This inspection took place on 19 September 2017 and was announced.

This service provides care to people living in their own homes and there were 30 people receiving personal care when we inspected. At the last inspection, in July 2015, the service was rated Good overall. At this inspection we found that the service remained good overall.

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 and associated Regulations about how the service is run.

People’s care was delivered in a safe way when they received care. Care staff protected people from the risk of potential abuse and understood the potential signs to report. People’s safety had been assessed and reviewed and their individual risks recorded. The plans showed care staff the steps needed to reduce a person's risks and prevent risk of harm or injury. People who had support with their medicines had them administered when needed, with staff that were trained and competent to do so.

The provider offered training linked to people’s needs and care staff were knowledgeable about their roles and responsibilities. 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. People told us they arranged their own healthcare appointments and that care staff were helpful in providing reminders of appointments.

People received care in their home from care staff they knew and liked. People received care that supported their independence and were able to direct staff on each call. People’s dignity had been supported and staff were respectful of people’s human rights.

People were involved in planning and changing their care which had been recorded in their care plans. The management team had been regularly reviewing these alongside people’s requests and people’s plans were updated when needed. People knew how to contact the office and were confident in how to make a complaint should they wish to.

People were contacted regularly from the management team to ask about their views and feedback on their care. Care staff spoke with the manager and provided feedback on the service. The manager told us they kept their knowledge current and provided staff with input and direction about the levels of care they expected through regular meetings and supervisions. The management team monitored the quality of the care that people received, this included reviewing records and observing staff practices.

This inspection took place on 14 July 2015. We gave the provider 48 hours’ notice of our inspection to ensure members of the management team would be available at the office, and to ensure they could make arrangements for us to meet with and speak to staff and people who used the service.

We last inspected this agency in May 2014. At that time the systems in place to monitor the safety and quality of the service were not adequate. We asked the provider to take action and at this inspection we found the required improvements had been made.

All Seasons Care provides support to people living in their own home. At the time of our inspection there were 90 people using the agency. People required support from the agency for a variety of reasons including age related conditions, needs relating to dementia, people experiencing mental ill health, and people living with physical and sensory impairments.

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.

People using this service told us they felt safe. The registered manager had developed systems that ensured there were always enough staff available to support people. The staff employed had been subject to robust recruitment checks and had received the training and support they required to safely meet people’s needs.

Some people required staff to support or prompt them to take their medicines. Records we viewed and conversations we had with both people using the service and members of staff provided evidence this was undertaken safely, and that people received their prescribed medicines at the correct time, in the correct dose.

Staff were able to support people to ensure they had adequate amounts to eat and drink. Staff we spoke with were aware of people’s dietary preferences and of their health needs which might impact on the food they should choose.

Staff we spoke with were able to describe a range of activities they undertook each day which ensured people stayed healthy. Staff described how they observed people’s feet and skin for signs of infection or sore places for example when they were supporting them with personal care. Staff described occasions when they had sought medical advice for people after observing a change in their condition. These observations and subsequent actions ensured people were able to maintain as good health as possible.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 (MCA) which applies to services providing care in the community. Staff we spoke with and the registered manager had undertaken training to ensure they were aware of their responsibilities under the act. In discussion they demonstrated a good awareness of the impact the MCA had on their work. Records showed that consideration was given to people’s needs under the MCA in the pre-admission assessment and at subsequent reviews. This would ensure changes in people’s needs or wishes would be identified and the support amended.

The culture of the agency had been built around providing a caring service. People and staff we spoke with consistently described ways in which they had felt supported or cared for. Staff we met spoke enthusiastically about the people they were supporting, and in discussions were able to explain people’s needs, their preferences and were aware of important people in the person’s life.

Before being offered a service by ‘All Seasons Care’ a senior member of staff would visit the person at home to determine what care and support the person required, and how they would like this care to be provided. This information was then developed into a care plan, and shared with staff that were supporting the person. This ensured all staff were aware of the person’s needs and wishes. Staff we met were able to describe at length how they met the individual needs of the people they supported.

The registered provider had developed a complaints procedure. We saw records showing the concerns that had been raised and how these had been investigated and resolved. People could be confident their feedback would contribute to the development and improvement of the service.

The feedback from people using the service, relatives, staff and professionals was consistently positive about the management of the agency. People told us the management team were approachable, friendly and that they did what they said they would do.

The registered manager had used feedback from the last inspection to develop the service, and we found the action plan they submitted had been effective at achieving the necessary improvements. The registered manager and registered provider shared with us ideas they had to further develop and establish the agency, building on their existing achievements.

Our inspection team was made up of one inspector who considered 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. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During this inspection we looked at the staff recruitment records for six members of staff. Appropriate checks had been undertaken before staff began work.

We spoke to people who used the service who confirmed they felt safe and were not afraid of any of the staff who came to support them. Comments from people included," If there is a problem the worker calls the office, they call me, I give advice. I have no concerns at all about my relatives safety" and "They are friendly and reliable. I feel completely safe with my carer."

We checked people's care plans and found that these were detailed and up to date. Risks related to people's homes or their specific care needs had been identified and recorded to ensure that people had their care provided safely and risks to them and / or other people were minimised.

There were policies and procedures in relation to safeguarding and the Mental Capacity Act. Staff had received or were booked onto training to update their knowledge about these areas.

Is the service effective?

People told us they were happy with their care and support. People's comments included, “It is all very good”, "I have no problem with them at all-excellent" and "They do what they are meant to do, when they are meant to do it. They knock the socks off other agencies we have used."

The records we looked at and the conversations we had with people using the service and their relatives indicated that people received plenty of time to undertake their personal care to a high standard.

Records showed that regular meetings were held with people or their relatives if appropriate, to review their care needs.On relative told us," They ask us regularly if we are happy with the care and if it meets our needs. If we suggest anything it is sorted straight away."

Is the service caring?

Staff we met spoke with compassion about the people they were supporting. People told us that staff were "Lovely", "Kind and lovely" and "The carers are excellent, they are clean, tidy and very caring and they are considerate, respectful and really interested in my mom’s health and care.”

Some people had support from the agency to promote their independence and community involvement. One person told us that staff had supported their relative to a hospital appointment. They had been pleased with the level of information that had been fed back to them.

Is the service responsive?

People told us they were regularly asked if they were happy with the service and were given the opportunity to make a complaint if they were unhappy. People told us they were able to raise any concerns they had. One person told us, “They often ask how the service is going. There is rarely anything negative to say but even small problems are quickly nipped in the bud." ”

Where people who used the service were able, they were asked to comment on the service provided, this included questions about the support they received. This feedback was used to develop the service or provide assurance that people were receiving safe and effective care that met their needs.

During our visit we looked at records of complaints and incidents. We found that consideration had been given to these by the registered manager and actions had been taken to reduce the likelihood of similar incidents happening in future.

Is the service well-led?

Feedback about the management and leadership of the service was overwhelmingly positive. Comments included,"The office staff are brilliant." Staff told us they felt supported by the management team and had access to advice and support when they needed it.

We found that the agency was generally operating in a very effective and well organised way. However we found that records did not always show people had received their prescribed medicines or had enough to eat for example. There was no system in place to identify these shortfalls and either provide reassurance or take remedial actions. The provider understood these comments and gave immediate feedback about what they would do to improve upon this.

We returned to All Seasons' agency to ensure that improvements had been made in the support offered to staff working at the agency.

We found that systems to ensure all staff received regular documented supervisions, spot checks of their practice and team meetings had been developed. These provided staff with an opportunity to speak with a member of the management team in confidence and for the agency to assure themselves that staff remained adequately trained and supported to undertake their role. This was a way of ensuring that people using the service were being cared for by staff with the training and support they needed to undertake their role.

People we spoke with us all told us they were entirely happy with the service provided to them by All Seasons Care. People said, "Everything is alright. More than alright, they have never let us down, and always oblige with extra hours if we need them."

We found that people had been involved in the planning of their care, and people went on to tell us how most staff asked them at each visit what they needed, and how they wished to be supported. We found that care was delivered in a way that was unique to each person, and took into account their specific needs.

We found that each person had a plan of care, and people we spoke with told us they were happy with the way care was given. Comments included," They are very thoughtful" and "It's just great. I can't say enough good about them."

We found that systems were in place to ensure that abusive practices would not be used or tolerated. Staff we spoke with had a good understanding of adult safeguarding, and what action to take in the event of abuse being reported or suspected.

We found that staff had been provided with the training they needed to undertake their role well. People told us all staff were of a high standard. We found that the agency was not carrying out suitable checks on staff performance or supporting them appropriately.

We found there were systems in place to check on the quality of the service provided.

We spoke with five people who received personal care from the agency. They all told us that they were happy with the quality of care received and that it made a difference to their every day lives. People told us “I really enjoy having the staff here and they really do help me.” and “I am a creature of habit. I have two regular carers and I am happy with the times that they come. I am more than happy with the service that I am receiving. The agency meets my needs."

People told us that they received a consistent service and that they were supported by staff who knew them well. People told us “The carers always turn up on time” and “The carers seem to know just what to do and what needs to be done. The arrangement is working extremely well. I am very pleased."

People told us that they were treated with respect and that staff maintained their privacy and dignity. A person that was using the agency told us “The staff are polite, friendly and very positive. It is so nice to have people come in and be positive, it is very refreshing."

People told us that they were involved in making decisions about the care that they received. A person that was using the agency told us “I find that the office are very obliging and very prompt if I want times and dates altered because of things like doctors appointments that I need to go to."

People we spoke with were confident that they could raise concerns if they were not happy with the care being received and that they would be listened to. People that were using the agency told us “I have not had to make any complaints but I know that I could talk to the managers about anything and they would put things right” and “The office staff are very approachable if I have anything that I want to discuss with them.”

During our review, we discussed the quality of the service provided by the agency with local authority colleagues involved in monitoring the agency. They said they had not got any concerns about the service being provided.