Alandra Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own houses. It is registered to provide care to those living with dementia, older people, physical disabilities, learning disabilities and younger adults.

This comprehensive inspection took place on 29 October and 05 November 2018 and was announced.

Not everyone using this service receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care, which means help with tasks related to personal hygiene and eating. Where people receive personal care we also take into account consider any wider social care provided. At the time of our inspection the service supported 39 people with their personal care needs.

The service had a registered manager. 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.

At the time of our inspection the service was in the process of being transferred to another provider. The transitional arrangements are reflected in this report.

At our last inspection in October 2017 we found breaches of regulation. These were a breach of Regulation 18 Care Quality Commission (Registration) Regulations 2009 for a failure to submit statutory notifications; breaches of Regulations 12, 17 and 18 Health and Social Care Act (Regulated Activities) Regulations 2014 for a failure to mitigate risks regarding safe and proper use of medicines, a failure to maintain quality assurance systems and a failure to deploy sufficient numbers of staff to meet the needs of people using the service.

At this inspection we found improvements had been made and these breaches had been met. A monitoring system for managing statutory notifications was in place. Risks relating to medicines were robustly documented and understood. More staff had been recruited and quality assurance systems and audits were in place to monitor the service people received.

While these improvements had been made since our last inspection, some areas of practice needed to be embedded and sustained. Quality assurances processes gave the registered manager oversight of the service, but some areas such as ensuring all staff were up to date with regular training still needed to improve. Some people who used the service told us that the transitional arrangements had impacted the quality of care they received. Staff did not feel fully integrated into one team with new staff from the new owners. The registered manager recognised these areas needed to be addressed and had a support plan in place and we saw evidence this was being actioned. While these improvements were being made, time was now needed to fully embed these changes to sustain improvement.

Risks to people and the environment had been identified and staff understood how to manage risks to help ensure people were safe. People were supported to receive their medicines safely by staff that were trained in administering medicines. People told us they felt safe. One person told us, “Yes, I feel safe, they are very good.”

People were protected from avoidable harm. There was a safeguarding policy and staff received training. Staff knew how to recognise the potential signs of abuse and knew what action to take to keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff understood best interest decision making where people lacked capacity in line with the principles of the Mental Capacity Act 2005. Staff sought people’s consent before giving personal care.

People were supported t

We inspected Alandra Care Limited on 2nd October 2017. The inspection was announced: We gave 48 hours’ notice of the inspection to allow enough time for the provider to arrange for us to visit people in their own homes on the day of the inspection.

Alandra Care Limited is a domiciliary care agency that provides personal care support to people in their own homes. The majority of people who receive support are older people aged 65 or over. People using the service have varying support needs, including physical disabilities, sensory impairments and dementia. People require varying levels of support, for example; some people may only require support once or twice a week, whilst others will require more than one call a day and support from two carers. At the time of our inspection the service was supporting 48 people.

The service has 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.

Alandra Care Limited was last inspected in May 2015. At that inspection it was rated good overall, and good in all domains. At this inspection the provider had not ensured they had maintained this and improvements are needed in a number of areas:

People’s support with medicines did not always correspond with the assessment of their needs and medicine records maintained by the service were not always up to date or accurate. Identification of risk and actions agreed to ensure the support provided was safe was missing for some people who had support with their medicines.

The service had recruitment and deployment issues with staff. Despite taking steps to address these issues the service had frequently not been able to ensure enough staff to cover shifts at weekends and some people were receiving consistently late care calls as a result.

Identification of risks to people in other areas of their support lacked formal guidance for staff about how to manage these risks safely. Peoples’ care plans sometimes lacked detail about people’s preferences and the support they needed.

Since the last inspection took place on the 8th and 19th May 2015, the provider had not always submitted notifications about important events at the service to the Care Quality Commission, as required by law.

The registered manager employed a range of systems to monitor and identify issues and areas for improvement at the service. However, issues were not always formally recorded and the provider had not always taken effective action in response to findings from the quality assurance systems or from people using the service and staff feedback.

Staff completed a comprehensive induction in which they obtained a QCF Level 2 Diploma in Health and Social Care, as well as receiving training in a range of relevant subjects. The registered manager was proactive about providing more specialised training for staff if the need arose. However, some staff training was not up to date and this meant staff did not always have the latest knowledge and skills when carrying out their roles. We have made a recommendation about updating staff training and reviewing this at appropriate intervals.

The service had an ethos of person centred care and involved people in the planning and delivery of their care. The service regularly reviewed people’s care and responded well to meeting any changes with people’s needs. However, the level of detail in people’s care plans did not always reflect their needs and preferences. We have made a recommendation about updating people’s care plans.

People had experienced positive outcomes with their health after being supported to access healthcare services. There was not always sufficient information in people’s care plans for staff to accurately supp

At this inspection we spoke with the registered manager and provider. We also spoke over the phone with seven care staff and fourteen people who used the service, or their relatives.

The inspection was carried out by one inspector. We answered our five 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. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had policies and procedures in place to safeguard people who used the service. There was evidence that the provider had taken appropriate action where safeguarding concerns were identified. Staff had received training in safeguarding vulnerable adults and told us they felt confident about what action they would take if they had any concerns.

We found that there were inconsistencies between the care records held at the office and in people's homes. The lack of consistency meant that inaccurate information could be being given out from the office, placing people at risk. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

Care staff had received the training needed to support them in their roles. Although staff told us they felt supported, the majority of staff had not received formal supervision and no staff had received an annual appraisal. This meant that staff were not fully supported to deliver care and treatment safely and to an appropriate standard. The provider had not made the required improvements identified at our last inspection. We have taken enforcement action in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that they were happy with the care that had been delivered and that their needs had been met. Comments included "No complaints", "They do a very good job", "They look after me" and "I am very satisfied with the care". The staff we spoke with demonstrated a commitment to making sure people were looked after.

Is the service responsive?

People’s needs were assessed and reviewed. Records confirmed that people’s preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people’s wishes. The provider had taken appropriate action where changes in needs had been identified.

Is the service well-led?

People who used the service were given opportunities to express their views. One person said "If I have a problem I call the office and they sort it". However, the provider did not have an effective system to identify non-compliance or the risk of non-compliance with the Regulations and take necessary action to return to compliance. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

This was a scheduled inspection which also followed up on areas of non-compliance identified at our previous inspection in February 2013. We spoke with the manager and provider and spoke over the phone with 14 care staff and 12 people who used the service.

People told us that they were happy with the care and support they received. Comments about the service included "Brilliant", "No problems", "Carers are helpful and friendly" and "Can't really fault them".

We found that people were treated with respect and dignity. People were given appropriate information about their care and support. Information included a Service User Guide which explained people's rights and expectations for the service.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Care plans provided clear guidance for care staff on how people needed to be supported. People told us that they received the care they needed.

Although most care staff told us they felt supported by management there was a lack of formal supervisions and team meetings. This meant that people were cared for by staff who were not fully supported to deliver care and treatment safely and to an appropriate standard.

We found that people who used the service were asked for their views about the service and these were acted on. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. Care plans were reviewed regularly and we saw that personal and confidential records were kept securely and could be located promptly when needed.

We were given the contact details of 17 people who use the service, and we telephoned ten people. Seven people who use the service, or their family members, spoke to us.

We spoke to the provider, the manager and the care coordinator. The rest of the staff team were given the opportunity to contact the CQC, to provide their views on this service; however they chose not to do this.

One person’s family member told us that, when this person was ill recently, the carer was “marvellous” and they had written to the agency to thank the carer. Another person said the agency provide “very good carers”.

The family member of a person who uses the service told us that the senior staff are “dedicated” but there have been issues with a few carers not arriving on time.

Three people who use the service, or their family member, told us that they do not receive information on time which tells them who is visiting and/or at what time the visit will be.

We inspected the offices of Alandra Care on 6 and 19 May 2015.

The agency provided care to 42 people living in their own homes. The majority of people who received a service were older persons. People had varying needs for support. Some people received infrequent visits, for example once a week. Other people received regular visits, some being visited several times a day. Some people who were living with a physical disability had two care workers to provide them with care for every visit. The agency employed 31 care workers in total; only 14 of the care workers supported people in their own homes. The other care workers worked as agency care workers in care homes. On infrequent occasions, for example if staff were sick at short notice, care workers who worked as agency staff in care homes could also support people in their own homes.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The agency’s last inspection was on 13 May 2014. At this inspection we had warned the agency they must take action to ensure staff were supported in their roles, so they could provide people with a safe service. We also found the agency were not appropriately assessing and monitoring the quality of the service provided or maintaining necessary records to ensure the safety of people. The agency sent us an action plan on 30 June 2014, which outlined how they would take action to address these matters. We found the agency had taken full action to address the issues raised.

People reported on how well managed the agency was. Staff were positive about improvements made in management of the agency since the last inspection. One care worker described it as “More organised.”

People told us they felt safe because of the service provided by the agency. Care workers knew what actions to take if they thought a person might be at risk. They were confident the manager would take appropriate action if they raised concerns about the vulnerability of a person.

The agency performed comprehensive risk assessments about people, and the environment they lived in. Where risks were identified, action was taken to reduce risk, including the involvement of external agencies if necessary.

There were effective systems for the safe recruitment of staff. There were sufficient care workers employed to ensure people’s visit plans were followed in the way people wanted.

People said they were supported by care workers if they became unwell. Care workers were aware of actions to take if people needed medical or emergency support. Where the agency supported people with taking their medicines, care workers were trained in how to do this. Full records were kept where the agency supported people with their medicines.

People told us the service was effective because staff knew how to support them. Staff were positive about the training they received which they said enabled them to support people in the way they needed. Staff said they were supported in their roles, so they could deliver safe care to people.

People described care workers as caring, respectful and polite. Care workers were aware of the importance of ensuring people’s privacy and confidentiality was protected. Care workers knew the people they supported as individuals. Due to this, care workers supported people in a sensitive way, taking account of their diverse needs when providing care. Care workers were aware of how to support people who were living with dementia and may need support with making decisions. There was full information in people’s records about who people wished to receive support from when making decisions.

All people had a care plan drawn up when they started receiving a service from the agency. Care plans were reviewed with the person when their needs changed. Care workers were responsive to people’s changing needs and informed the office staff of any changes. Care workers supported people with their diet and fluids when needed. They maintained relevant records relating to this and observed for key factors such as a person losing weight.

People said they could raise complaints or bring up other issues with the agency if they needed to. They said they were confident the agency would take action if they raised issues. For example one person had requested a change in care worker. This was actioned by the agency.

The agency maintained clear records, which were clear and easy to audit. They had clear policies to support in the management of the agency. Questionnaires were sent out to people and care workers. These showed a positive response about the management of the agency. People were positive about the culture of the service.