We carried out the inspection on 11 April 2018 and it was announced.

Albury Care Limited 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, younger disabled adults and children.

At the time of the inspection, 62 people were using the service.

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 in.

This was a comprehensive inspection to see what improvements the provider had made to ensure they met regulatory requirements.

At our last comprehensive inspection on 8 November 2016, the service was in breach of two regulations related to quality monitoring and staff training. We rated the service as requiring improvement. We had found that care records lacked detail and were not reviewed regularly. In addition, monitoring systems to manage complaints, incidents and accidents were ineffective. We also found that staff had not completed the provider's mandatory training and refresher courses.

At this inspection, we found improvements made ensured people received effective care. Care plans showed sufficient detail about people’s needs and the support they required. The quality of care underwent checks and monitoring to identify and resolve concerns about people’s safety.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

People had an assessment of their needs and preferences about care delivery. Staff were aware of risks to people’s health and safety and knew how to support them safely. People received the support they required with their nutrition and hydration and to maintain their health. Enough suitably recruited staff were deployed to meet people’s needs. Staff administered and managed people’s medicines in line with the provider’s procedures. Staff knew how to prevent and control the risk of infection.

Staff provided care in line with best practice guidance and the requirements of the Mental Capacity Act 2005 (MCA). People received care from staff who received an induction, training and supervision to enable them to deliver care effectively.

People received care that met their individual needs in line with their preferences. Staff treated people with respect and maintained their dignity and privacy.

People using the service and their relatives knew how to raise concerns and make a complaint about care delivery if they needed to.

People enjoyed a person centred approach to their care and support. Staff were supported in their roles and had access to guidance from the registered manager and the management team.

An open and honest culture existed at the service about care delivery. The quality of the service underwent regular monitoring to improve the care and support provided to people. The registered manager worked closely with other agencies to provide effective care.

We undertook an announced inspection on 8 November 2016. We gave the provider 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

Albury Care Limited provides domiciliary and live in care to people in the community. At the time of our inspection 12 people were receiving 24 hour live in care and support with their personal care. In addition, 12 people were receiving a domiciliary care service. Of the 12 people receiving a domiciliary care services, four people were supported with their personal care.

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 did not have a registered manager. The current manager had been in post since August 2016 and had applied to be the registered manager. The CQC registration team were undertaking a fit persons’ interview two days after our inspection to formally assess their suitability.

At our previous inspection on 4 December 2013 the service was in breach of the Health and Social Care Act 2008 (regulated activities) 2010 regulation relating to care records. At this inspection we found that whilst improvements had been made there were still areas requiring improvement. Some care records still lacked detail and were not regularly reviewed to ensure they were accurate and up to date.

In addition the provider did not have robust procedures in place to review key performance information to identify trends and areas requiring improvement in regards to complaints, incidents and accidents. A formal process was not in place to spot check staff’s performance and check on the quality of care delivery.

At our previous inspection we identified the provider’s training records was not kept up to date. At this inspection the training records had been updated but showed that staff were not up to date with their training requirements and had not completed the provider’s mandatory refresher courses.

The provider was in breach of the legal requirements relating to staffing and good governance. You can see what action we have asked the provider to take at the back of this report.

Improvements had been to made to review risks to people’s safety and ensure appropriate management plans were in place. Staff supported people to manage and mitigate the risks to their safety and welfare.

Staff had updated records relating to medicines management. We saw that accurate medicines administration records were maintained and people confirmed they received the support they required to ensure they received their medicines.

There were sufficient staff to meet people’s needs. The manager arranged the staff rota to ensure people received support from the same care staff to enable consistency in service delivery. The manager matched staff and people to ensure they were comfortable with each other and were able to build a good rapport.

Staff provided people with the support they required. This included their personal care as well as with nutritional and healthcare needs. Staff liaised with people’s relatives and the other healthcare professionals involved in their care if they had concerns about a person’s health.

Staff involved people in decisions about their care and undertook care in line with people’s preferences. Staff adhered to the Mental Capacity Act’s 2005 code of practice and people consented to care delivery. Where people were unable to consent to their care the manager involved legally nominated persons to make best interests’ decisions on the person’s behalf.

There were processes in place to obtain feedback from people and their relatives. The manager had recently sent satisfaction questionnaires to peo

One person we spoke with confirmed the care plan was kept in the home and updated by staff each day. They also told us “I am very pleased with the service, the staff are excellent”. A relative said “I am completely happy with the care and support we receive”. We were told that the manager or the deputy manager went to see people and their relatives every fortnight when the staff changed over. This ensured there was a regular opportunity to raise any issues of concern.

Some people's records did not include important information and others were completed inaccurately. We found that when a person's medication or their treatment was changed this information was not recorded appropriately in their records. This meant their risk assessments were not updated and the manager was not informed of these changes in line with the provider's policy.

We spoke with three people whose relatives used the service. One person said; “I can’t praise them highly enough, I’m very satisfied with them. The care they provide is very good. I get asked for feedback and the staff appear to be very well trained”. A second person said; “They are always reliable. They are very good and go above and beyond. They are very respectful and ask questions and offer options. The management are very approachable and the staff are well trained”. A third person we spoke with said; “They are absolutely brilliant. I am very relaxed with the quality of the care. The management are very good and I am very happy with it. The staff are well trained and they respect (my relatives) and their decisions”.

We found people had been involved in the planning and delivery of their care by contributing to their care plans and being asked their preferences, likes and dislikes. The service had ensured people’s safety and welfare by completing risk assessments and reviewing these on a regular basis.

The service had an appropriate recruitment process in place and had followed this when recruiting staff. Staff had been provided with appropriate training and support to work effectively and the service had taken steps to obtain people’s feedback and act upon it to improve the service.

We did not manage to talk to all the people whom we telephoned as some people would not talk to us. We did talk to their next of kin and their views are reported under the Other Evidence within the Outcomes of this report.

People who used the service told us that they made choices every day, and that their carers encouraged them to make choices. We were told that staff always attended to their personal care needs in private, and that the staff respected their privacy and dignity. They told us that they could not remember if they had a care plan. They told us that they were asked lots of questions about themselves. We were told that staff always listened to them, and they would do anything they asked of them. They stated that staff were very nice and helpful.