia. At the time of our inspection, 66 people were using the service.

Not everyone using A&M Bewdley Care Services receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Rating at last inspection: At the last inspection the service was rated Good. The report was published 09 December 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

People’s experience of using this service:

¿ People continued to tell us they felt safe and well supported.

¿ Staff had a good understanding in how they protected people from harm and recognised different types of abuse and how to report it.

¿ Potential risks to people had not always been identified, assessed and monitored. The manager was aware of this had was implementing new procedures to better manage and record this.

¿ There were enough staff on duty to keep people safe and meet their needs.

¿ The provider did not always follow safe protocols for the administration of medicines.

¿ Safe practice was carried out to reduce the risk of infection.

¿ People’s care continued to be assessed and reviewed with the person involved throughout.

¿ People were supported to have a healthy balanced diet and were given food they enjoyed.

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

¿ Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice.

¿ Staff treated people as individuals and respected the choices they made.

¿ People’s care was delivered in line with their preferences, with any changes in care being communicated clearly to the staff team.

¿ Staff supported people with their end of life care.

¿ People had access to information about how to raise a complaint, where complaints had been received the provider had managed these in line with their policy.

¿ The provider was not meeting the legal requirement to have a registered manager in place.

¿ The manager and provider were aware of the shortfalls and had plans in place to improve these.

¿ The provider made to ensure the service was meeting people’s needs and focused upon people’s views and experiences.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This inspection was announced and took place on 15 November 2016. We gave the provider 48 hours’ of our intention to undertake the inspection. This was because the service provides domiciliary care to people in their own homes and we needed to make sure someone would be available at the office.

A & M Bewdley care services is a domiciliary care agency registered to provide personal care to people living in their own homes. A registered manager was 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 the time of our inspection 59 people received care and support services.

People we spoke with told us that they felt safe with staff supporting them. Staff were able to tell us of the needs of the people they provided care for and their roles and responsibilities in keeping people safe. Staff understood how to protect people from abuse and were clear about the steps they would need to take if they suspected someone was unsafe.

People had their individual risks assessed and had plans in place to manage them. Medicines were administered by staff that had received training. The provider had procedures in place to monitor that people received their medicines to safely meet their health needs.

Care staff had been recruited following appropriate checks and the provider had arrangements in place to make sure that there were sufficient care staff to provide support to people in their own homes. Staff said training helped them do their job and gave them the right skills to meet the needs of the people they supported.

People told us they had developed good relationships with staff who they said were caring. Staff treated people with privacy and dignity. Staff respected people’s homes and belongings and people were supported to maintain their independence. People told us they were happy with the way in which care staff supported them to choose and prepare meals.

People were involved in how their care and support was received. People were given choices and their wishes were respected by staff. Staff understood they could only care for and support people who consented to being cared for. People told us responded when they were unwell and that care staff arranged health appointments on their behalf if they asked.

People who used the service were able to raise concerns and the provider had a system to deal with any complaints. People said staff listened to them and they felt confident they could raise any issues should the need arise and action would be taken.

The provider ensured regular checks were completed to monitor the quality of care that people received and look at where improvements could be made.

The inspection was carried out by one inspector. At the time of the inspection 71 people were using the service. Below is a summary of our findings. We gathered evidence by speaking with four people who used the service and two relatives by telephone. We spoke with three staff during our visit to the office, two by telephone and two professionals by telephone.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe and comfortable with the staff who provided their care and support. People we spoke with told us they would report to management of the service if they had any concerns about their safety. Safeguarding procedures were robust and staff had received training. We spoke with three staff who demonstrated a good knowledge of safeguarding and how to respond when concerns arose. There were risk management plans in place for people, their health and safety and premises and safe moving and handling manoeuvres. Staff knew about risk management and we saw examples of where they had been followed. Recruitment practices were thorough and safe. Newly recruited staff had a structured induction and did not work by themselves until they felt confident and when they had been assessed to do so.

Is the service effective?

People and relatives told us their care plans were up to date and reflected their current needs. Care plans included detailed information about people’s personal preferences about how they wanted their care to be provided. Specialist needs were clearly recorded. Staff had received training to ensure they possessed the knowledge and skills to provide the specialist care. For example; people’s catheter care and how to monitor people who had diabetes. Other health needs had been assessed such as nutrition and mobility. Staff we spoke with told us they would report any changes in a person’s condition to senior staff. Senior staff would visit the person to check if their care and support needs had changed and to make appropriate arrangements in line with the assess needs.

Is the service caring?

The people and relatives we spoke with were positive about the way they were cared for and supported. One person told us: "The carers provide first class care.” People were cared for by kind and attentive staff who showed patience when attending to people. People using the service or their relatives were involved with the assessment and development of their care plans and regular reviews. A relative said: “I am satisfied with the care, it’s working well. They are very good with A (the person who was using the service). They talk to A. Overall I’m quite pleased with the service. They are listening to my comments and these are being addressed.” People’s references, interests, aspirations and diverse needs had been recorded. Care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People had been assessed before they were offered care. This was to ensure staff could meet people’s needs. During regular reviews that had taken place we saw that two people were dissatisfied with their visit times. Arrangements had quickly been made by senior staff to change the visit times to suit the individual’s preferences. The service worked well with other agencies and professionals to ensure people received care and support in a coherent way. For example; social workers, occupational therapists and specialist community nurses. The professional staff we spoke with confirmed this. People knew how to make a complaint if they were unhappy. People can be assured that complaints were investigated and action taken when necessary.

Is the service well led?

The service had a quality assurance system in place that involved people who used the service. Regular audits were carried out regarding staff practices in medicines and recordings in people’s care files. Records showed us that improvements had been made when they were identified through monitoring processes. Staff told us they were clear about their roles and responsibilities. Staff had attended appropriate training and senior staff checked that they carried out their roles in the correct way. We found that there was effective staff line management and that staff worked well as a team to provide a good service.

This inspection was announced and took place on 9 December 2015. We gave the provider 48 hours’ notice of our intention to undertake the inspection. This was because the service provides domiciliary care to people in their own homes and we needed to make sure someone would be available at the office.

A & M Bewdley Care Services is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of our inspection 52 people received care and support services.

There was a registered manager in place. 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.

On the day of our inspection the registered manager was on a period of leave. In response to this the provider had made cover arrangements and we spoke with the deputy manager.

People we spoke with told us that they felt safe when staff entered their home and that staff knew how to support them. Staff were able to tell us of the needs of the people they provided care for and their roles and responsibilities in keeping people safe.

People were supported by sufficient numbers of suitably qualified staff, who had a good understanding of protecting people from the risk of abuse and harm and their responsibilities to report suspected abuse. Medicines were administered by staff that had received training to do this. The provider had procedures in place to check that people received their medicines as prescribed to effectively and safely meet their health needs.

People told us they received consistent care from a regular team of trained staff who understood their likes, dislikes and preferences for care and support.

Staff supported people to make their own choices and decision’s about their care and support. People were actively involved in how their care was planned and their needs met. Staff supported people to access health care services such as their GP and district nurses by arranging appointments or making the necessary contact.

People spoke positively about both support they received and the staff that provided it. People told us they were treated with dignity and respect and staff demonstrated their understanding of people’s right to refuse care.

People received care that met their individual needs. People and staff said managers listened to them and they felt confident they could raise any issues should the need arise.

Relevant notifications had not been submitted to CQC where safeguarding reports had been referred to the local authority. CQC requires this information to look at the risks to people who use care services.

The provider and managers were accessible and approachable and the provider ensured regular checks were completed to monitor the quality of care.

People told us there had been a number of management changes and communication could be improved. The provider acknowledged there had been a period of change but felt positive changes had been introduced, for example the introduction of a new computerised call system would in future enable people to access information when they required it via their own computer.

The provider monitored the quality of care provided and support staff. They encouraged an open office where staff could ‘pop in at any time’ and staff confirmed that management were available and supportive.