Agincare UK Newcastle under Lyme is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults, younger disabled adults and children. At the time of our inspection there were 68 people using the service.

There was a manager in post at the time of the inspection; they had made an application to register with us (Care Quality Commission). 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 our last inspection on 28 and 29 September 2016 we found the service was rated Requires Improvement. This was because there were not robust systems in place to ensure staff were suitable to work with people that used the service, there was not clear guidance for staff for administering some medicines and the systems to monitor the quality of the service were not effective. We issued the service with a requirement notice for breach of Regulation 17, governance arrangements. At this inspection we found improvements had been made and the provider was meeting the regulations. Improvements to the systems for checking staff were suitable to work with people had been made and the guidance was available for staff on administering medicines and overall governance arrangements had improved, but further work was needed.

This is the third consecutive time the service has been rated Requires Improvement.

People did not always receive support from staff at their preferred time. Medicine stocks were not always available where staff were responsible for ordering peoples medicine. Governance arrangements needed further improvement and peoples feedback needed to be considered to drive improvement within the service. The manager had systems in place to implement learning from incidents and when things went wrong, however these were not always used as they should be by staff.

Risk assessments and management plans were in place to keep people safe. People were safeguarded from abuse. People were protected from the risk of infection.

People’s needs were assessed and their care plans were used to deliver effective care. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were trained to deliver effective support to people and had their competency checked. People were supported to maintain a healthy diet. People were supported to access health professionals when required.

People were supported by caring staff that protected their privacy and dignity. People had support to make decisions and choices about their care and maintain their independence. People’s communication needs were assessed and they received support to communicate effectively.

People’s preferences were understood by staff and were used to provide person centred care. People understood how to make a complaint. People received support with care at the end of their life, which allowed them to have a dignified and pain free death.

This inspection took place on 28 and 29 September 2016 and was unannounced. At our last inspection in October 2015 we found that the service required improvement in providing a service that was safe, effective, responsive and well led. We issued the service with a requirement notice for breach of Regulation 17, governance arrangements. The provider did not always use systems or processes which ensured the proper assessment, monitoring and improvement of the quality and safety of the service. This included the management of risks to people and the keeping of accurate, complete and contemporaneous records in respect of each person who used the service. We received an action plan from the provider confirming when the improvements would be made. At this inspection we found improvements had been made to assessing, recording and reviewing people’s care and support needs but we continued to have concerns that the management did not have a good oversight of staff backgrounds to ensure they were suitable to work with people who used the service.

Agincare UK Newcastle under Lyme is a domiciliary care provider providing personal care and support to people in their own homes. At the time of this inspection 120 people used the service.

The service did not have a registered manager. A person had been recruited into this position and was undergoing their registration with us. 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.

Robust systems were not in place to ensure care workers were suitable to work with people who used the service.

People's medicines were not always managed safely; guidance for the administration of some medicines was not available for staff.

The provider had some systems in place to monitor the quality of the service, however improvements were required to ensure that all areas of the service delivery were audited and checked to ensure a safe and quality service was provided.

Care being delivered generally met people's personal preferences and was regularly reviewed to ensure it met people's needs.

People felt safe, carers and managers knew what to do if they suspected someone may have been abused.

The provider followed the principles of the Mental Capacity Act 2005 (MCA 2005) and ensured that people consented to or were supported to consent to their care and support.

People received care from carers who were supported and trained to fulfil their role well.

People were supported with their nutritional needs and if they became unwell carers responded and gained the appropriate healthcare support.

People were treated with dignity and their privacy was respected.

There was a complaints procedure and people knew how to use it. The provider took the necessary action when complaints were raised.

The manager was well liked and respected and demonstrated a commitment to improving the service being delivered to people. The manager was currently undergoing the registration process with us.

This inspection took place on 1 October 2015 and was announced. The provider was given 48 hours notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to speak with us.

The service provides personal care to people who live in their own homes. At the time of the inspection there were 147 people using the service. 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.

We found that some people did not have specific risk assessments or plans to show how risks were minimised. Some people’s care plans were not reviewed to ensure they met their current needs. People with complex needs in relation to eating and drinking did not have detailed, up to date plans in place for staff to follow.

People told us they felt safe and that staff were friendly and caring towards them. However, people told us that staff were sometimes late for their calls without informing them. Staff were aware of how to recognise and report abuse and we saw that referrals to the local authority had been made when needed in order to keep people safe from unnecessary harm and abuse.

Some people who used the service were not able to make decisions about their care and support. Assessments of their mental capacity did not show how people were supported to be involved in decision making. Some people had attorneys to make decisions on their behalf but the service did not have copies of the legal documents to ensure the right people had been involved in making decisions in people’s best interests.

People told us that staff had the right skills to support them and we saw that staff had completed training. Staff felt supported by the registered manager who offered additional support to staff if required.

People told us that staff treated them with respect and supported them to be independent. However, some people felt that staff rushed them. People valued the relationships with their regular staff and felt that regular staff had made an effort to get to know them.

Care records did not always contain the information staff needed to enable them to keep people safe and meet people’s individual preferences and needs. People’s care plans were focussed on tasks and did not describe how individuals liked to be supported. Staff told us that they knew people well and that consistency was improving following changes made by the registered manager.

There was a range of ways that people could feedback their experiences to the registered manager and we saw that complaints were dealt with in a timely manner. The registered manager had systems in place to monitor quality and was working on a number of ways to improve the quality of the service.

The management did not have a clear oversight of staff backgrounds. We found examples where staff needed a risk assessment to ensure that they were suitable to work alone with people in the community and this had not been done. We found that medication records were not fully and accurately completed. These issues resulted in a breach 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 the report.

We had given the provider 48 hours notice of our inspection so that they could arrange for the relevant staff and manager to be present. The provider had also arranged for us to accompany a care assessor on visits to two people in their own homes.

People were happy with the care and support provided to them. They liked the consistency of care and they told us that care and support was delivered to them at a time and in a way they preferred. They told us that staff were caring, polite and respectful. One person said, "The staff are very good and they know how I like things done."

The staff we spoke with felt well supported and told us that they received the training and supervision they needed to do their jobs properly. New staff had received appropriate induction training. One staff member said, "This is the best induction I have ever had."

The service was well managed and quality monitoring audits showed how the service had improved over the last few months.

People who used the service felt able to raise concerns and their views about the way they were cared for were taken into account by the provider.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection was led by a Care Quality Commission inspector who was supported by an 'expert-by-experience' who has personal experience of using or caring for someone who uses this type of service.

We visited three people in their own home as part of this review and spoke with them

about their experiences of the support they have received. We spoke with 15 people

over the telephone who received a service from this agency.

People spoke positively about their regular care workers and felt that they knew how they wanted their care to be provided. However some people did not have regular care workers and they were less satisfied with the service. Some people said when they did not have regular care workers they sometimes needed to guide them to provide the care in the way they wanted.

People felt that they were treated with respect and were spoken with in a respectful manner. However one person felt that their relative's dignity could be better promoted and this was reported to the manager to act upon.

Everyone had an assessment of their needs and a plan of care that showed the care they needed and how this was to be provided. People said they were asked about their needs before any care was provided. Most people said that staff from the agency visited to check that their care was meeting their needs.

People felt that their care was personalised and that the agency took account of their wishes. People were called by their preferred name. Where people's needs changed the agency responded to this promptly.

Everyone had an assessment of their needs and a plan of care that showed the care they needed and how this was to be provided. People said they were asked about their needs before any care was provided. Most people said that staff from the agency visited to check that their care was meeting their needs.

People said that they felt safe and would tell the staff at the agency or a relative if they had any concerns.

Information we hold in relation to this service told us that there were concerns in relation to missed visits, missed medication, and keeping people safe.

We spoke with people using the service, their relatives and or representatives.

People we spoke with told us they were happy with the care and support provided, they told us the service was flexible and was meeting their needs.

We visited the service on 16 November 2011. During our visit we looked at the care and medication records of four people using the service. This was to check that the service was keeping people safe, meeting people's needs, and that there were safe systems in place in regard to the administration of medication.

We checked that medication systems had been reviewed to ensure that people using the service safely received medication when they were prescribed it. We also looked at four medication administration records.

We spoke with staff about medication training, staffing levels and the support they received from their manager.

We saw that monitoring of the quality of the service had taken place, with evidence that the outcomes were being shared with people using the service