This inspection took place on 3 May 2017 and was announced.

Ace Care Agency is registered to provide a domiciliary care service to people living in their own homes. There were 29 people using the service on the day of our inspection.

A registered manager was in post and was present during our inspection. 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 was last inspected on 10 and 11 May 2016, where we gave it an overall rating of requires improvement.

At the last inspection we asked the provider to take action to ensure statutory notifications were submitted to us. Registered persons are required, by law, to send us these notifications. These inform us about specific and important events which occur at the service. We had asked the provider to send us an action plan detailing how they would ensure this requirement was met, which they did. At this inspection, we found this action had been completed.

Systems were in place to assess the quality of the service provided, but these were not always effectively managed. They also did not give an overview of the quality of the service as a whole.

People received care which protected them from avoidable harm and abuse. Risks to people’s safety were identified and measures were in place to help reduce these risks.

Staff were available to respond to and meet people's needs safely. Checks were completed on potential new staff to make sure they were suitable to support people in their own homes. People received the support they needed to help make sure they received their medicines when they needed them.

Staff had received training to give them the skills and knowledge they needed to meet people's needs. These skills were kept up to date through regular training and staff were supported in their roles by managers and their colleagues.

Staff asked people’s permission before they helped them with any care or support. People’s right to make their own decisions about their own care and treatment were supported by staff.

People were supported by staff who knew them well and had good relationships with them. People felt involved in their own care and that staff listened to what they wanted. People were treated with dignity and respect and staff understood how important this was in the way they cared for people.

People received care that was individual to them. Staff recognised when people’s needs changed and arrangements were put into place for care needs to be reviewed and reassessed as appropriate.

People were happy and positive about the service they received. Staff were motivated to provide the best care they could and they understood the needs of the people they supported. Staff were happy in their work and were clear about their roles and responsibilities; they felt supported by management and involved in the development of the service.

This inspection took place on 10 May 2016 and was announced. At the last inspection completed 30 July 2014 the provider was meeting all of the legal requirements we looked at.

Ace Care Agency provides personal care to people living in their homes. At the time of the inspection there were 22 older people using the service some of whom were living with dementia. 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.

People were protected by staff who could describe how they would recognise the potential signs of abuse and were confident in reporting and whistleblowing. The Registered Manager managed risks to people but did not always report concerns to the local safeguarding authority as required. People were kept safe by staff who understood the risks to them and could manage those risks. People received their medicines as prescribed.

People told us that they did not always receive their care visits at the expected times and they were not always informed if care staff would be arriving late. Pre-employment checks were completed for all new staff members. However, where additional checks or risk assessments were required to ensure staff members suitable for their role these were not always completed.

People were supported by a staff team who had the required skills and support to provide effective care. People were enabled to consent to the care and support they received. People were supported to maintain their day to day health and receive food and drink when required.

People were supported by a care staff team who were caring and treated people with kindness and respect. People were enabled to make day to day choices around their care. People’s privacy, dignity and independence were protected and promoted by care staff.

People received care that reflected their needs and preferences. Care plans reflected the care that people received although not everyone was aware of their care plan and felt involved in it’s development. People felt able to raise concerns and complaints if needed and told us their complaints were taken seriously and resolved.

People did not always feel involved in the service and some people told us that they did not have sufficient contact with managers and office staff. Relatives told us that they felt the service was well-run. People were supported by a staff team who were motivated and felt supported by the managers. Quality assurance systems were in place but needed development in order to identify all areas of improvement required in the service. The Registered Manager was not always submitting notifications of significant events to the Care Quality Commission as required by law.

We found that the provider was in breach of the regulation requiring them to submit notifications about significant events to the Care Quality Commission. You can see what action we told the provider to take at the back of the full version of the report.

The inspection was completed by a single adult social care inspector. On the day of the inspection the service was provided to 40 people. As part of this inspection we spoke with two people who used the service and five relatives. We spoke with the registered manager and their partner who were the owners. We spoke with three members of staff. We also reviewed records relating to the management of the home, and training records. We looked at two care plans.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, and the records we looked at. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

Risk assessments were in place for things such as moving and handling and medication. Control measures had been put in place. This meant that people’s needs were met and people were kept safe. People and their relatives confirmed they felt the service was safe. A relative we spoke with said, “They [The staff] are very respectful of X’s dignity.” Another relative said, “I can’t fault them they are excellent.”

Staff had received training in dementia and mental health which incorporated aspects of the Mental Capacity Act 2005. The manager told us they would be arranging specific training on the Mental Capacity Act 2005. We saw mental capacity assessments and any subsequent best interest decisions that had been made. Records identified when people lacked capacity to make their own decisions. This meant that systems were in place to safeguard people as required.

People received care and support from staff who had the skills, experience and knowledge to meet people’s needs. Staff were supported to achieve qualifications in health and social care. We saw a training matrix which showed staff had recently undertaken some refresher training in things such as safeguarding and medication. Staff received supervision and appraisal. Staff team meetings were due to be re-introduced. This helped to ensure that people’s needs were always met and that staff had the opportunity to raise any issues.

On a previous inspection we found that we could not be certain that people would always be protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not being maintained. During this inspection we saw evidence that improvements had been made. Care plans had been personalised to reflect the care delivered and people’s preferences had been recorded. This meant people received care that was personalised to them to which ensured their safety.

Is the service effective?

People experienced care and support that met their needs. People told us how they were supported. The registered manager told us they worked with other agencies to ensure people’s health and social care needs were met. Relatives confirmed that the people receiving care and support were involved in decisions about their care. This meant that people received care in the way they wanted.

Relatives we spoke with told us they had no concerns about the timekeeping of staff. However, some staff we spoke with felt that occasionally a little more time was required to meet people’s needs.

Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people’s needs.

Is the service caring?

People were supported by kind and attentive staff. Staff we spoke with told us how they supported people. People and relatives confirmed staff were caring, respectful and polite. One person said, “I am satisfied with the carers I have got.” A relative said, “X is developing good relationships with staff, they are one of the best care agency’s in the area.” Another relative told us their family member usually had the same care staff but a new person would be working with their family member. They told us they were apprehensive about this and would have preferred a staff member.

People’s preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People were involved in their day to day care and were supported to maintain their independence. This meant people’s diversity and individuality were promoted and respected.

Is the service responsive?

People were treated with respect and dignity by the staff. Person centred care plans had been developed. They identified people’s needs and were reviewed annually or when there was a change in need. Staff demonstrated a good understanding of people’s needs. People were given choices and supported to make decisions themselves.

We saw records that showed the service responded quickly to meet people’s needs and ensured people’s safety and dignity was maintained. For example, paramedics were called when a person had suffered a fall. People and their relatives confirmed that they were given choices and encouraged to express their views.

People and relatives told us they had emergency contact numbers. They said they would speak to the registered manager if they had a complaint. A relative said, “I have no complaints.”

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff felt supported in their roles and felt their views were listened to. One staff member said, “If I had any concerns I would go straight to management.” Staff told us they enjoyed their jobs and working for the service. Most people and their relatives told us they had confidence in the manager / owners. One person said, “I have every confidence in the manger.”

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. People had access to a copy of the complaints procedure. This reduced the risks to people and helped the service to continually improve.

The service had a quality assurance system in place. Audits were undertaken regularly. The registered manager showed us analysis of feedback from people and their relatives. The registered manager told us that they took action as a result of findings. This meant the quality of the service was able to continually improve.

We visited Ace Care Agency in October 2013. The providers knew we were coming and had arranged for us to visit five people who received personal care. The people we visited all had a dementia-type condition. Most also had a level of physical disability. None of the people had capacity to make decisions about their care or to tell us about their experience of being cared for.

We spoke with people’s family members or other representative. They were positive about the care their relative or friend received. One person told us: “It’s like having an extra family. Ace are fantastic; nothing is too much trouble. I don’t know how we would manage without them”. Another person’s family member described the way in which the care workers were attempting to win the trust of their relative in order to provide the support they needed. They told us they: “Appreciated the kindness” the care workers showed.

When we looked at people’s care files, we saw that people’s representative had given their consent to the care package. People told us that the staff at Ace Care Agency understood their relatives’ needs and that the care provided met their needs.

When we looked at staff files, we found that safe recruitment practices were in place. We saw that the service used a variety of ways to monitor how people were cared for and to ensure that the quality of service provision was good. We found that the area where Ace Care Agency must improve their service was in record keeping.

During the inspection we spoke with one person who uses the service, four of their relatives, two staff and the registered provider.

People told us they had clear information to help them make choices about whether or not they wanted to use the service. They told us that they were involved in agreeing their care and that the staff treated them with dignity and respect and observed their privacy. One person said: “They came out to do an assessment and care plan, both mom and myself were involved in this.” We found that people were encouraged to be as independent as possible whilst receiving care.

We found that people received the care they needed and that procedures were in place to ensure the care is delivered safely and as agreed with the person using the service and their relatives. We saw that the provider took account of people’s diverse needs whilst delivering the care. People told us they were happy with the care they received and had no concerns whatsoever about the service.

People told us they felt safe using the service and with the staff that visit them. One person said: “Mom feels safe with the care staff, if she wasn’t she would let me know.” We found that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that people received a service from staff that were trained and supported to meet their needs. Staff we spoke with were confident in their role and people we spoke with told us they had confidence in the staff. One person said: “I know that they train the staff I go to the office and all the certificates are there for you to see.”

People told us that they were able to raise their concerns with the provider and felt they would be acted upon. People told us they were asked their views on the quality of the service they received. We found that the provider monitors the service provided to ensure that it is of good quality.