We undertook an announced inspection of APDA Homecare c/o Daycare and Development Centre on 21 December 2016. APDA Homecare c/o Daycare and Development Centre is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides care to children and older people with physical and learning disabilities. The service caters for the Asian community and at the time of inspection the service provided care to seven people.

At our last inspection on 11 February 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the service not appropriately assessing people’s mental capacity, some risks not being appropriately identified and effectively managed for people and care support workers having a lack of knowledge and understanding of safeguarding and whistleblowing procedures. During the inspection on 21 December 2016 we found the service had taken necessary action to address the breaches of regulations identified at the previous inspection.

There was a registered manager in post 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.

People who used the service were children or they had some form of physical or learning disability and were unable to verbally communicate with us. We therefore spoke with their relatives who lived with them. Relatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and people were safe when cared for by the service.

At the previous inspection in February 2016 we found a breach of regulations because risk assessments were not person centred and individualised. We also found that risk assessments lacked instructions to staff detailing how to assist people with various aspects of their care. During the inspection in December 2016 we found that since the previous inspection the service had taken appropriate action and had reviewed people’s risk assessments and implemented new format risk assessments which included the appropriate information about potential risks and how to mitigate these.

The inspection in February 2016 found a breach of regulations in respect of safeguarding because care support workers we spoke with lacked knowledge and understanding of safeguarding and whistleblowing procedures. During the inspection in December 2016 we found that the service had taken appropriate action in order to improve this area. We found that there were systems and processes were in place to help protect people from the risk of harm. Care support workers had received refresher training in safeguarding adults and staff we spoke with knew how to recognise and report any concerns or allegations of abuse.

The inspection in February 2016 found that care plans lacked information about people’s capacity to make decisions and care support workers we spoke with lacked knowledge of this area. During the inspection in December 2016 we found the service had taken appropriate action to address this breach. Care support workers we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). They were aware that when a person lacked the capacity to make a specific decision, people's families, staff and others including health and social care professionals would be involved in making a decision in the person's best interests. The service had a Mental Capacity Act 2005 (MCA) policy in place. Care plans included information about people's mental health and their levels of capacity to make decisions and provide consent to their care.

Relatives told us that care support workers turned u

We undertook an announced inspection of Daycare and Development Centre on 11 February 2016.

Daycare and Development Centre is a small domiciliary care agency registered to provide personal care to people in their own homes. The service caters for the Asian community and at the time of inspection the service provided care to 13 people. The service provides care to children and older people with physical and learning disabilities.

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.

At our last inspection on 5 November 2013 the service met the regulations inspected.

People who used the service had some form of physical or learning disability and were unable to verbally communicate with us. We therefore spoke with their relatives who lived with them. Relatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and people were safe when cared for by the service.

Individual risk assessments were completed for each person. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. This could result in people receiving unsafe care and we found a breach of regulations in respect of this.

There were processes in place to help ensure people were protected from the risk of abuse. Despite receiving safeguarding training, the majority of staff we spoke with were unable to describe the process for identifying and reporting concerns and were unable able to give example of types of abuse that may occur.

People using the service experienced consistency in the care they received and had regular care staff. Relatives we spoke with confirmed this and said that they were happy about this.

Records showed and staff told us they received training and received support from the registered manager. Appropriate checks were carried out when staff were recruited.

Care plans lacked information about peoples’ mental health and their levels of capacity to make decisions and provide consent to their care. There was no information in people’s care plans which showed how people who had limited capacity or were not able to verbally communicate were supported to make decisions and how their consent was gained. We found a breach of regulations in respect of this.

Relatives told us that people were treated with respect and dignity. They told us that care staff were caring and helpful. Staff were able to give us examples of how they ensured that they were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care.

Care plans were individualised and addressed areas such as people’s personal care, what tasks needed to be done each day, time of visits, people’s needs and how these needs were to be met. Staff were provided with clear instructions of what tasks needed to be carried out.

The service had a complaints procedure and there was a record of complaints received. Complaints we examined had all been responded to and staff knew what action to take if they received a complaint.

Relatives and staff we spoke with were satisfied with the management at the service. They said that management were approachable and supportive.

The service had a quality assurance policy and checks of the service had been carried out by management. These involved quarterly reviews with people and their relatives, staff spot checks and satisfaction questionnaires.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We talked to staff and two relatives to check what arrangements were in place for seeking and obtaining valid consent from people using the service. Overall, the provider had systems in place to gain and review consent from people.

We looked at how the service reduced the risk of people receiving unsafe and inappropriate care. Largely, the care needs of people had been assessed, together with actions for minimising potential risks.

We asked questions to examine if people were protected from abuse, or the risk of abuse. A relative commented, “my relative likes the staff and is not scared to go out with them”. The manager and staff were aware of procedures to follow in the event of abuse or an allegation.

Staff were properly supported to provide care by means of being provided with relevant training, along with regular supervision and appraisals. A relative told us, “Staff come on time and they do a good job”.

People told us staff were friendly and respectful and confirmed their privacy and dignity were always respected. We spoke with people who use the service and one told us "staff are polite and are always there for me".

People informed us that they were satisfied with the care provided. They indicated that they had been consulted and their views had been taken into account in the delivery of care. One person told us "I am involved in my care".

We found appropriate checks were undertaken before staff began work.

We were concerned that the provider had not taken all reasonable steps, in terms of training of staff, to identify the possibility of abuse and prevent abuse from happening and there were no arrangements in place to supervise staff.