All Care is a domiciliary care agency which provides personal care to a range of people living in their own homes. These included people living with dementia, older people, people with a physical disability or learning disability. At the time our visit the service supported 53 people.

We inspected this service on 12 December 2016. We last inspected this service in August 2015 and we had some concerns around staff not being trained effectively, peoples needs not being met, staff not obtaining peoples consent before providing care, peoples needs not being reviewed on a regular basis and systems and processes not being established and operating effectively to investigate any concerns. This resulted in some breaches in regulation and the service was rated requires improvement. During this inspection, we saw the registered manager had made the necessary improvements to ensure they met all of the regulations.

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.

The provider was given 48 hours’ notice of our visit. This was to ensure documentation and people were accessible on the day of our inspection.

People were complimentary about the service they received from All Care. People’s needs were assessed and appropriate information was given to people before the service commenced.

Staff had a good knowledge of safeguarding procedures and were clear about the actions they would take to help protect people. Where safeguarding concerns had been identified the service had made the appropriate referrals and was open and transparent. Risk assessments had been completed to help staff to support people with everyday risks and help to keep them safe.

Systems were in place to assist people with the management of their medication and to help ensure people received their medication as prescribed. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. Staff told us that they felt well supported to carry out their work and had received regular support and training.

There were sufficient numbers of staff, with the right competencies, skills and experience available to help meet the needs of the people who used the service.

Where needed people were supported to eat and drink sufficient amounts to help meet their nutritional needs and staff knew who to speak with if they had any concerns around people’s nutrition. People were supported by staff to maintain good healthcare and were assisted to gain access to healthcare providers where possible.

People had agreed to their care and been asked how they would like this provided. People said they had been treated with dignity and respect and that staff provided their care in a kind and caring manner.

The registered manager had a good understanding of Mental Capacity Act 2005 and who to approach if they had any concerns and the appropriate government body if people were not able to make decisions for themselves.

People knew who to raise complaints or concerns to. The service had a clear complaints procedure in place and people had been provided with this information as part of the assessment process. This included information on the process and also any timespan for response. We saw that complaints had been appropriately investigated and recorded.

The service had an effective quality assurance system and had regular contact with people who used the service. People felt listened to and that their views and opinions had been sought. The quality assurance system was effective and improvements had been made as a result of learning from people’s views and opinions.

We spoke with four people who used the service who told us that they were consulted about the care they were provided with. One person said, “They always ask if there's anything else they can do for me before they leave.” Another person said, “We get on really well and they treat me with respect which I like.”

We saw that risk assessments were included in people's records which identified how the risks in their care and support were minimised. These included risks associated with moving and handling, pressure area prevention and falls.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw evidence in the staff handbook of a code of conduct for care workers and guidance on how to respond to allegations or suspicions of abuse.

Two people told us that if care workers were running late they were always informed. People told us that they were provided with a regular group of care workers who were known to them. One person said, “They are very professional. They know exactly what I want and how I want it done. They are friends.”

We saw assessments completed prior to the service commencing work with people who used the service. These included assessments to identify and manage risks to the health, safety and welfare of people who use the service and others.

People told us that the care workers from All Care were kind, considerate and respectful, that they were patient and took their time. People told us they felt safe with their care workers and trusted them. One person said "I trust them to help me and I feel comfortable and safe in talking about how I feel too. Having kind, friendly faces visiting you can lift your spirits." Another person said "All Care provided the care very quickly when I needed it. I only had to tell one person and it was sorted out."

People with whom we spoke told us positive information regarding All Care. One person had commented, "thank you so much for your kind support and all the hard work the care staff have provided my X with over the last year". In addition to this one person commented, "you have turned our lives around. Thank you so much for all your time and support for my X".

One person with whom we spoke commented, "we are involved in my X's care plan", and “they review our care plan periodically or when there is a change".

We saw that the care plans had been reviewed at least annually or when there was a change of need. A person with whom we spoke commented, "its very useful to have as it helps the new staff know what to do and tells them the support my X needs".

A representative of a person told us that "the support my X receives is good, the staff are always attentive to X's need's". In addition to this we were told that the care plans are also held in the service users own home so that staff could access these each visit to ensure they knew what was required. The individual also confirmed that each time a visit occurs that the staff write in the care log book.

One person with whom we spoke to told us that they feel that All Care is safeguarding them and commented, "All Care always ensure that the welfare of the person they are helping is of a high standard. The care staff are very caring and always do a good job. We don’t have any complaints".

People with whom we spoke to told us that, "if I have any concerns I always call the office and speak to a senior person. I don’t have any complaints". In addition to this a person with whom we spoke to told us that, "I have information about how to complain in my care file held at my home", and “the staff seems to be trained, some more than others, but we have no issues or complaints".

We inspected this domiciliary care agency on the 12 and 14 August 2015. The agency was last inspected in January 2015 and we identified some breaches in regulation. This resulted in a requires improvement rating. This inspection of 12 and 14 August was brought forward because of some concerns we received about the service. During the inspection we saw a genuine effort had been made to improve the service but there were still areas that required improvement.

This agency provides different levels of support to people in their own homes ranging from personal care to helping people with domestic skills and shopping. The majority of people using the service were older people but they do support people with a learning disability, mental health needs or physical disability. 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 people received their medicines safety and records relating to administration of medicines had improved.

Risks assessments were more robust than before and there was more monitoring of the risk assessments designated senior staff.

Staff training and induction was improving but we found there were some concerns about the skills and competence of some of the staff and people did not always feel they were able to meet their needs. We attributed this partly to poor record keeping with care plans not always being up to date. People’s health was not always adequately monitored and the impact was that people were at increased risk of receiving poor care.

Staff training in Mental Capacity is being planned following our inspection. Senior staff had adequate knowledge and people’s consent was sought before staff provided care and support to them. However staff had limited understanding of capacity and we were not assured that they were acting lawfully.

Staff providing care were reported to be kind and caring and their performance was monitored to ensure they were upholding people’s dignity, self- determination and dignity. New records being introduced focussed much more on the individual and how they wished to have their care needs met.

People were consulted about the service provided to them and felt the service acted upon concern’s

The service provided was improving In terms of record keeping. However people did not always have up to date records about their care needs and this was being addressed.

The service was improving in terms of fewer complaints received and fewer missed calls. There had been one this year which was a big improvement on previous years. However there were still gap in terms of the reliability of the service and the robustness of investigations into incidents affecting the well-being and or safety of people using the service.

There were quality assurance systems in place which included feedback from people using the service to help the service know where the agency required improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in multiple regulations. You can see what action we told the provider to take at the back of the full version of this report.