All About Care is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided personal care and support for 90 people living in Weymouth, Dorchester and Purbeck. There was a 24 hour on-call service available.

There was a registered manager who has worked at the service for over five years, in various roles and was registered as manager in March 2017. 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 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People needed minimal support and prompting with their medicines and this support was managed safely. Any risks to people were identified and managed in order to keep people safe.

People received care and support in a personalised way. People’s needs were assessed and planned for. Staff knew people well and understood their needs. We found that people received the health, personal care and support they needed.

People and relatives spoke very highly of the caring and compassionate qualities of staff. People and relatives told us they had good relationships with staff and that there was often lots of laughter between people and staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of the Mental Capacity Act 2015.

Staff were recruited safely and there were enough staff to make sure people had the care and support they needed. Staff were trained and had the opportunity for personal and professional development.

People and relatives knew how to complain and raise any concerns. People and their relatives did not raise any concerns with us.

The culture within the service was personalised and open. There was a clear management structure and staff felt well supported and listened to. There were systems in place to monitor the safety and quality of the service provided.

Further information is in the detailed findings below

This inspection took place on 22, 24 and 26 February 2016. It was carried out by two inspectors.

All About Care is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided personal care and support for 112 people. The core hours of the service were 7 am to 10 pm. There was a 24 hour on-call service available.

There was a registered manager. 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 of All About Care in February 2014 we had concerns that people were not asked for their consent before they received care. The service was not acting in accordance with the legal requirements of the Mental Capacity Act 2005 (MCA), as people’s mental capacity was not assessed appropriately. We had concerns that peoples medicines were not managed safely and that there was insufficient systems to monitor the quality of service that people received. We asked the provider to make improvements and they told us they would meet the requirements by July 2014.

We found the provider had made improvements since our last inspection in December 2014. People had an assessment of their capacity to consent to care and treatment and the service was acting within accordance of the legal requirements of the MCA .The medicines policy had been updated and people had an individual assessment for medicines. There were systems for monitoring the quality of care plans.

People told us they felt safe with the care and support they received. People had their risks assessed and they had support plans which provided guidance to staff on how to minimise people’s risks. People were encouraged to be as independent as possible with their medicines. When medicines were administered, there were checks in place to ensure people had received them correctly.

Staff were aware of what constitutes abuse and what actions they should take if they suspected someone was being abused.

People mostly received their visits on time and some people acknowledged that there were occasional unavoidable circumstances which may delay staff, for example traffic. Staff mostly felt their visits were well organised although some staff identified more pressures with travel times at weekends.

Staff received appropriate training and new staff completed an induction which they told us prepared them for their job role. Staff had regular supervision and an annual appraisal. There was a system for carrying out spot checks on staff.

Staff had received training on the Mental Capacity Act 2005 (MCA) and understood how it applied to their work.

Staff referred people for healthcare when they needed it; healthcare professionals told us that staff communicated appropriately and followed any recommendations they made.

People were treated with dignity and respect and their privacy was maintained. There were positive interactions between people and staff. People received personalised care and staff treated them as individuals. Some people received support from a particular member of staff and described the positive benefits of this. There was recognition that due to staff availability , the location of people and timings of visits, that some people received care from different members of staff.

Concerns and complaints were dealt with appropriately and people told us they could contact the office if they wanted to grumble. Staff stated they could contact the office when needed although there was acknowledgement from some staff that the office was busy. Staff described management as supportive. They were encouraged to enrol in further learning such as health and social care qualifications.

The service was piloting a rapid response ser

We visited three people in their own homes and an expert by experience spoke with ten people and five relatives by telephone. We also spoke with ten members of staff, the registered manager and nominated individual.

The provider did not have a formal system to assess mental capacity and record consent to care. There were some people that were receiving care that they had not agreed to, or sometimes withdrew their consent to, without an assessment of their mental capacity.

People received care that was planned and delivered appropriately. Approximately 95% of people we spoke with were happy with the care that they, or their relative, received. Comments made included: “We can’t fault them.”

We looked at the administration of medicines in the agency. We found that processes to ensure people had the medicines they were prescribed were not always followed. We saw that some risks had not been identified and appropriately assessed.

People spoke positively about the capabilities of the staff. One relative told us, “They understand her needs very well and have the right skills to meet them.” Staff told us they felt they had received the training they needed to do their jobs and they felt supported by the agency.

There was a system in place to monitor and assess the quality of the service that people received. However, this system was not always effective in ensuring that risks to people’s health and welfare were identified and appropriate action taken.