Ace Community Services is a domiciliary care agency. The service provides care and support to people in their own homes, some of whom may be living with dementia, chronic health conditions and physical disabilities. At the time of the inspection, 73 people received support from the service within a geographical area that covered Mid and Central Bedfordshire and North and West Hertfordshire. Not everyone using Ace Community Services receives the 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.

This inspection was carried out on 29 May 2018 and was announced.

The service had a registered manager. 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 previous inspection in November 2017 the service was rated as ‘Requires Improvement’ because the provider was found not to be meeting the required standards. We had found that people had not consistently received person centred care that took account of their health and social care needs and were not involved in planning or reviewing their care. We also found that people had not always received safe care and treatment and that the provider’s governance systems were not effective because they had not identified the shortfalls we had found.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-led to at least good.

The registered manager and provider had made some improvements to how the service operated since the previous inspection in November 2017. However there were some areas that still needed further development and embedding into daily practice.

Staff members had not always received the basic core training, refresher training and meaningful supervision to support them to meet people's needs safely. People and their relatives told us that the care and support provided by staff of Ace Community Services was appropriate to meet people's needs. The service worked to the principles of the Mental Capacity Act (2005) which provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. People were provided with prompting where needed to have a healthy diet and fluid intake. People’s health care appointments and health care needs were managed by themselves or their relatives.

At the previous inspection in November 2017 we had found that people's care plans contained limited guidance for staff to be able to support people with person centred care. At this inspection we found further development was necessary to help ensure that staff had all the information they needed to provide people with safe care and support. People told us that they, or their relatives where appropriate, had been involved in planning and reviewing their care needs. All people and relatives that we spoke with during the course of this inspection were confident that the registered manager would take the necessary actions to manage any complaints raised with them.

At this inspection we found that some improvements had been made but further work was necessary to implement a robust system of meaningful audits and provide a comprehensive training programme and system of competency assessment so that the provider and registered manager could satisfy themselves that people received safe care and support. Increase in staffing meant that the registered manager had dedicated time to undertake routine spot checks, audits and monitoring as part of their

Ace Community Care Ltd provides care and support to people in their own homes, some of whom may be living with dementia, chronic health conditions and physical disabilities. At the time of the inspection, 68 people were being supported by the service within a geographical area that covered Central Bedfordshire, North Hertfordshire, and West Hertfordshire.

This announced inspection took place between 4 October 2017 and 6 November 2017.

Prior to the inspection we received information of concern that the service did not have enough staff and subsequently, some people had experienced missed care visits. However, the provider told us of their on-going staff recruitment programme. Some of the staff in West Hertfordshire had told us that some of the people using the service did not always receive good quality care, and they were concerned that the registered manager did not take appropriate action to ensure that improvements were made. We looked into the issues during the inspection and we found the provider was not meeting five regulations. This was because they did not always have sufficient staff to provide safe care, and people's care records lacked detailed information to enable staff to provide person centred care. Additionally, potential safeguarding incidents had not been reported to relevant organisations, and the registered manager did not always complete audits to assess and monitor the quality of the service.

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

The service had a registered manager. 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. However, the registered manager required more support to understand her role and responsibilities in relation to her registration with the Care Quality Commission.

People told us they were safe because they were supported well by care staff. Staff told us that they had been trained on how to protect people from abuse, but the training records were not organised in a way that enabled us to check that all staff had been trained. People had risk assessments in place, but records had not always been updated in a timely way to evidence that these remained relevant to people’s needs. Staff’s recruitment records were not always up to date and for one member of staff, there was no evidence in their file to show that concerns recorded in their Disclosure and Barring Service report had been assessed. Although people told us their medicines were managed safely, medicines administration records had not been formally audited to identify any potential errors.

People told us they were supported effectively by their regular staff, who knew their needs well. However, we could not be certain that staff had been supported to acquire skills and knowledge necessary to support people well because the staff training records were not up to date. Staff also told us that the training provided was not of good quality. We have made a recommendation that the service finds out more about training for staff, based on current best practice guidance.

The requirements of the Mental Capacity Act 2005 were being met and people told us that staff asked for their consent before providing care. People were happy with how they were supported with food and drinks. Where required, the service ensured that people had been supported to access healthcare services and equipment they needed to maintain their health and wellbeing.

People told us that staff were kind and caring. They also said that staff treated them with respect, and supported them to maintain their independence as much as possible. People made choices about how their care was provided and they valued staff’s su

This inspection took place on 05 and 08 February 2016 and on10 February we made telephone calls to people who use the service. This inspection was announced. 48 hours’ notice of the inspection was given because the manager is often out of the office supporting staff or providing care. We needed to be sure they would be present and that all the required documentation was available for us to review. When we last inspected the service in May 2013 we found that the provider was meeting the legal requirements in the areas that we looked at. At that time the service was registered at a different address.

The service provides personal care to people in their own homes. At the time of the inspection they were providing personal care for 43 people with a range of needs, including people with physical or learning disabilities and Older People, some of whom may be living with dementia.

The service had a manager who was not registered by the Care Quality Commission (CQC) yet, although our records confirmed that their application had been received. 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 & Social Care Act and associated regulations about how the service is run.

Without exception, the feedback we received from people who used the service, their relatives and health and social care professionals who worked with the service was excellent. They expressed a high level of confidence in the management and individual staff to provide safe, compassionate care that met their needs in the way they liked to be supported. Many of those we spoke with gave examples of times when the manager and care staff had gone above and beyond what was expected of them.

Staff demonstrated a clear commitment to protecting people from possible harm, and were knowledgeable about how they should do this. Systems were in place to identify and minimise any risks to people.

Staff were well trained and had a very good understanding of people’s care needs. The manager offered high level support to staff, ensuring that they were familiar with people’s needs, and had the skills and knowledge to meet them before they started to provide support. Each person was supported by a consistent team of staff to ensure that they received care from staff who knew them and that they felt safe with.

The provider demonstrated a compassionate and person centred approach to care and people told us they enjoyed positive relationships with staff that were friendly and respectful. They confirmed staff took care to protect their dignity and privacy.

The service provided to people was based on their individual needs and was flexible to accommodate any changes that were required in a timely way. People felt able to express their views and the provider was continuously looking for feedback from people to support the development of the service.

There were effective processes in place to monitor the quality of the care provided to people who used the service. The provider demonstrated strong values based on high quality person centred care, and this was reflected by the staff, who were proud to work for the service and were clearly motivated to do their jobs well.