On 20 January 2016 we inspected A1 Home Care Services and found them to be in breach of one Regulation under the Health and Social Care Act 2008, (Regulated Activities) Regulations 2014. The breach was in relation to the lack of systems for the monitoring of the health, safety and welfare of people (Regulation 17). The service was rated as Good overall but Well Led was 'Requires improvement'. The provider sent us an action plan outlining what improvements they would make.

On 5 April 2017 we returned to the service to assess whether improvements had been made. We found that the quality of the service was assessed and monitored, that improvements had been made to the staff rostering system and that processes were in place for the supervision of staff. We have made a recommendation about the rota system given to people who use the service.

The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

A1 Home Care Services provides a variety of care and support to people in their own homes. This includes supporting people with personal care needs, shopping, cooking, and companionship. .

The service has 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.

The service had appropriate systems in place to protect people from harm and uphold their rights. Staff had the knowledge and understanding to provide effective and safe care for people.

People’s medicines were given to them safely and in a timely way and risks to people’s health and wellbeing were appropriately assessed, managed and reviewed.

There were sufficient numbers of staff available to meet people’s needs. A recruitment process was in place to protect people and staff had been employed safely with the right skills and knowledge to provide care and support to people.

People were assisted with the preparation of meals of their choosing which met their nutritional needs. They were treated with kindness and respect by staff and their dignity was maintained. Staff understood people’s needs and provided care and support accordingly. Caring relationships had been developed and people were fully involved in their care arrangements.

Quality assurance arrangements had been improved to monitor the quality of the service for people and staff. There was a system for responding to complaints and concerns. The visible leadership of the service showed that person centred care was being delivered to people who used the service and the staff that worked there.

A comprehensive, announced inspection of A1 Home Care Services took place on the 20 January 2016. We gave the provider 48 hours’ notice so that we could be sure that someone from the service would be there to greet us.

A1 Home Care provides a variety of care and support to people in their own homes. This includes supporting people with personal care needs, shopping, cooking, and companionship. The service also providers 24 hour care within people’s homes. Located close to Chelmsford Town Centre, A1 Home Care serves the people within and around Chelmsford.

The service has 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.

The service has been rated as Good over all, with requires improvement under well led.

The registered manager and management team communicated appropriately with other organisations and within the guidance set out with the Registration Act 2009. However, there was no clear line of accountability for supervision of care staff and senior staff and regular 1:1 supervision did not take place. Informal reporting systems between staff and management were in place, which meant that information could be lost and we could not be certain that staff concerns had been addressed.

People using the service could not be confident that visits to provide care and support met their needs in a timely manner. Calls were often late and whilst people and staff had complained about late calls, the provider had not taken action to appropriately monitor late calls and remedy the cause of them.

However, the service provided safe care. Managers responded to concerns about care standards in a timely way. People using the service could be assured that staff had been through a rigorous employment process and safely recruited. Care teams were chosen to ensure consistency of care and competence in care delivery. Care workers followed safeguarding procedures appropriately and had used whistleblowing procedures to protect people

The service took seriously the need for care workers to be trained to deliver safe, effective care in a caring manner. People who used the service and health and social care professionals commented on staff competence and commitment. Care practices were monitored through regular observations, and when needed care workers would receive additional training. Comprehensive risk assessments were completed and regularly reviewed so that people’s changing needs could be identified, and staff had a good understanding of infection control and were provided with the appropriate clothing and protective wear.

People who use the service describe care staff and managers as kind and caring. Care workers knew people’s individual, diverse cultural, religious and gender needs and preferences, and had developed positive relationships with people and provided care that was respectful and dignified. Health and social care workers spoke of staff as “excellent advocates” for people in their care.

Care workers were responsive to people’s needs. Small core care teams for individual people meant that care workers had been able to develop positive relationships with people. When people’s needs changed, care workers would notify the registered manager and communicate with other health professionals in order to ensure people received the right care and treatment. People using the service could be confident that when they complained about standards of care from care workers that these would be acted upon quickly and sensitively and they would be informed of the outcome. The service worked collaboratively with other organisations so that people did not go without care when they needed it.

During this inspection, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

People we spoke with told us that they were happy with the level of service, care and support that they received from A1 Home Care. They told us that they received a reliable service and that they were treated with respect and involved in making decisions about their care and treatment.

We saw that people using the service were provided with information about the service and how to make contact, raise complaints or concerns. The service had an effective complaints procedure. People we spoke with told us that they were aware of how to complain. Those people we spoke with told us that they did not have any complaints about the service they received.

We saw that care was planned and delivered so as to be reliable and effective. Risks to the health, safety and welfare of staff and people using the service were well managed.

There service has robust procedures for recruiting staff. All of the required checks including employment references and Disclosure and Barring Services (DBS) checks were carried out so as to determine the suitability and fitness of people who worked for the service.

We did not speak to the people using the service at this follow up inspection.

One relative of a person using the service described A1 Home Care as "Absolutely amazing" and that the staff are "So respectful and kind."

A person who uses the service said "They come and ask me what I want and it's all done as I need it to be done."