This inspection took place over two days on 11 and 12 January 2017 and was announced.

Age UK Medway provides personal care to 112 people in their own homes and visits another 111 people every six to eight weeks to provide a nail cutting service. The care was managed from an office in Chatham. The personal care provided to the 112 people was tailored to their needs so that people could maintain their health, wellbeing and independence and remain living at home. The care was delivered to adults, some of whom may be living with dementia, long-term health conditions or physical disabilities.

At the previous inspection on 7 and 10 December 2015, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to the recording of detailed information on risk assessments, ensuring that staff did not have gaps in their employment records when recruited and the effectiveness of auditing systems. The provider sent us an action plan telling us what steps they would be taking to remedy the breaches in Regulations we had identified. At this inspection we checked they had implemented the changes.

At the previous inspection on 7 and 10 December 2015 we also made two recommendations to assist the provider to make improvements to the service provided. These recommendations were in relation to the recording of topical medicines (creams and lotions) when administered and the effective communication of changes in staff deployment at weekends. At this inspection we found improvements had been made.

There was a registered manager employed at the service. 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 was also the provider.

People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. People told us that they felt safe when receiving their care. They told us that having continuity in staff attending helped them have confidence and feel safe.

Risks were assessed by staff to protect people. There were systems in place to monitor incidents and accidents. The registered manager had improved the way risk assessments were written so that they gave staff more detailed information about minimising risk.

Staff were recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding. Recruitment policies were in place that had been followed. Safe recruitment practices included background and criminal records checks and now also included a record of explanation for any gaps in employment, prior to staff starting work.

People were happy with the leadership and approachability of the service’s registered manager and the management team. Staff felt well supported by registered manager. Audits were now more effective and risks were monitored by the registered manager to keep people safe.

Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well. Records showed and staff confirmed they were now keeping proper records of the administration of topical creams and lotions.

The registered manager ensured that they could provide a workforce who could adapt and be flexible to meet people’s needs and when more staff were needed to deliver care, they were provided. Some people needed more than one member of staff to provide support to them. People were now made aware of which staff were providing weekend care.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse. Procedures for reporting any concerns were

An expert by experience telephoned people who used the service to help us gain the views of twenty five people who used the service and/or their relatives.

People said that they had been involved in developing their plans of care and that they were consulted with all aspects of their care and treatment. Care plans were detailed so that staff had clear guidance to follow to meet people’s individual needs.

People were very complimentary about the skills of the staff team. Comments included, “I’m really satisfied with the way they look after my wife.”; “The carer does everything I want and beyond, she’s very good.”; “It’s what my mother needs and it suits her very well”; and, “Very, very fond of my carer – look forward to her coming.”

Staff had been trained in how to give people medicines safely. Records did not always clearly show if people had taken their ‘as required’ medication (PRN).

Effective measures were in place to safeguard people when new staff were recruited to the agency.

Most people told us that they had never had the need to make a complaint about the agency. People who had made a compliant said that it had been resolved to their satisfaction.

The agency had comprehensive systems in place for monitoring the quality of service that it provided, which included regularly asking people who used the service for their views.

We found that the service had reviewed the way that it stored, completed and monitored records about people's care and treatment. It had taken action to make sure that records were easy to read, kept up to date and accessible to staff, so that people's individual needs could be met.

We found that care staff supported people to meet their individual needs in a way that respected people's privacy and dignity and encouraged their independence.

There was good communication between people who used the service, relatives and office staff. "They have never let us down", exclaimed one relative.

Care staff did not rush and had time to sit down and talk to people who used the service. One person told us, "The staff are superb. They chat to Mum and ask how she is when they visit". People said that staff taking time to talk to their relative was a very important part of their relatives care.

Relatives said that they felt confident in leaving their relative to the care of the care staff team. The care staff team knew what to do if they had any concerns about the people in their care.

Care staff had the necessary skills and experience to support people. Care staff were described as, "superb" and "human". Relatives said that the people who use the service were "fond" of specific care staff.

The agency asked the views of people who used the service on a regular basis and took action to make any changes to the service as necessary. Although care staff knew how to support people, care plans records did not always accurately reflect people's changing care needs.

We inspected the service on the 07 and 10 December 2015. This inspection was announced.

Age UK Medway is a domiciliary care agency which provides personal care to older people, including people with dementia and physical disabilities. The agency provides care for people in the Medway area and the office is situated in Chatham Dockyard. There were 192 people receiving support to meet their personal care needs on the day we inspected.

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.

People’s views about the service they received were positive.

Recruitment practices were not always safe. Gaps in employment history had not always been explored.

Risk assessments lacked detail and did not give staff guidance about any action staff needed to take to make sure people were protected from harm.

There were suitable numbers of staff on shift to meet people’s needs. However, when people’s planned care had been allocated to another member of staff and at a different time, people were not always informed. We made a recommendation about this.

Topical medicines and creams administered were not adequately recorded to ensure that people received their medicines in a safe manner. We made a recommendation about this.

Audit systems in place were not always operated effectively to monitor and improve the quality and safety of the service.

Staff knew and understood how to safeguard people from abuse, they had attended training, and there were effective procedures in place to keep people safe from abuse and mistreatment.

Staff received regular support and supervision from the registered manager. Staff had received training relevant to their roles.

People were supported and helped to maintain their health and to access health services when they needed them.

People told us staff were kind, caring and communicated well with them. People’s information was treated confidentially, paper records were stored securely in locked filing cabinets.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) was in place which included steps that staff should take to comply with legal requirements.

People’s view and experiences were sought through review meetings and through surveys.

People were supported to be as independent as possible. People had access to additional resources through the service to prevent loneliness.

People told us that the service was well run. Staff were positive about the support they received from the registered manager. They felt they could raise concerns and they would be listened to.

Communication between staff within the service was good. They were made aware of significant events and any changes in people’s behaviour.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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