This inspection was announced and took place on15 November 2016. The provider was given 48 hours’ notice of inspection to ensure the registered manager would be available to meet us at the provider’s office and also to make arrangements for us to visit some of the people in their own homes.

The last inspection of the service was carried out on 26 September 2014. This was a follow-up inspection, to check the provider's progress against areas where we found non-compliance on our previous inspection visit. At this inspection we found improvements had taken place.

Agincare UK Ferndown is a domiciliary care agency that provides a visiting service and assistance with personal care needs. They are registered to provide personal care. At the time of this inspection they were providing personal care and support for 170 people in their own homes.

There is 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.

People and their relatives were very complimentary about the quality of the service provided and about the management and staff team. They felt the care was exceptionally good. One person said, “They always rally around and go above and beyond. I have been supported for many years by the service and always feel well cared for”.

People we spoke with felt they received support from familiar and consistent care workers. They told us they would recommend the service to other people. They confirmed care workers arrived on time and had the skills and knowledge to provide the support they needed. One person told us, “It is great care, but I am in control of how I want the care delivered. I get a weekly rota and always know who is coming to support me. If it is going to be someone different they let me know”.

The provider had effective systems to manage staff rosters, match staff skills with people’s needs and identify what capacity they had to take on new care packages. This meant that the service only took on new work if they knew there were the right staff available to meet people’s needs.

The office administration team planned visits to make sure staff arrived to each person at the agreed time. Staff told us they had enough time to travel and complete their duties.

The provider had a recruitment procedure that ensured the suitability of staff was checked before they began work. Staff knew how to recognise signs of abuse and all said they were confident that any issues raised would be appropriately addressed by the registered manager. People felt safe with the staff who supported them.

Staff completed an induction when they first started working at the home. They also shadowed more experienced staff and worked through an induction booklet. This covered information about the provider, HR topics, and all aspects of caring for people and managing risks, and essential health and safety subjects such as fire, infection control and manual handling. The registered manager told us the provider had a training department which enabled staff to receive specific training to meet individual needs.

Risk assessments included risks associated with people’s homes and risks to the person using the service. Staff had access to care plans and risk assessments and were aware of how to protect people from risks of harm.

Care was planned and delivered in a way that was personalised to each person. Staff monitored people’s healthcare needs and, where changes in needs were identified, care was adjusted to make sure people continued to receive care which met their needs and supported their independence. Care plans gave clear information about the support people required to meet both their physical and emotional needs and had information about

A single inspector carried out this inspection. This was a follow-up inspection, to check the provider’s progress against areas where we found non-compliance on our previous inspection visit. We considered our inspection findings to in relation to questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? As it was a limited inspection to check specific areas of previous non-compliance, we did not gather evidence to answer all five questions but focused on whether the service was safe, effective and well led.

We spoke with the registered manager and a senior member of staff, and inspected the service’s records, systems and procedures. It was not necessary for us to speak with people using the service during this follow-up inspection.

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Failure to carry out mental capacity assessments properly meant the provider could not be sure that people who lacked capacity to consent to their own care had been correctly identified. This meant there was a risk that people were not properly protected by safeguards contained within legislation.

The provider had taken steps to address the concerns raised in our previous inspection about cooperating with other providers to effectively support people’s health, safety and welfare. Revised moving and handling guidance clarified the different roles and responsibilities of the agency’s staff and the ambulance service, which lessened the likelihood of future confusion or disagreement. The guidance explained clearly how staff were to respond to different scenarios, and the steps to be taken which would help minimise the risks to people using the service. People’s health, safety and welfare were protected because the provider worked in co-operation with others.

Is the service effective?

Failure to carry out mental capacity assessments properly meant there was a clear risk that people had been assessed as lacking capacity to consent to their own care, when in fact they did have capacity to make such a decision.

Before people received any care or treatment they were not always asked for their consent, which meant the provider could not demonstrate they had acted lawfully in accordance with their wishes.

The provider could not demonstrate that appropriate best interests decision making processes had been followed, which meant there was a risk that the care people received was not actually in their ‘best interest’.

Is the service well-led?

We found the provider had not addressed the issues we had identified previously in regard to mental capacity and consent. Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements.

We had previously inspected Agincare Ferndown on the 8 September 2011. At that inspection we were concerned that people who use the service did not have their views and preferences taken into account. That administrative problems meant people were experiencing missed visits, changing rotas and insufficient staff. The arrangements in place to manage safeguarding concerns were not always followed.

We were also concerned on the visit on 8 September 2011that whilst staff received training the arrangements for formal supervision and appraisal sessions were not carried out routinely. The agency did not audit or monitor the care provided to ensure that people receive appropriate and safe care. We also found the records used by the agency lacked the proper information about people’s care and treatment.

As a result of the inspection visit in 2011 we issued compliance actions to tell the provider to improve standards in relation to peoples involvement in their care, the care and welfare, safeguarding people, staff training and quality assurance and record keeping.

We carried out this inspection visit to review if compliance had been achieved.

We telephoned five people who used the service, three wished to discuss the service they had received. People told us that staff did what they agreed for them to do.

One person said staff regularly asked them if everything was ok. Another person said they had received a questionnaire from the head office. People we spoke with thought that the majority of staff were respectful.

People said staff stayed until they had completed the tasks that were required and usually arrived within the expected time. One person said there had been problems with some care staff staying for the right amount of time but this had been sorted out.

The people using the service we spoke with felt they were able to give their opinion about the management of the service. One person told us, "I can give my opinion and frequently do. I am always listened to, if there's anything that needs changing then it is done."

In this inspection we considered five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on evidence from observations during the inspection, speaking with people using the service and relatives, staff supporting them and relevant external agencies, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had taken steps to ensure people’s care and welfare needs would continue to be met in the event of foreseeable emergencies.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others in most instances.

There was a small but identifiable risk that an ongoing difference of opinion between the provider and the emergency ambulance service might have an impact on the welfare of people using the service.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in their own plans of care. Effective planning of care helped ensure that the service met people’s care and support needs.

People who used the service and their representatives were asked for their views about their care and treatment and they were acted on. People benefited because their views were sought and the provider took steps to act on feedback to improve the service. This helped ensure that the care and support provided was also in line with people’s wishes.

Is the service caring?

People were supported by kind and attentive staff. People told us staff were respectful and responsive to their individual needs. They told us care workers were patient and caring when supporting them. A relative told us, “the service has been fantastic really.” Another person believed the success of their recovery had been, in part, due to the “exemplary care from the regulars of the care team within Agincare.”

Is the service responsive?

We found the provider had not taken full and appropriate action in response to a number of issues we had identified previously in relation to people’s capacity to consent to care.

When we raised a number of issues with the registered manager and provider during the inspection, their response was swift and positive; they took immediate action to start to address concerns raised.

People using the service and their representatives completed regular customer satisfaction surveys. Where shortfalls or concerns were raised these were addressed.

Care plans were reviewed regularly and updated as and when required. The service responded to people’s changing needs. Effective systems for the ongoing review of people’s care needs enabled staff to deliver continuous care according to those changing needs.

Is the service well-led?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The service had a quality assurance system, and records showed that identified shortfalls were addressed promptly.

The registered manager and senior staff had appropriate experience of care provision and were knowledgeable about the systems and processes required for the service’s effective operation. Effective leadership meant staff followed those systems and processes, which helped to ensure people’s care and support needs were met.