The inspection was announced and took place on 21 and 22 May 2018. We gave the provider 48 hours’ notice of the inspection. We did this to ensure key staff would be available at the service. The previous inspection was carried out on 21 February 2017 and there had been one breach of legal requirement at that time. We rated the service requires improvement overall. The registered manager had submitted an action plan to the Care Quality Commission so that we could monitor the improvements made. We found at this inspection significant improvements had been made.

At the time of the inspection 85 people were receiving a personal care service from Agincare UK Bristol. This service is a domiciliary care agency. It provides personal care to people living in their own home. Not everyone using the service receives a 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.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager and provider. People told us they were confident to raise any concerns they had with staff and that any concerns they had raised had been acted on. People had individual risk assessments so that staff had the information they needed to support them safely and minimise the identified risks.

People's medicines were now being managed safely. Medicine administration records were fully completed and signed by staff. Changes in people's health were identified quickly and staff supported people and their relatives to contact their health care professionals.

There were sufficient staff to meet people's needs. People told us staff generally arrived on time however some people had experienced late calls. The registered manager had already identified this as an issue and had tightened the areas that staff worked within to avoid this from happening. The staff told us they now had sufficient time between care visits.

The service carried out pre-employment checks on staff before they worked with people to assess their suitability. Staff were provided with sufficient personal protective equipment to prevent risk of spread of infection.

Spot checks were carried out to monitor staff performance. Staff attended regular training to ensure they could meet people's needs. There was a thorough induction to the service and staff felt confident to meet people's needs before they worked independently.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff understood the importance of gaining consent from people and acted in accordance with the principles of the Mental Capacity Act 2005. Staff assumed people had capacity and respected the decisions they made.

Staff provided care in a way that respected people’s dignity, privacy and independence. People told us staff treated them as individuals and delivered personalised care.

People's care plans were personalised and gave information on their background history, likes and dislikes. Staff were trained in person-centred care and knew how people liked to be supported. Care records were reviewed with people and they had been provided with sufficient information about the service. People and their relatives knew how to make a complaint.

The registered manager assessed and monitored the

We carried out an inspection of Agincare UK (Bristol) on 21 January 2016 where we found the provider had not met the regulations in relation to the safe management of medicines, the provider did not have an effective system to regularly assess, monitor and improve the quality of service that people received. An action plan was submitted by the provider that detailed how they would meet the requirements by 16 March 2016.

We undertook an announced inspection on 21 February 2017 to check the provider had made improvements and to confirm that they had done what they told us they would do in the action plan sent to us. At this inspection we found improvements had been made in relation to safe management of medicines. However, improvements were still required in relation to aspects of medicines management and assessing and monitoring the quality of service that people received.

We told the provider 48 hours before our visit that we would be coming. We did this because they were sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure that they would be available.

Agincare UK (Bristol) 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 older adults. At the time of our inspection 115 people were receiving personal care. Some people who used the service required support to maintain this independence. Other people required more support due to their long term healthcare needs such as diabetes and Parkinson’s disease or the risk of falls. Some people were living with dementia type illnesses.

There was a registered manager in post. 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 this inspection we found medicines were managed safely and there was clear guidance about how staff should apply topical creams to people who required them. However, the medicines administration record charts were not completed correctly. This put the people who used the service at risk.

There were systems to assess the quality of the service provided. However the registered manager had not identified the shortfalls we found.

Care plans contained information which reflect people’s current support needs and included the level of detail staff required to provide people with their level of support.

People told us staff were helpful, caring and polite and supported them in the way they chose. Staff knew people well as individuals and had a good understanding of people’s care and support needs. There was information about people’s mental capacity in their care plans and we found when people lacked capacity it was clear how consent was sought or how decisions were made in their best interest.

There were enough staff and recruitment practices were followed to employ staff to look after people who used the service. The registered manager undertook an assessment before people started using the service to ensure there were enough staff to support them appropriately.

Staff had received regular supervision or spot checks to ensure they were supporting people properly

When required people received support from staff to have enough to eat and drink and maintain a healthy diet. This was recorded in their care plans and staff had a good understanding of the support people needed.

People told us the registered manager was approachable and they were able to discuss any concerns or issues with them.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report

This inspection took place on 21 January 2016 and was announced. We gave the service 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be available at the office.

At the last inspection of the service on 8 May 2013 we found the service was meeting the regulations we looked at.

Agincare (UK) Bristol provide support to people who live in the community. The range of support includes assistance with personal care, shopping, activities and appointments. At the time of our inspection Agincare (UK) Bristol provided services to 102 people.

There was a registered manager for the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

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

People’s medicines were not always managed safely although they were administered to people as prescribed. There were processes in place to help make sure people were protected from the risk of abuse. Staff were aware of safeguarding vulnerable adults procedures. However, the provider’s policy in relation to managing people’s finances was not being followed accurately.

People who used the service said they were safe. The staff team were well trained and had good support from the registered manager and senior staff. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support people needed.

Assessments were undertaken of risks to people who used the service and staff. Written plans were in place to manage these risks. However for one person an assessment had not been updated following alterations at their home.

The management team used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. Overall satisfaction with the service was found to be positive. However, some audits had not identified shortfalls to ensure lessons could be learnt to improve the service.

The people we spoke with expressed positive views about the service and spoke highly of staff and the registered manager. People were consulted about their care, needs and wishes. Where people lacked the capacity to consent, policies and procedures were in place in line with the Mental Capacity Act 2005 (MCA). Staff had an understanding of the requirements of the MCA and had received training on the subject.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported. People were involved in making decisions about their care. People told us they liked the staff and looked forward to the staff coming to their homes.

When meeting with people in their own homes we saw staff treating people with respect and providing assistance in a kind and caring manner. It was evident that people and staff members had cordial and friendly relationships.

Care records provided information to direct staff to deliver people’s care and support safely. Records had been kept under review so information reflected the current and changing needs of people.

Staff had a good understanding of people’s daily care needs and, where necessary, ensured that people who used the service had access to community health care and support. Health and social care professionals we spoke with gave positive feedback about the service and felt staff were professional and cooperative.

We visited the office on the 8 May 2013 to look at records and to observe how the office was managed. We spoke with the manager, two care co-ordinators, and two members of staff.

We conducted telephone interviews with a further four members of staff, seven people who use the service and two relatives on the 9 and 10 May 2013. This was to enable us to make a judgement about the care that was being provided to people receiving a service from Agincare.

People told us they had a care plan and that they had been involved in making decisions about how they wanted to be supported. People confirmed they were happy with the service and this had improved over the last twelve months.

One person told us “I am happy with the service that I get from Agincare, the girls are lovely, cannot fault them”. Another person said “the service has improved over the last twelve months I am now having regular staff and usually they arrive on time if not they will ring”.

People can be assured staff received training and support to enable them to fulfil their role. Systems were in place to ensure suitable staff were recruited to support them.

People were asked for their views in respect of the service they were receiving.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. The newly appointed manager had developed an action plan to further improve the running of the business including staff training and supervision.

We conducted this review in order to check that improvements had been made following our review in January 2012. At that time the agency was found to be non-compliant. We carried out this review to check that staff had now received safeguarding training and that the agency had carried out effective supervision. In addition we reviewed the agency’s quality monitoring system and how complaints were managed.

In April 2012 we carried out a review to check that the provider had carried out improvements in care and welfare for which we issued a warning notice. The provider was still non-compliant with this essential standard.

In the review we carried out in April 2012 people told us the service had improved and they had more confidence in the agency.

People told us at the review in April 2012 that they were happy with the service provided by individual care staff and that the care they received was of good quality.

At the review in April 2012 one person told us, “It’s new ones (staff) all the time. They are all very good. I have no complaints at all”. Another person told us that they had a regular carer who was, “a brilliant chap”.

We spoke to six people and three relatives. One person told us told us, ""We don't always get someone when we should and a few times nobody has turned up" and "I'm just not happy with them". A relative told us that, "It's been very uncertain whether they are going to come or not", they also said, "The staff that come along, they're all lovely. Unfortunately they cannot stick to the times we asked for".

All the people we spoke to told us that visits had been missed and that care staff were often late. People were anxious not only about what time care staff would arrive but worried that they would not turn up at all.

People had complained to the office staff but nothing had changed. People told us that they were unhappy about not having regular care staff although they told us that most staff provided very good care.

People told us that a lot of staff had left recently.

We have completed three reviews since January 2012. These were published in March, April and June 2012. We used our enforcement powers and served a warning notice in relation to non compliance with outcome 4 care and welfare and outcome 20 due to the lack of reporting of incidents to us, the Care Quality Commission.

The agency has now met both the warning notices that were served in January 2012 as evidenced in previous reports about the service and during this visit.

People told us they were happy with the care and support they were receiving from the care staff and the improvements that had been made to the running of the office.

We were told that care staff and the timings of visits were more consistent. People told us they were sent a weekly letter detailing the times of the calls and the names of the staff that were to attend to them. These were being monitored.

People’s views about the service were being sought and acted upon.