This inspection took place on 30 April 2018 and was announced. At the last inspection on 28 July 2016, the service was rated as good overall with requires improvement under Well led. We found the registered manager did not always notify the CQC of safeguarding alerts, which they were legally obliged to inform us about. This action has been completed.

Following the last inspection in July 2016, we asked the provider to complete an action plan to show what they would do and by when to improve the well led domain to at least good. We did receive a comprehensive action plan within the time allocated to them. We asked the provider to take action to make improvements in sending us notifications, which they were legally obliged to do. This action had been completed and the provider now met legal requirements.

Annie's Healthcare Community Interest Company provides support, including personal care, to people in their own homes. At the time of the inspection there were 16 people receiving care and support from the service.

There was a registered manager in place at the time of our inspection. 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.

Staff were aware of their responsibilities to ensure that people were protected from the risk or potential risk of harm. There were policies and procedures in place for staff to follow. Potential risks to people’s health and welfare were assessed and there was guidance on how to manage these risks and keep people safe.

There were enough staff to meet the needs of the people. Before newly recruited staff started employment, the provider undertook all necessary employment checks. Staff had received training to meet the needs of the people.

There were systems in place to manage people's medicines so that they received them when they needed.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA). They were aware of how to support people who could not make decisions for themselves when required.

People were supported to eat and drink sufficient amounts to meet their needs. Records showed people had regular access to health and social care professionals. People received care and support in a compassionate way from a staff team that knew them well and were familiar with their needs. Each person had a care plan outlining how they needed support and how they liked to be helped.

The provider had a complaints procedure which people could access and were made aware of. The registered manager ensured that any issues raised were resolved to the satisfaction of the person. People who used the service, their representatives and staff were asked for their views and they were acted on.

This was an announced inspection carried out on 28 July 2016. The registered manager was given 48 hours’ notice of the inspection so they would be available at the office to facilitate our inspection. The service had previously been inspected in February 2014 and was found to be compliant with the Health and Social Care Act 2008 Regulations at that time.

There was 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.

Annie's Healthcare Community Interest Company provides support, including personal care, to people in their own homes. At the time of the inspection there were 16 people receiving care and support from the service.

People and their relatives told us they were happy with the service and staff working there. They felt the service was managed well. However, we found the registered manager did not submit statutory notifications to the Care Quality Commission, as required by law.

People were protected from the risk of abuse because the provider had taken steps to identify the possibility of abuse and prevent abuse from happening. Incidents and accidents were documented.

There was a recruitment system in place that helped the provider make safer recruitment decisions when employing new staff. People were safe as staffing levels were sufficient to meet their needs.

People’s needs had been assessed before they started using the service. Care plans reflected people’s needs and preferences, as well as any risks associated with their care and the environment they lived in. These were reviewed regularly to ensure staff continued to meet people’s changing needs.

Staff had a good knowledge of people they supported and respected their privacy and dignity. They promoted people’s independence and supported them to eat and drink sufficient amounts to meet their needs.

Where people needed assistance taking their medicines this was administered safely by staff who had been trained to do so.

Staff felt supported and received regular supervision and an annual appraisal. They received a structured induction and training to meet the needs of people they supported.

Staff demonstrated a good understanding of the requirements of the Mental Capacity Act (2005) and knew what they should do should a person lack the capacity to make decision.

People had regular access to health and social care professionals and staff supported them to attend their appointments when requested.

The service had a complaints policy which was included in the information pack provided to people at the start of their care package. People were aware who they would contact if they were not happy about the service they received.

There were regular quality assurance checks and audits undertaken by the office staff. Where improvements were needed the registered manager had put action plans in place to address these.

People told us that their relatives received high quality care from the provider. One person told us, "The staff are approachable and very caring." People's consent was sought before care and treatment was carried out. We saw in the care records that people had signed in agreement for the support plan to be delivered. Staff told us that they respected people's wishes.

We looked at four care records and spoke with two relatives. We saw that the care plans were detailed and included risk assessments. People told us that the provider involved them in the planning and delivery of care. One person commented, "Nothing is done without consulting us."

The provider supported their staff in their professional development and provided them with supervision and training. One member of staff told us, "They are a good employer."

We saw that the provider had a system to monitor the quality of services and contacted people for their views. People told us that they were satisfied with the services. One person told us, "They know my views."

We saw that the provider had a complaints procedure and kept a log of complaints and concerns. They had not received any formal complaint in the last year. One informal complaint was dealt with satisfactorily. One person told us, "They are always at the end of a phone."

People told us about the service that the agency provided. They were very happy with the quality of service and said that they were well cared for. A relative said “the service is reliable and we are very happy with it. My mother relies on her carer and trusts her.” Another said “I have every confidence in the agency. They are very good and very reliable.”

People were treated with respect and their care and welfare needs were being met. Systems were in place to safeguard people from abuse. Staff had received specialised training to meet people’s complex needs. A healthcare professional told us “they are a very good agency and support people with complex needs. We are pleased with the service and do not have any concerns.” The provider monitored the quality of the service provided to ensure that it was safe and met people’s needs.

All of the people that we talked with spoke very highly of the services provided by Annie’s Healthcare. They said:

“It is brilliant and very good. They are very caring and helpful. Mum is really pleased with them and there are never any concerns. They treat her well and she has one regular girl. She always knows who is coming and they are very punctual. My mother feels very safe with the carer and we are really quite happy with them. We had another agency previously and they were terrible. Annie’s is nothing like that, we don’t have any problems”.

“The care is always excellent. My mother-in-law is very happy with the care and is thrilled with the service from her main carer. She’s regular and punctual. The continuity of care has been brilliant. When the main carer was off another person came in and was introduced before she actually worked with my relative. The current carer goes beyond the call of duty. They are very good at keeping touch with the family when needed”.

“I have a high opinion of the service. They are pretty good at time keeping and regularity, very caring and patient. No concerns. Staff are patient and attentive and allow the right balance to get my mother to do the small amount that she can herself. It gives me peace of mind to know that my mother is safe and cared for. I feel we can trust the agency”.

“Annie’s is the best company that we have had on board. They know exactly what to do and are competent. Our relative is very comfortable with the staff and has confidence in them. They respect him as a young adult with the right to make his own decisions and they allow this. The girls don’t smother him. We feel that he is safe with the current carers”.

A healthcare professional told us, “Very good agency. I feel that they are very particular about who they employ, that staff care, and are well trained and pretty capable. Overall they are excellent with regular carers”.

A healthcare manager said, “One of the best providers that we have had. We mainly use them for end of life care and feedback has always been positive. I have never had to raise any concerns about carers not turning up. I have had feedback from the district nurse that the quality of the service is good”.