We inspected the service on 19 January 2017 and the inspection was announced. The provider was given 48 hours notice of the inspection. This was because the location provides a domiciliary care service. We needed to be sure that the manager would be available to speak with us.

Amicare House provides personal care to older people in their own homes. At the time of the inspection there were 257 people using the service.

There was a registered manager in post. It is a requirement that the service has 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.

People told us they felt safe. Staff had received training and understood their responsibilities to protect people from abuse and avoidable harm. Risk assessments had been carried out and staff knew how to minimise risk. People knew how to raise a concern and knew how to contact the office. There were a suitable number of staff to meet people's needs. Recruitment checks had been carried out so that as far as possible only staff with the right character and experience were employed.

People were supported to take their prescribed medicines in a safe way. Staff had received training and had access to policies and procedures about the management of people's medicine's. People were supported to eat and drink sufficient amounts. Staff supported people to access the healthcare professionals they required.

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 were able to make their own decisions. Staff had some understanding of the Mental Capacity Act 20015 and Deprivation of Liberty Safeguards. Staff told us that they sought people’s consent before providing support. People were treated with respect and had their privacy and dignity maintained.

Staff had received training and were supported to meet people's needs. They knew about people's likes and dislikes and the way they preferred to receive care and support.

People had their needs assessed and were involved in developing their care plan. The provider had a complaints procedure. People said they would feel confident making a complaint if they needed to.

People and staff felt the service was well managed. The manager was experienced and had been with the service for more than 12 years. People who used the service and staff had confidence in them and felt supported.

People and their relatives had opportunities to give feedback about the quality of the service that they had received. The provider had processes in place so that checks were carried out on the quality of the service that was delivered.

We carried out an unannounced inspection of the service on 9 June 2015. At our previous inspection on 17 February 2014 we found that the service was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which following legislative changes of 1st April 2015 corresponds with Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found then that staff had not always sought people’s consent in accordance with the requirements of the Mental Capacity Act (MCA) 2005. After our inspection the provider sent us an action plan setting out what they would to address the breach of regulation.

At this inspection we found that the provider had made the necessary improvements and now met this regulation.

The service provides care and support for over 200 people who live in their own homes. The service had a registered manager. 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 the service were safe. They told us they felt safe because they were mostly supported by the same care workers who were knowledgeable about their needs. They knew which care workers would be visiting them which made them feel secure. Care workers knew how to recognise and respond to signs that a person was at risk of abuse.

People’s care plans included assessments of risks associated with their care and support. Care workers used the information to support people safely.

The provider effectively deployed care workers so that people received visits when they needed. They had robust recruitment procedures to ensure as far as possible that only staff suitable to work with the service were employed.

People were supported to take their medicines by care workers who had received training in medicines management.

Care workers were supported through training and supervision to be able to meet the care needs of people they supported. Staff who arranged home visits took care to ensure that people with cultural needs were supported by care workers with the same cultural background if that is what they wanted.

Care workers understood their responsibilities under the Mental Capacity Act 2005. They sought people’s consent before providing care and support. They were attentive to people’s nutritional and heath needs.

Care workers developed caring relationships with people because they supported the same people and grew to know them and understand their needs and preferences. People were involved in decisions about their care and support. They told us that care workers respected the choices they made and treated them with dignity and respect.

People received care and support that was centred on their individual needs. Their care plans included information about their needs and how they wanted to be supported. The care plans were referred to by care workers.

People and staff were involved in the development of the service because their views were sought and acted upon. People and staff felt the service was well managed. The service was well organised and led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009. The provider had effective arrangements for monitoring and assessing the quality of the service.

During our inspection of this service we spoke with seven members of staff working at the service, the registered manager, twenty people who used the service, eight relatives of people using the service and the carer of someone who used the service.

None of the people who used the service, or their relatives or carers, had any concerns with the care workers who came and delivered the care. People described professional staff who met their needs and treated them with respect. People told us that there was a copy of their care plan at their home and that staff made records each time they visited. Many people also told us that the service had held regular reviews to assess the quality of care being delivered.

Staff were positive about working at the service. They described being supported by the management and said that they felt people using the service were well cared for.

We found that, whilst consent was being obtained for people who had the capacity to give their consent, the service was not assessing people's mental capacity and acting in accordance with the Mental Capacity Act for people who may have lacked the capacity to consent to their plan of care and support.

We found that the service ensured people's health and well-being. We saw evidence of the service regularly seeking the views of people using it and regularly assessing and monitoring the quality of the service.

There were robust recruitment procedures in place and staff were well supported.

As part of our inspection of this service we spoke with five people using the service, three relatives of people using the service and 10 members of staff working at the service. The people we spoke with who used the service were very happy with the care they were receiving. One person told us, "I've never had anything I've had to complain about." Another person described the service as, "Excellent" and went on to comment that, "I have no problems with them at all and I never have had."

Staff working at the service described being well supported by management and felt adequately trained to carry out their role. One member of staff said, "I thought I wouldn't like the personal care side of things but I do and that's through good training." Another staff member told us, "I love the job. Staff here are brilliant. You just walk in and your problem is sorted."

The relatives we spoke to were positive about the care their family member received. One relative said that the person using the service had changed for the better since he had started using the agency. They said, "They're really quite good. He's different since they started coming and he's very happy with them. They have a nice laugh with him."

Service users and relatives told us that they were more than satisfied with the care and support they experienced. Some service users told us that the quality of support was sometimes not as good when they were supported by non-regular carers.