This inspection took place on 15 November 2016.

Angel Touch Care Agency provides domiciliary care to people in their own homes. At the time of our inspection, 41 people were supported with personal care.

This service was last inspected on 13 August 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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 felt safe with the staff who supported them. Staff received training to safeguard people from abuse. They were supported by the provider, who acted on concerns raised and ensured staff followed safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were mostly identified and staff were aware of current risks, and how they should be managed. Work was under way to ensure risk reduction plans were documented in new electronic care plans as well as paper care records.

People were administered medicines by staff who were trained and assessed as competent to give medicines safely. Records indicated people’s medicines were given in a timely way and as prescribed. Checks ensured medicines were managed safely.

There were enough staff to meet people’s needs effectively, and people told us they had a consistent and small group of staff who supported them, which they appreciated. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in their homes.

People told us staff asked their consent before undertaking any care tasks. Where people were able to make their own decisions, staff respected their right to do so. Some people’s ability to make their own decisions fluctuated, and there was not always detailed information on this. However, staff and the registered manager had a good understanding of the Mental Capacity Act.

People and relatives told us staff were respectful and treated them with dignity, kindness and respect. People’s privacy was maintained. People were supported to make choices about their day to day lives. For example, they were supported to do things for themselves where they were able to.

People saw health professionals when needed and the care and support provided was in line with what they had recommended. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. Some care plans were updated with the most recent information and were detailed, others were not. The registered manager was aware of this and was working on ensuring all were updated. People were involved in how their care and support was delivered, as were their relatives if people needed this.

People and relatives felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the registered manager and senior staff were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided, and the provider was improving the way it gathered feedback from people and their relatives with a view to improving the service going forwards.

On the day of our visit 60 people were using the service. They were supported by eleven staff including the registered manager and the provider. We spoke with two people who use the service, three relatives, three care staff: the registered manager and the provider. The focus of the inspection was to answer five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found:

Is the service safe?

The service was safe. People who use the service and their relatives said they were confident that staff were properly qualified and experienced to support them appropriately. Staff had been trained in the management of medication so where appropriate people were being given medicines in a safe and proper manner.

People’s care plans had included full needs and risk assessments to ensure they were treated in a way that did not put them at risk of receiving inappropriate care.

Is the service effective?

The service was effective. People told us they felt properly cared for and that staff were trained and competent to carry out their duties. Each person had a fully completed and up to date care plan which was tailored to their specific needs. .

There were sufficient numbers of staff to provide an appropriate level of care to people. Care staff had either completed, or were in the process of completing, appropriate qualifications in health and social care.

Is the service caring?

The service was caring. People we spoke with were positive about the service they received. One relative described the service as “very good” and said it was very responsive. One of the people who use the service described it as being “very, very good” and that all the staff were “lovely”.

Care staff had a good awareness of people’s needs. They were able to monitor people’s health and wellbeing and where necessary make amendments to a person’s care plan.

Is the service responsive?

The service was responsive. Staff were usually punctual when they visited people and would take their time completing their work. The office would always let people know if staff were running late.

Care plans were regularly updated to reflect changes in people’s needs.

People’s views and specific preferences were taken into account, through a process of continual dialogue with staff

Is the service well led?

We found that the service was well led. The service had a registered manager. The provider regularly talked with all staff to seek their views, and to share any issues with them that might affect the service.

The manager and the provider of the service were very much ‘hands-on’ in their approach which meant they were always aware of any issues that might have arisen that might have affected the safety and quality of the service.

On the day of our visit we were met by the registered manager and the managing director, who was the owner.

We found that people who used the service were always being asked by staff if they consented to their care, and their right to refuse care was being respected. The people we spoke with said that carers were always polite and courteous, and asked their permission before offering care. We also found the provider had a process in place to deal with situations where decisions had to be taken in a person’s best interest.

We found that people were happy with their care and that staff engaged with people in an appropriate and sensitive manner. People said things like: “They are absolutely fantastic – I can’t praise them enough.” We also found that people’s needs were being properly assessed, managed and reviewed.

We found that people were being properly protected against abuse and staff were able to identify, respond to, and report abuse. All the people and relatives we spoke with said they felt safe having carers in their home.

We found that staff were properly supported through induction, training, and supervision. However, we found that the provider did not carry out staff appraisals.

We found that the provider was regularly obtaining feedback from people and staff. We also found that the provider was monitoring and assessing the quality of the service on a regular basis, although most of this was done in an informal way.

We telephoned two people who used the service and spoke to two family members of other service users. Everyone we spoke to said they were happy with their regular care workers and gave us positive feedback about them.

People told us the agency's care worker knew their needs well and how they liked things to be done. A family member said about the care their relative received "The care is good. They are very friendly and cheerful."

All the people we spoke to said that the agency arranged a replacement care worker when their regular care worker was away and almost all said that replacement care workers supplied were good. The manager told us that the agency did not guarantee continuity of care workers, but did try to send regular care workers to people who used the service. None of the people we spoke to, or their families, said that they had ever had any concerns about the treatment they received from care workers.

A service user told us "I am happy with the service; they are helpful to have around." Another service user told us "I would recommend them." We found that the agency considered people's individual needs and circumstances when providing care. The staff at the agency reported that they were well supported by the management team.

We found that the agency had some policies and procedures in place to quality assure the services they provided to people, and that the agency had work in progress to further quality assure the agency’s services.