About the service: Ambercare Ltd is a domiciliary care agency providing personal care to people living in their own homes in the Lincolnshire and North Lincolnshire area. It provides a service to older people and those living with dementia, physical disability or a sensory impairment and people with a learning disability and/or autism. Not everyone using Ambercare Ltd receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, help with tasks related to personal hygiene and eating and drinking. For these people we also take into account any wider social care provided.

At the time of the inspection, they were providing a regulated activity of personal care to 76 people.

People’s experience of using this service: We received very positive views from people about the support provided to them. When talking about the service people told us, “I am really happy with them,” and “They do a fantastic job.” Without exception people said they felt safe and staff were respectful.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received their medicines safely and on time and their health was well managed. Staff had positive links with healthcare professionals which promoted people’s well-being.

People said they received care in a timely way from a regular team of care staff. People told us, “We have the same group of carer’s, from my husband’s point of view this is very good. It is really important to him.”

The provider had systems in place to safeguard people from abuse. Staff could recognise and report any safeguarding concerns if they suspected abuse. Relevant risk assessments had been completed. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.

Staff had appropriate skills and knowledge to deliver care and support people in a person-centred way. Staff recruitment was safe and staff understood how to keep people safe.

People told us they were happy with the service they received and felt staff had a clear understanding of their needs and preferences. People were supported with good nutrition and could access appropriate healthcare services.

Care plans had been developed and were regularly reviewed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. People told us, “I can please myself and this is respected.”

The registered manager and staff team worked together in a positive way to support people to remain as independent as possible and to be safe. Staff told us they were well supported by the registered manager and management team.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people's lives.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at the last inspection: Good: last report was published 1 November 2016. We rated the Well-Led domain as requires improvement. At this inspection we found improvements had been made to records for the providers audit systems.

Why we inspected: This was a scheduled ins

Amber Care provides care for people in their own homes. The service can provide care for adults of all ages including people with a physical disability, sensory needs, mental health issues and a learning disability. It can also provide care for people who live with dementia and people who are receiving palliative care at the end of their lives. At the time of our inspection the service was providing care for 62 people most of whom were older people. The service had its office in Market Rasen and covered an area within a fifteen mile radius of the town. It also covered an area of north Lincoln within a five mile radius of Brigg.

The service was owned and operated by a company. It was owned by two directors both of whom were involved in the day to day running of the service. One of the directors was the registered manager and the other was the director of operations. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse. People had been helped to avoid the risk of accidents and medicines were managed safely. There were enough staff to complete all of the planned visits and background checks had been completed for new staff.

Staff had received training and guidance and they knew how to support people in the right way. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed.

CQC is required by law to monitor how registered persons apply the Mental Capacity Act 2005 (MCA) and to report on what we find. The registered manager and staff had received training in this subject and this enabled them to help people make decisions for themselves. When people lacked the capacity to make their own decisions the principles of the Mental Capacity Act 2005 and codes of practice were followed. This helped to protect people’s rights by ensuring decisions were made that were in their best interests.

People were treated with kindness and compassion. Staff recognised people’s right to privacy and promoted their dignity. Confidential information was kept private.

People had been consulted about the care they wanted to receive and they had been given all of the assistance they needed. Staff were innovative when supporting people who lived with dementia. People were helped to pursue their hobbies and interests and there was a system for resolving complaints.

Some quality checks had not been completed regularly to ensure that people reliably received all of the care they needed. People had not been fully consulted about how best to develop the service. Staff were supported to speak out if they had any concerns, good team work was promoted and people had benefited from staff acting upon good practice guidance.

We visited the office of Amber Care and looked at management records, people’s care records and other documentation. We also spoke with people who used the service, their relatives and the staff who supported them.

At the time of our inspection there were 13 people who received a service in their own homes. A single inspector carried out this inspection.

During our inspection we spoke with two people who used the service and three relatives of people who received care. We also spoke with the provider and six staff members.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, relatives we spoke with and staff told us.

If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

Procedures were in place for safeguarding vulnerable adults. Staff had received training and knew what to do in the event of suspected abuse.

People were helped to stay safe by avoiding risks to their health and safety. Staff had assessed and managed potential risks together with the person and their representative to identify how risks could be reduced.

The manager told us no applications had been needed or made by the service to restrict anyone’s liberty in any way. This would usually be done to protect the person or others under the Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

Visits to people’s homes had been undertaken on time, staff had completed the required tasks and they had stayed for the correct time. These measures contributed to people receiving a service that provided them with effective care at home.

We spoke with people who were supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example one person told us, “They (staff) turn up on time. They stay for all the time allocated and more if needed. The staff are so friendly and I think they care a lot about what they do.” A relative we spoke with said, “We know who is coming and it’s reassuring to know the consistency of care is maintained. This very important for XXX.”

Is the service caring?

We saw that people's individual needs were assessed and met. This also included people's individual choices and preferences about how they wanted to be cared for at home. We saw individual care plans were developed from the completed assessments and were kept up to date. Staff then carried out the care as described in the care plans.

When speaking with staff it was clear that they genuinely cared for the people they supported.

Is the service responsive?

We saw people were supported to have the care they needed, when they needed it. The service worked well with other agencies and services to make sure people received care in a joined up way.

Records showed people were involved in an assessment of their needs and care was given by staff who knew about each person’s individual needs. Where changes to care needs had been identified, staff acted promptly to respond to the changes needed and update their records.

People knew how to make a complaint if they were unhappy and informal concerns were addressed immediately. The provider confirmed although they had not received any formal complaints any concerns raised with them would be addressed in line with their complaints policy.

Is the service well led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The service worked well with other agencies and services to ensure people received their care in a joined up way. The provider had quality assurance records which showed that any shortfalls identified were addressed in the right way.

Robust recruitment procedures were in place. Legal checks were made and staff underwent an induction and shadowed more experienced staff. Staff told us they felt supported in their role and were pleased to be working for the provider. This was because of the service’s person centred approach.