The announced inspection took place on the 27, 28 November and the 3 and 4 December 2018.

Advanced Care Yorkshire Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults with a variety of needs.

Not everyone using Advanced Care Yorkshire receives 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. At the time of inspection 78 people were receiving a regulated activity.

There was a registered manager in post at the time of inspection. The registered manager was also the 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. The registered manager and the training manager were present during the office visits to support the inspection. The training manager took on a variety of roles within the organisation including supporting the registered manager with the running of the service.

We found there was no robust governance and monitoring of the service. There was no formal system to audit parts of the service to ensure compliance and continuous improvement. Spot checks were carried out by the service. However, these were not consistently completed so did not always identify areas found at the inspection. There was no monitoring of accidents and incidents to monitor for trends. When incidents occurred, we found there was no records available.

Person centred detail was not always included in people's care records and some people did not have care plans in place. People's care records did not reflect their needs or detail how people like to receive their support. Staff told us they did not always read peoples care plans. This meant staff did not always have information to provide people with person centred care.

We found not all risks relating to the health and safety of people who used the service were assessed and managed. Risk assessments were not always completed when a risk had been identified and control measures were not always in place to try to reduce the risk to people.

There was no call monitoring system in place to monitor late or missed calls. This meant the service relied on people or their families to inform them if staff did not attend the call. We received mixed views regarding staff attending calls on time. During the inspection we attended a call where a staff member was 20 minutes late.

We reviewed people’s medication administration records and found gaps in recording. There was no evidence people did not receive their medication as prescribed.

Staff were not receiving regular supervisions or appraisals as in line with the company’s policy.

People told us they felt safe. Staff had knowledge of safeguarding procedures. People and relatives told us staff were caring and their privacy and dignity was respected.

Staff attended an induction programme which included training and shadowing, and received ongoing training the provider classed as mandatory.

Staff told us they felt supported by the management team. The manager told us they communicated with people through newsletters.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

The inspection of Advanced Care Yorkshire Limited took place on 16 and 17 June 2016 and was unannounced. At the last inspection in August 2013 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Advanced Care Yorkshire Limited provides care and support to adults and children in their own homes in Hull and the East Riding of Yorkshire area. People that use the service may be elderly, disabled or have a medical condition, which means they require support with their daily living, personal care or health care. The service is a medium sized service, providing support to approximately 80 people who are supported by 45 support workers.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for four and a half years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Support workers were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and environmental basis so that people avoided injury of harm wherever possible.

Staffing numbers were sufficient to meet people’s needs and people we spoke with were satisfied with the calls they received, the punctuality of workers and the length of time workers stayed to assist them. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication was safely carried out, in cases where people required this.

People were cared for and supported by qualified and competent staff that had excellent opportunities for training and updating this. Support workers were regularly supervised and their personal performance was assessed using an appraisal system. Communication within the organisation was effective.

People’s mental capacity was appropriately assessed and their rights were protected. Support workers had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act 2005 (MCA) and they understood the importance of people being supported to make decisions for themselves. Where a person lacked capacity to make their own decisions the registered manager was able to explain how the service worked with other health and social care professionals and family members to ensure a decision was made in the person’s best interests.

Where people required support with their meals this was provided to ensure they received adequate nutrition and hydration for their health and wellbeing. Support workers had completed a food hygiene training course.

People received care and support from workers that were caring and helpful and knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before support workers undertook care and support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected and support workers helped them to maintain these wherever possible. This ensured people were respected, that they felt satisfied and were encouraged