About the service: Advanced Care is a domiciliary care agency. It provides personal care to people living in their own homes, including, older people, younger adults, people with mental health problems, physical and learning disabilities, sensory impairment and people living with dementia. At the time of our inspection approximately 130 people received care and support from this service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

• People’s needs were assessed to ensure they could be met by the service.

• People received their care calls from staff they knew who were caring, helpful and friendly.

• Care calls were consistently provided at the times people expected and for the length of time agreed.

• People felt safe and were protected from avoidable harm.

• Staff knew about the risks associated with people’s care and understood how to keep people safe.

• Staff followed best practice guidance in relation to the prevention and control of infection and supported people to take their medicines safely.

• People received information about the service in a way they could understand and chose how to live their lives in the least restrictive way possible.

• Staff were recruited safely and received the support and training they needed to be effective in their roles.

• Staff respected people’s rights to privacy and dignity and promoted their independence.

• Where needed people were supported to meet their nutritional needs and to maintain their health and well-being.

• The provider had developed good relationships with health and social care professionals which assisted in improving outcomes for people.

• People were involved in planning and agreeing their care. Most care plans contained the information staff needed to provide personalised care.

• The service had received positive feedback from people and relatives who were very satisfied with the care they received and the way the service was managed.

• Systems were in place to manage and respond to any complaints or any concerns raised.

• The providers quality assurance systems supported the service to continually improve. Lessons were learnt when things had gone wrong.

• The provider was investing in new technologies to further improve outcomes for people.

At this inspection we found the evidence supported a rating of 'Good' in all areas. More information in 'Detailed Findings' below.

Rating at last inspection: Good (The last report was published on 25 February 2016).

Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This inspection was carried out on 13 January 2016.

Advanced Care is registered to provide personal care and support for people in their own homes. At the time of our inspection,111 people in Coventry received care and support from this service.

The provider for this service is an individual owner. Unlike a registered company, they are not required by law to have a separate registered manager, unless they do not have the skills and experience to manage the service themselves. The provider for Advanced Care, undertook all of the day to day management tasks.

People we spoke with were happy with the care and support that they received.

People told us staff respected their choices and nothing was done without their agreement. Staff understood the principles of consent and providing care that was individual to the person.

People felt safe with staff who provided their care. They received care and support from staff they were familiar with, and who mostly attended calls at the expected time. Sufficient staff were employed to meet people’s needs.

Recruitment procedures reduced the risk of unsuitable staff being employed. Staff understood their responsibilities to safeguard people, and knew what to do if they had concerns that people were not safe.

The office team and care staff were kind and caring to people who used the service. Staff had been provided with training to effectively and safely meet people’s needs. Staff administered medicines to people safely.

People’s care records contained the relevant information for staff to meet people’s health needs and manage risks appropriately. Care plans and risk assessments were clear and updated when people’s needs changed.

People, staff, and professionals told us the service was managed well. They thought the provider and her team were approachable and acted on information received to benefit the people who used the service.

On the day of our visit we met the manager and two other members of staff. We later spoke with a further two members of staff. We also spoke with nine people who used the service and five people who had relatives who used the service.

People told us they shared a good rapport with staff and they treated them with respect and dignity. One person said, "Staff are kind, caring and respectful towards me, they help me to do things and give me privacy to help myself."

People we spoke with said that they and their relatives were involved in planning and agreeing care packages. One person told us, "My relative has a care plan and the service usually come out every six months or so to see if things are still in line with what we need."

Some people told us they were not always happy with the time staff arrived at their home. One person said, "Sometimes they are late and I often get different carers. Overall I’m fairly happy with how they look after me." Another person said, "Lately there have been too many staff changes and the times are not good and don’t always link in with when my relative needs their medication."

Some people we spoke said they would like more interaction with the manager. Other people told us they were satisfied with the service provided.

People told us they felt safe with the staff that visited them. One person told us, "I feel completely safe and comfortable with them.”

On the day of our visit we met the manager and three other members of staff. We reviewed staff files and spoke with people who had used the agency, or who had relatives who used the agency.

We asked people about their experience of the care provided, and if they were happy with the care they had received. We asked people if they were treated with consideration and respect. People told us that they were happy with the care they had received. One person told us, “They do a good job. Excellent." Another person said, "They are fantastic, I can't fault them."

Everyone we spoke with had arranged care requirements according to their own personal needs.

During our visit we reviewed policies and procedures the agency had in place for the safeguarding of vulnerable adults. We saw that a system was in place to record and report any issues that could be considered as safeguarding.

We observed recruitment procedures and found they were robust.

We saw that the agency had good auditing procedures in place. Evidence was available to show that checks were regularly made on records including care plans, medication administration, call logs and timesheets.

People who use the service told us the agency carried out an assessment before the service started and that they have a copy of the care and support plan in their home. People said they had regular care workers who understood what they had to do. One person said “All the carers are good, but the morning carers are brilliant, they know mum really well, they can identify any changes in health and let me know if they are concerned about anything”. “They always talk to her respectfully and always make sure she is comfortable”. Another person said, “My carers are all nice, they do not rush me, they stay long enough to do everything they have to and always make sure I’m ok before they leave”.

People we visited told us that carers didn’t assist them to take medication, but they did put cream on their legs. Staff told us that they complete medication training and are assessed as competent before they can assist people with their prescribed medication.

People who use the service said staff were always polite and treated them with respect. Staff told us they knew what to do to keep people safe and would have no hesitation reporting poor practice to the senior staff and managers. People we spoke to said they would contact the office if they were concerned about anything but had never had cause to do this.

A recent survey completed by the agency in January 2011 show people were generally very happy with the care they receive, Comments included,

‘I am happy with all my support workers there is nothing I would improve’

‘I get along with most of my support workers’.

‘I am happy with all my carers’.

‘The agency provides excellent care’.

‘My support workers are wonderful’.

There were a few surveys that identified rushed calls, the manager had looked into this and found this applied to calls made in one area of the city. Spot checks and discussions with clients and staff had taken place to address this.