This inspection took place on 13 July 2018 and was announced. At our previous comprehensive inspection of the service on 26 January 2017 we found the service was breaching regulations in relation to safe care and treatment, staff support and good governance and rated the service requires improvement. We undertook a focused inspection on 16 October 2017 to check the service now met legal requirements. We found the service had improved in all areas although we were unable to change the rating as we needed to see the improvements sustained over a period of time.

Amethyst Home Care is a domiciliary care service. It providers personal care to people living in their own houses and flats. It providers a service to older adults. At the time of our inspection there were five people receiving care and support from the service. The service had a registered manager in place. 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 this inspection we found the provider had sustained the improvements and we rated the service Good in all areas and overall.

People’s medicines were managed safely. Staff received training in managing medicines and the provider assessed staff were competent.

There were enough staff to care for people and the registered manager provided care to people to ensure they knew people well. People received consistency of care and developed good relationships with staff.

Staff were recruited following robust procedures to check their suitability to care for people and the registered manager continued to check staff suitability during their probationary period.

Risks relating to people’s care were reduced, such as those relating to medicines management, the environment and moving and handling. The provider assessed risks and put management plans in place for staff to follow.

Risks relating to infection control were reduced as staff received training and followed suitable practices.

Processes were in place to protect people from abuse and neglect. Staff received training in safeguarding each year and the registered manager and staff understood the signs people may be being abused and how to respond to keep people safe.

People received support in relation to food and drink and received meals of their choice. Staff supported people to maintain their health and to access healthcare services where this was part of their care package.

People received care in line with the Mental Capacity Act (MCA) 2005, although no people using the service were suspected to lack capacity to make decisions in relation to their care. Staff understood their responsibilities in relation to the MCA and received training in this each year.

Staff were supported to meet people’s needs effectively with induction, training and regular supervision. Staff felt well supported by the provider.

People were positive about the staff who supported them as staff were caring. Staff knew the people they supported and developed good relationships with them.

Staff treated people with dignity and respect and understood people’s diverse needs include those relating to gender identity.

People were involved in decisions about their care and were encouraged to maintain their independence as far as possible.

People’s care plans clearly set out the care they required as well as their backgrounds, preferences and people who were important to them. People were involved in developing their care plans.

People were supported to take part in activities and keep in contact with relatives and friends when this was part of their care. This helped reduce their risk of social isolation.

The provider’s complaint process remained unchanged and the provider informed people about how t

This inspection took place on 16 October 2017 and was announced. We gave the provider 48 hours’ notice to ensure they would be available to meet with us. We carried out our last inspection on 26 January 2017 and found the service was breaching regulations in relation to safe care and treatment, staff support and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements and had addressed all areas where improvement was needed.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Amethyst Home Care on our website at www.cqc.org.uk.

Amethyst Home Care provides care and support to older adults in their own homes. At the time of our inspection there were nine people receiving care and support from the service. The service had a registered manager in place. 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 this inspection we found the provider had taken all the necessary action to improve the service in respect of the breaches we previously found.

The provider had improved medicines management. The provider had trained all staff in medicines management and had assessed their competency to administer medicines since our last inspection. In addition the provider had carried out assessed risks relating to medicines for people using the service which set out how the risks would be managed. Staff recorded medicines administration appropriately. The provider audited medicines records and took action when anomalies were identified.

The provider supervised all staff to provide them with frequent opportunity to discuss any concerns, review their training needs and receive feedback on their performance.

The provider had improved their systems to assess, monitor and improve the quality of care people received. This was because the provider gathered feedback from people using the service weekly or monthly and recorded their findings. The provider also requested people complete a questionnaire detailing their views and experiences every three months. The provider had a system in place to monitor the time staff provided care to people to check people received care for the agreed times.

We conducted an announced inspection of Amethyst Homecare on 26 January 2017.

At the previous inspection in March 2016, we found a breach of the regulations in relation to the arrangements in place to protect people from avoidable harm. The provider sent us an action plan setting out the steps they would take to make the required improvements. These actions have now been completed.

Amethyst Homecare provides care and support to older adults in their own homes. At the time of our inspection there were five people receiving care and support from the service. Two people were receiving 24 hour care and support.

People were satisfied with the standard of care and support they received. The staff were kind and caring, and always respected people's privacy and dignity. Staff had developed caring and friendly relationships with people. The registered manager and staff were knowledgeable about the personal care needs of the people they supported.

The registered manager and staff knew what constituted abuse and who to report it to if they suspected people were at risk. They had received training in safeguarding adults. People were protected from avoidable harm because staff had access to appropriate guidance to ensure identified risks to people were effectively managed.

People were supported to stay healthy. If staff had any concerns about a person’s health, appropriate professional advice and support was sought. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals.

Staff had not been trained to administer medicines and there were no arrangements in place to check their competency to do so. This meant there was a risk of people not receiving their medicines safely.

The provider operated safe recruitment practices which were consistently applied. Appropriate checks were carried out on staff before they were allowed to work with people. There were enough staff to meet people's needs.

People felt informed and involved in making decisions about their care and treatment. They also knew who to contact if they had any concerns and felt comfortable doing so.

There was a lack of effective systems in place to assess and monitor the quality of care people received.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the lack of systems in place to ensure people received their medicines safely, the lack of staff supervision and the ineffective systems in place to assess and monitor the quality of care people received. You can see what action we told the provider to take at the back of the full version of the report.

We inspected Amethyst Home Care on 18 March 2016. The inspection was announced 48 hours in advance because we needed to ensure the registered manager was available.

Amethyst Home Care is a service which provides personal care to adults in their own home. At the time of our visit there were seven people using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previously inspected Amethyst Homecare in December 2013. We found the provider was meeting all the legal requirements and regulations we inspected.

There were arrangements in place to protect people from abuse which staff were familiar with. Staff had received safeguarding training and had good knowledge about how to identify abuse or report any concerns.

However care was not always planned and delivered to ensure people were protected against foreseeable harm. Risk assessments were not conducted which meant that people's care plans did not always give staff information on the risks people faced or how to manage them.

Staff arrived on time and stayed for the time allocated. People were cared for by a sufficient number of suitable staff to keep them safe and meet their needs. Staff were recruited using an effective procedure which was consistently applied. Staff controlled the risk and spread of infection by following the service’s infection control policy.

There were appropriate arrangements in place to ensure people received their medicines safely. Care plans provided information to staff about how to meet people’s individual needs.

Staff had the knowledge, skills and experience to deliver care effectively. Staff supported people to have a sufficient amount to eat and drink. Staff worked with a variety of healthcare professionals to support people to maintain good health.

Staff understood the relevant requirements of the Mental Capacity Act 2005 and how it applied to people in their care. People were given choice and felt in control of the care they received.

Staff were kind, caring and treated people with respect. People were satisfied with the quality of care they received and told us there was continuity of care. People were supported to express their views and give feedback on the care they received. The provider listened to and learned from people’s experiences to improve the service.

Staff understood their roles and responsibilities and felt supported by the registered manager. People felt able to contact the service’s office to make a complaint and discuss their care. There were systems in place to assess and monitor the quality of care people received.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to how the provider protected people from avoidable harm.

You can see what action we told the provider to take at the back of the full version of this report.

Amethyst Home Care Home Services provide care to people in their own homes; at the time of our inspection they were working with older people who fund their own care. The agency had only operated for a relatively short time; the registered manager of the service was the sole carer and was in day-to-day charge of the agency.

We were able to speak with someone who used the service and in one instance, someone’s representative. Both people we spoke with were very positive about the care that they received from the agency. One person told us, “Absolutely fabulous, high quality care, I can’t fault her”. Someone else told us, “Very good, very caring…knows my routines.”

Amethyst Home Care Services provides care to people in their own homes. As an agency they have only be operating for a short time. The registered manager of the service was the sole carer and manager. The agency had one client and we were able to speak to their relative.

We received some very positive comments from the relative which included “they do everything for him; cook, clean, wash and make him laugh” and “I can’t speak highly enough of her (the carer), not a bad thing to say”.