The inspection site visit took place on 1 November and 2 November 2018 and was announced.

AA-I-Care – 35 Southwell is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using the service receives a regulated activity; the 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.

At the time of the inspection the service was providing personal care to 23 people living in their own homes.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to if abuse was suspected.

Staffing levels were sufficient to provide safe care, and recruitment checks had ensured they were suitable to work with vulnerable adults.

When people were at risk staff had access to risk assessments and understood the actions needed to minimise avoidable harm.

The service was responsive when things went wrong, they were open and reviewed practices and had a robust system in place to manage incidents.

Medicines were administered and managed safely by trained and competent staff. The quality assurance and management lead carried out monthly audits of Medicine Administration Records (MAR).

People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as nurses, occupational therapists and social workers.

People were supported to have maximum choice and control of their lives and the policies and systems in the service together with staff understanding supported this practice.

The registered person and the quality assurance and management lead, actively sought to work in partnership with other organisations to improve and nurture positive outcomes for people using the service.

Care and support was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. Staff felt supported by the registered person and quality assurance and management lead.

People, their relatives and professionals described the staff as caring and caring. People could express their views about their care and felt in control of their day to day lives.

People had their dignity, privacy and independence respected and staff understood their responsibilities in relation to this.

People had their care needs met by staff who were knowledgeable about how their individual preferences.

The service had an effective complaints process and people were aware of it and knew how to make a complaint. People and their relatives told us they felt confident their concerns would be addressed. The service actively encouraged feedback from people.

Relatives and professionals had confidence in the service. The service had an open and positive culture.

Leadership was visible in the service and promoted inclusion. Staff spoke positively about the management team and felt supported by them.

There were quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and those responsible kept things up to date.

The service understood their legal responsibilities for reporting and sharing information with other services.

AA-I-Care - 35 Southwell is a domiciliary care service registered to provide personal care to people in their own homes. 28 people were receiving personal care at the time of our inspection. Most of these people were older adults with needs associated with physical disability, dementia or long term conditions. There were also a small number of younger adults with disabilities receiving care.

The owner of the service was the registered provider and the manager and this meant there was no registration requirement for a registered manager to be in post. As registered provider, they were a ‘registered person’. 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 in October 2014 we had concerns about how feedback from staff and people was used to improve quality. There was a breach of regulation. At this inspection we found improvements had been made. Feedback from people and staff was now captured formally and informally and used to improve the service people received.

Staff understood how people consented to the care they provided and encouraged people to make decisions about their care. Care plans did not reflect that care was being delivered within the framework of the Mental Capacity Act 2005 when people did not have capacity to make decisions for themselves. However, staff showed they understood the importance of enabling people to make their own decisions wherever possible and providing care that was in a person’s best interests.

Staff were consistent in their knowledge of people’s care needs and spoke with confidence about the care they provided to meet these needs. They told us they felt supported in their roles and had received training that provided them with the necessary knowledge and skills to do their job effectively.

People felt safe and well cared for. They were protected from harm because staff understood the risks they faced and how to reduce these risks. They also knew how to identify and respond to abuse. They knew how to access the contact details of agencies they should report concerns about people’s care to. Care and treatment was delivered in a way that met people’s individual needs and promoted their independence and dignity. Staff kept accurate records about the care they provided.

People had access to health care professionals and were supported to maintain their health by staff. Staff understood changes in people’s health and shared the information necessary for people to receive safe care. Where people had their food and drink prepared by AA-I-Care staff they told us this was prepared well. People were left with access to drinks and food appropriately. People received their medicines as prescribed.

People were positive about the care they received and told us the staff were friendly and compassionate. Staff treated people and each other with respect and kindness throughout our inspection.

We undertook an announced inspection of AAI Care on 13 October 2014, giving short notice to ensure we had the opportunity to speak with people receiving a service before the inspection visit took place.

The inspection team included an expert by experience who spoke with 19 people before the visit took place. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. We used this method to help us focus on the experience of people using the service. At the time of our inspection 60 people were receiving a personal care service, including sitting and live-in services. Most people were older adults with needs associated with physical disability, dementia or long term conditions. There were also a small number of younger adults with physical or learning disabilities. Some people had complex needs which were met by the provider, working jointly with other agencies.

At the last inspection of 25 September 2013, we found the provider was not meeting the standard for assessing and monitoring the quality of the service. At this inspection we found actions had been taken however not all were completed. The use of electronic call monitoring had been developed effectively and the appointment of additional staff to carry out training and development had allowed improvements to take place. Staff told us they found this helpful. There were action plans for on-going improvements which were monitored. Although there were systems in place for assessing and monitoring the quality of the service these were not sufficiently developed to ensure the service was always consistent in all areas. In particular, the service did not have effective methods to understand the experience of people or the views of staff, which meant the service was not consistently caring and responsive.

There was a registered manager in post who was also the owner. 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 and associated Regulations about how the service is run. The manager was present for the inspection.

People told us they would prefer a more consistent service, with less change to the staff attending to them, and to be informed about changes in advance. People told us this affected their experience of the service and sometimes affected their wellbeing. One person told us, “I don’t want to keep complaining every day, all day. It is a struggle when they don’t take it on board. I have more trouble with the office than the carers.”

People spoke highly of the care staff and told us they were treated with respect. Staff demonstrated their understanding of offering choice in day to day care and the need to seek people’s consent to receiving care and support.

Staff supported people to attend healthcare appointments. The provider worked in partnership with GPs and other health and social care professionals to meet people’s needs and ensure risks were well managed. We spoke with other agencies and professionals who were positive about collaborative working with AAI-Care. Staff received regular training and understood their role and responsibilities. They had the skills and knowledge required to support people with their care and support needs and they were receiving support to learn.

Care plans were in place detailing how people wished to be supported. The service was implementing plans to ensure all these were reviewed and any changes recorded. The lack of up to date records in some places meant there was a risk that changes in the needs of people or in their circumstances may not be noticed or acted upon. However this was mitigated by communication between staff and the office about changes. Some people told us they did not feel involved in decisions about their service as they had not yet received a review The provider was aware of the delays and actions were in progress to address this. Some people and their relatives did feel involved in making decisions about their care plan and were satisfied with the service.

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

The service was provided to mostly older adults, some with complex needs and a small number of adults with learning and physical disabilities.

We found that the provider worked well with other agencies, especially with healthcare colleagues to meet the needs of the service users.

Respect and dignity for people was reflected in the training, induction and supervision of staff and this was strongly promoted by the management of the service.

One service user told us ‘I’ve found the staff pretty good to get on with’ and another person told us that the staff ‘were fantastic in the recent bad weather as they still got to me’. Some service users told us that their carers could appear rushed on occasions however people were very positive about the service they received overall.

The care records were detailed, included information about preferences and risk assessments were completed and linked to the care plan. This helped to ensure that the needs of people were met appropriately and safely.

We inspected the practice for safeguarding adults and found that staff understood their role in providing safe care. We found that procedures had been implemented for dealing with safeguarding issues. People were aware of who to contact if they had concerns.

We found that there were systems in place to regularly monitor, observe and improve the quality of service delivery.

We visited the agency after concerning information was received about the care of one person.

We spoke with seven people who used the service and two relatives. Everyone we spoke with was happy with the care that they, or their relative, received. Comments made included: "I’m perfectly happy with it.”, “They are efficient, caring and they look after (name removed) well”, and, “They go beyond the call of duty”. People told us that the service was reliable and responsive and care was planned and delivered appropriately.

The provider worked with other professionals and agencies to ensure care was planned to meet the needs of the people who used the service.

People were protected from abuse and staff knew how to respond appropriately to allegations of abuse.

Staff felt supported to carry out their roles, however some mandatory training was not current.

The agency did not have a system of quality assurance in place that monitored the quality of the service provided.