This was an announced inspection carried out on the 20 July 2017. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be available at the office.

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Angel Care Support Limited is a domiciliary care agency registered to provide personal care to people in their own homes. There were eight people being supported with the regulated activity of personal care at the time of our inspection.

At our last visit we found that the induction training for new staff who had been employed did not meet the requirements of the Care Certificate standards. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection, the provider wrote to us to say what they would do to improve in this area. At this inspection we found that this regulation had been met.

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 were supported by staff in a respectful and caring way. Individualised support and care plans were in place which recorded people’s care and support needs. These plans enabled staff to provide any assistance a person may have required.

People, when needed, were assisted to access a range of external health care professionals and were assisted to maintain their health and well-being. Where required, staff supported people to maintain their links with the local community to promote social inclusion. People’s health and nutritional needs were met.

People were able to raise any concerns or suggestions they had with the registered manager and staff and they felt listened to. Communication between people and the office staff and management was good.

Staff demonstrated that they respected people’s choices about how they would like to be supported. All staff were able to demonstrate a sufficient understanding of Mental Capacity Act (MCA).

Plans were put in place to reduce people’s identified risks, to enable people to live as safe and independent a life as possible. Arrangements were in place to ensure that people were supported with their prescribed medication when needed. Accurate records of staff supporting people with their prescribed medication were kept.

There were pre-employment safety checks in place to ensure that all new staff were deemed suitable to work with the people they supported. There were enough staff available to meet people’s care and support needs. Staff understood their responsibility to report any concerns about poor care practice.

Staff were trained to provide care which met people’s individual care and support needs. Staff were assisted with their training needs by the registered manager to maintain and develop their skills. The standard of staff members’ work performance was reviewed by the registered manager through supervisions, appraisals and spot checks. This was to ensure that staff were competent and confident to deliver the care and support required.

There was a quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who used the service. This included audits on care plans, medication and complaints.

The inspection was carried out on 20 April 2016 and was announced. We gave the provider 48 hours notice of the inspection to ensure that the manager who worked part time was available. The service was last inspected in June 2013 and at that time there was no breaches of regulations.

At the time of this inspection the service was providing support to 25 people, young adults or children. However, only 13 of them received a personal care service that was within the remit of their Care Quality Commission registration. For the purposes of this report we have referred to all age groups as people, unless there was specific information regarding one such group.

The service was provided to people who lived in the South Gloucestershire, Bristol and Bath and North East Somerset (B&NES) areas. The service did not commission directly with any of the local authorities. The majority of people funded their care and support themselves through the direct payments scheme. The service employed 20 support workers.

There was a registered manager in post, however at the time of the inspection they were on extended leave from the service. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. In the meantime an interim manager had been appointed to manage the service along with the registered provider.

Many of the support workers who worked for the service had done so for a long period and staff turnover was low. However, the induction training for those new staff who had been employed did not meet the requirements of the Care Certificate standards. People received the service they expected and their specific care and support needs were met. Support workers were competent to carry out their jobs and were well supported.

The aim of the service was that people were looked after by the minimum number of care workers. This would ensure they received a consistent service. The provider had purposely made a business decision not to expand their service. They felt this would result in being unable to consistently provide continuity of care to people. All contracted hours at point of care plan inception were covered, however some people had then received further funding for extra hours that the service was unable to fill. This had been a management decision to ensure the service remained reliable and consistent and not ‘overstretched’. The provider and manager continually kept the support workers work schedules under review.

People were safe with the support workers who looked after them. They had a programme of mandatory training to complete and this included safeguarding adults, child protection and health and safety training. New staff were recruited following thorough recruitment procedures which meant that unsuitable staff would not be employed. The support workers knew to report any concerns they had about a person’s welfare to the provider or manager. Any risks to people were well managed and management plans were put in place to reduce or eliminate the risk. Where people were supported with their medicines this was safely managed.

People received the service they had agreed upon and consent was obtained before support workers provided assistance. Support workers talked about the people they supported in a respectful manner and received the appropriate training to enable them to undertake their roles effectively. People received a person centred service and were assisted to have sufficient food and drink where this was an assessed need. People were supported to access health care services and where appropriate, support workers worked in conjunction with other health and social care professionals.

People were supported by staff who were kind and caring and treated them with respect. Their preferences and choices were respected. They were provided with a copy of their care plan and we

We spoke with people who used the agency. They told us "The staff are very well trained” and “All the staff are very supportive and caring”.

People told us that they were supported by a regular team of care staff, staff arrived on time and they were contacted if carers were going to be late. We spoke with people about how staff assisted them and what the care staff were like. Comments were positive about the care and the support they received. One person told us "All the carers are very kind and caring and help to support me.

The provider took account of complaints and comments to improve the service. We saw evidence that there had been one complaint since 2012 which had been investigated with the appropriate action taken. People we spoke with during the inspection told us they felt able to raise any concerns they may have with the manager and felt they would be listened to, and appropriate action taken.

People were given support by the provider to make a comment or complaint where they needed assistance. We asked people what they would do if they were unhappy with the service they received and wanted to make a complaint, people told us "I would ring the office and discuss directly” and “I would tell the care staff when they arrive that I was unhappy”.

“In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time”.

People were supported in promoting their independence and community involvement. We spoke to people who used the service. One person told us, “My carer supports me to visit family and friends, I always plan where I like to go, they have supported me to go to London on a train recently”.

We spoke with three care workers and they told us that they had received training in child protection and safeguarding vulnerable adults (SOVA) and that safeguarding matters were also discussed in staff meetings and individual supervisions.

We found that people who used the service were allocated a care worker or a small team of care workers, in order to keep the number of staff who visited them, to a minimum so that consistency of care was promoted.

People that we spoke with during our visit told us, "My carer is lovely I could not ask for anything more" and “If my carer was running late they always phone me to let me know".