Accolade Care Services Ltd provides personal care to people in their own homes. The provider changed the name of this service from Rhema Care Services since our last inspection. People who use the agency were mainly older people. There were 96 people using the service at the time of this inspection.

This inspection took place on 18 January 2018. We gave two days’ notice to the provider to ensure someone was available to assist us with the inspection.

We last inspected the service in October 2015 and found the provider was meeting the fundamental standards. We rated the service ‘Good’ overall.

People felt safe with the staff who cared for them. Risks relating to people’s care were reduced as the provider assessed and managed risks. There were systems in place safeguarding people and staff understood their responsibilities in relation to this. Systems were in place to manage people’s medicines safely. There were enough staff deployed to care for people and staff were recruited through processes to check their suitability.

Staff received a programme of induction, training, support, supervision and appraisal to help them understand and meet people’s needs.

People received the support they required in relation to maintaining their health and also eating and drinking. People received care in line with the Mental Capacity Act 2005 (MCA).

The provider assessed people’s care needs holistically through consulting with people and their relatives and reviewing any professional reports. The provider developed care plans which guided staff on people’s physical, mental, emotional and social needs and informed them of their personal history. Staff knew the people they cared for and developed positive relationships with them.

People were treated with kindness, dignity and respect by staff and their privacy was maintained. The provider encouraged staff to become Dignity Champions and follow the ‘ten dignity do’s’ expected of high quality services in respecting people’s dignity. Staff were provided with sufficient training and also time to care for people in a person-centred way. Staff supported people to maintain their independence and people were involved in decisions about their care.

The provider used concerns and complaints as a way of monitoring quality and improving the service. The provider investigated and responded to complaints appropriately.

The service was well-led by a competent registered manager who was also the director of the service and had led the service for 17 years. Staff also understood their role and responsibilities.

The provider had suitable systems in place to assess, monitor and improve the service. The provider gathered feedback from people and relatives regarding the quality of care and carried out observations of staff to check they provided care at the expected standard. The provider communicated openly with staff and external professionals.

At our last inspection, 23 October 2013, we found that the provider had not obtained all of the information required before some staff began working at the service. During this visit we found that the provider had obtained all of the information required and updated staff files.

We visited three people using the service in their homes and spoke to one of these people’s relatives. We also spoke on the telephone with two people using the service and the relatives of seven other people using the service. Thy all made positive comments about the agency and the care staff and the service they or their relatives received. They all told us that staff turned up on time and carried out the care tasks recorded in their care plans. They all told us they knew how to make a complaint if they needed to.

One person using the service said “The service I receive is excellent. The carers turn up on time and do what they are supposed to. I have a care plan and know what staff are supposed to do for me”. Another person said “The provider visits to check on staff and to make sure I am happy and everything is being done as it should be”.

A relative of a person using the service said “They are doing a great job. My mother cannot speak English and they sent us a carer who can speak my mother’s language which is Urdu. This is very helpful as my mother can communicate with them. The agency is fantastic”.

We found that the provider had appropriate arrangements in place to manage medicines. They had effective systems in place to regularly assess and monitor the quality of service that people received. However we found that appropriate checks were not always undertaken before staff began working at the service.

Croydon Social Services commission services from the agency. They told us they had no concerns about the service.

There were approximately fifty people using the service and twenty two staff employed, on the day of our inspection. We visited the agency office and met with the registered manager and three staff. We spoke by telephone with five people who used the service or their relative's and another member of staff. Generally the feedback was complimentary about the care and services provided. People said that the service was reliable and well organised. People felt staff were caring and treated them with dignity and respect. They told us they had regular carers and were kept informed if there was a change. Comments included, “they are all great” “they go out of their way” and “the carer is a right gem.”

They said they could voice their concerns and had been given all the information they needed. Although the service had recently lost two members of office staff the manager had recruitment processes in place and we were assured that the positions were to be filled quickly. Staff told us that they felt well supported from the office and received appropriate training to meet people's needs. There were a range of systems in place to help monitor the quality of the service and to identify improvements.

We spoke on the telephone to a selection of people who use the service, their relatives or representatives and some of the agency's staff and other professionals who have an interest in the agency. The overall feedback was highly complimentary about the care and services provided and that people benefit from a well-organised and reliable service. A relative commented that their carer works “above and beyond what they are supposed to do.” Other responses from people using the agency included:

“Very happy, nothings too much trouble; I’ve never had such good care”

“I have the same girl and she does what she’s supposed to do”

“Whatever we want they do for us”

“The carer works very well, turns up on time and is very reliable”

“I’ve never had such good care”

“I trust them, they do what they are supposed to do, nothing could be better.”

Staff told us that they felt well supported and had good training to meet people’s needs. Comments included:

“They trained me before I went out on my own”;

“Training is good and they always supply all the things we need.”

“I am satisfied with the way the agency is operating, can’t fault anything”

“They ask me if I have any problems, if there’s something that concerns me, the manager supports me.”

Commissioners of the service were complimentary about the agency and had no concerns at the time of our review. Comments included:

“They are co-operative with any problems and attend and contribute to review meetings.”

“They always feedback and inform you of concerns.”

Please refer to each outcome in the main report for more detailed comments about specific aspects of the service.

Rhema Care Services Limited provides personal care to people in their own homes and supplies carers both as direct private arrangements and through a contract with the local authority. People who use the agency include older people and younger adults with disabilities. The agency does not provide a service to children. Services offered include assistance with all personal care needs as well as support services such as cleaning and shopping. There were 64 people using the service at the time of this inspection.

This inspection took place over two and half days on 23, 27 and 28 October 2015. We gave short notice of the inspection, to ensure someone was available to assist us with the inspection.

We last inspected the service on 23 October 2013 and found the provider was meeting the required standards.

The service had a registered manager who was also the registered provider. 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.

People received consistent support from staff who knew them well. People felt safe and secure when receiving care and had been able to build positive relationships with their regular care workers and were confident in the service. There were robust arrangements in place to protect people from the risk of harm or abuse. Staff had the knowledge and confidence to identify safeguarding concerns and act on them to protect people.

People felt they were treated with kindness and said their privacy and dignity was always respected. People were fully involved in planning their care how they wanted. Care plans were agreed with the person or someone close to them and took account of people's rights and independence.

Changes in people’s needs were identified and their care package amended to meet their changing needs or circumstances. The registered manager gave us examples of situations where they had identified a need and involved various relevant health professionals to ensure the person received appropriate care.

Appropriate recruitment checks had been made to make sure that staff were suitable to support people in their homes. There were enough staff to make sure people had the care and support they needed at the right time. All care staff received a thorough induction when they joined the agency. This was followed by ongoing training to update and develop their knowledge and skills.

Staff made sure people’s dignity was upheld and their rights protected. Staff understood their responsibilities where people lacked capacity to consent or make decisions. This was because they had received training on the principles of the Mental Capacity Act (MCA) 2005.

Staff experienced effective leadership and direction from the registered manager. They felt fully supported to undertake their roles and were given ongoing training, supervision and development opportunities.

The registered manager demonstrated a good understanding of the importance of effective quality assurance systems such as spot checks, appraisals and surveys. There were processes in place to monitor quality and understand the experiences of people who used the service. People said they could raise any concerns or complaints with the agency. Where issues were raised the agency made improvements.