This inspection took place on 04 and 07 October 2016. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to be sure the deputy manager would be available for the inspection. It also allowed us to arrange to visit people receiving a service in their own homes.

Amber Home Care provides personal care to people living in a wide area including Somerset, Bath and North East Somerset. At the time of this inspection they were providing personal care for 31 people. They also provided a domestic service to people living in their own homes.

The last inspection of the service was carried out in July 2014. At the 2014 inspection we found the provider failed to assess and monitor the service provided. At this inspection we found improvements had been made, We felt confident the new systems in place would form part of the quality auditing process, to identify any areas in need of improvement.

There is 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 registered manager was unable to be present during the inspection; however the deputy manager acted on their behalf.

Although people and staff told us care staff were well trained we found records maintained by the agency did not evidence the training had been carried out. The deputy manager had identified this shortfall and at the time of the inspection was developing a spreadsheet record of all staff training. The deputy manager had also recently introduced regular staff one to one supervision and spot checks. All staff spoken with said they had experienced a spot check and had been given the opportunity to speak with the deputy manager in a one to one meeting. Staff also had the opportunity to meet as a team when they could discuss working practices and share best practice tips and ideas.

There were systems in place to monitor the care provided and people’s views and opinions were sought through care reviews and an annual survey. Suggestions for change were listened to and actions taken where possible to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

People who received personal care and support from Amber Home Care told us they were happy with the service provided. They said the registered manager and staff were open and approachable, cared about their personal preferences and kept them involved in decision making around their care. One person said, “I do feel involved and listened to.”

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during our home visits. However people had mixed opinions about the consistency of the staff team visiting them. Some people said they had a regular team of staff who they knew and had built relationships with, whilst others said they had met a number of different staff members. The deputy manager confirmed a successful staff recruitment programme meant they were now able to provide people with a more consistent team of staff.

People’s care needs were recorded and reviewed regularly, with, senior care workers and the person receiving the care or a relevant representative. All care plans included written consent to the care provided. Care workers had comprehensive information and guidance in care plans to enable them to deliver consistent care the way people preferred. One person’s care plan clearly showed how they liked their care provided and the exact routine they liked to follow.

People were protected from abuse because the provider had

A single inspector carried out this inspection and spoke with five people who use the service, three relatives, the registered manager, the office manager, the company secretary and one senior carer. We also reviewed records relating to the management of the service which included four care plans and four daily care records. 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 people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were enough staff on duty to meet the needs of the people using the service and a member of the management team was available on call in case of emergencies.

Staff personnel records did not contain all the information that the provider requested as part of their own recruitment process. This meant that the provider did not follow their own process.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us "I don't know what I'd do without them” and "they come and get me washed and dressed every morning". Staff had received training to meet the needs of the people using the service.

Is the service caring?

People told us "the carers are very good", "X is an excellent carer" and "honestly and truthfully, the carers are fantastic". One staff member told us "I want people to be looked after at home the way I'd want my parents to be looked after".

Is the service responsive?

Records we saw showed us that people's needs and preferences had been documented. Several people told us that staff often arrived outside of the allocated time slot. Some people told us they didn't mind this, but others told us they found it frustrating because they couldn't plan their day. People told us that there was a high turnover of staff and that they would prefer more continuity of care. The registered manager told us they were aware of the issues and was reviewing the operational running of the service.

Is the service well led?

We saw that people were asked for their feedback on the service they received and they had also filled in a customer satisfaction survey. However, people we spoke with were unaware of the results of the survey and felt that their comments had not been listened to. Staff that we spoke with told us they felt trained and able to perform their role. One staff member told us "the manager is always open to new ideas on how we can improve".

We saw the recruitment process check list that the provider had implemented following a previous inspection had not been audited. We saw that the provider's sign-off process for newly employed staff was not audited. We were not provided with any evidence of checks undertaken to monitor quality of care provided by staff. This meant that there was a risk that staff had been recruited who were unsuitable to work with vulnerable adults and the provider did not monitor this risk. We saw that people's comments regarding punctuality of arrival times had not improved their experiences. We heard from several people we spoke with that staff turnover was high. This meant the provider could not demonstrate that they had listened to and acted upon comments from people who use the service. A compliance action has been set for this and the provider must tell us how they plan to improve

We found that the agency had addressed the areas of non compliance we had identified in our last inspection of March 2013. They had put arrangements in place to audit and improve practices relating to risk assessments and the giving of medicines.

We found that care plans were comprehensive and included information about personal choices and preferences. People told us that their care needs were met and staff were friendly and very good. We were also told that people were supported by a small group of care workers.

In looking at the recruitment practice of the agency we found significant shortfalls in the procedures they followed. The agency failed to make sure the required checks were undertaken to evidence and be assured that perspective employees were suitable and fit to work with vulnerable adults.

We saw that improvements had been made in having an effective system to monitor and audit the quality of the service. However we had not established if these improvements would be sustained in that they had only been implemented in the past two months.

Records we looked evidenced the service people had received and how this was being managed by the agency. There were the necessary policies and procedures in place so that people were protected from unsafe care. We have noted the failure to make sure the agency recruitment practice was effective in ensuring people employed by the agency were fit to be care workers supporting vulnerable adults.

People we spoke with told us they were treated with respect by care worker. One person told us "they are all very friendly and I have no complaints". Care plans were comprehensive in setting out the care needs of people. People told us that their needs were met. Reviews had been held to make sure that people received the necessary care and support. The service was delivered in a consistent and reliable manner.

There were inconsistencies about the assessment of risk and providing guidance to staff about potential risks to people's health and welfare.

We found there were failures in the arrangements for the safe administering of medicines. Where care workers supported people with their medication they received the necessary training.

Care staff told us they were well supported and received the training they needed. One person who received a service told us they found care workers professional. Care staff told us management were approachable. We saw that there were no arrangements for formal one to one supervision of staff.

There were questionnaires sent to people receiving a service. They provided positive feedback about the quality of the service. The provider had made changes as a result of comments received about people wanting regular care workers. There were no structured systems in place to monitor, assess and review all aspects of the service.