The inspection took place on the 29 and 31 August 2018 and was unannounced. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection there were 51 people receiving a service from the agency.

The service has 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 and were supported by staff who understood how to recognise and report suspected abuse. People’s risks were understood and actions were in place to minimise risks of avoidable harm including the risk of preventable infections. People received their medicines safely and staff understood the actions needed if an error occurred. Staff had been recruited safely including checks to ensure they were suitable to work with vulnerable adults. Staffing levels provided flexibility in meeting people’s changing needs and included office staff carrying out care duties and staff supporting from a neighbouring Apex Prime Care branch. When things had gone wrong lessons were learnt and shared to improve learning and improve outcomes for people.

Assessments had been completed with people to gather information about their care needs and lifestyle choices. People had their eating and drinking requirements met as staff understood people’s likes, dislikes and any barriers to eating a well-balanced diet. Assessments included any need of technology such as alarm pendants and these were then included in care plans for regular testing. Staff received an induction and ongoing training and support that enabled them to carry out their roles effectively. Working links had been developed with other professionals such as district nurses and occupational therapists which meant more effective health and welfare outcomes for people. People were supported with access to healthcare for both planned and emergency situations.

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. A complaints process was in place and people felt if they raised concerns they would be listened to and actions taken. There had been no formal complaints since our last inspection.

People spoke positively about the care team describing them as kind, patient and caring. One person described how, when they felt low in mood, staff understood and, through encouragement, helped them feel better. People felt involved in decisions about their care including the care staff that visited them in their homes. People were treated with respect and dignity and described staff as supportive with helping them maintain their independence.

People had person centred care plans which reflected people’s diversity and were understood by the staff team. Reviews took place at least six monthly with people and, if appropriate, their families. When changes in people’s care needs were identified actions were taken to ensure the care provided reflected the person’s changing needs and choices. Links with the community had been made which provided additional social support for people such as a dog walking befriending service. Assessments had been completed detailing people’s individual communication preferences and these were understood by the staff team. People had an opportunity to be involved in end of life care plans which included a monthly review of any ‘do not attempt resuscitation’ decisions.

People, their families and staff described the office as well organised and always available when contacted. Staff underst

The inspection took place on the 23 August and 29 August 2017 and was announced. When we last inspected in July 2016 we found breaches in regulation. People were not always having risk assessments and care plans in place that protected them from avoidable harm. We found that actions taken had led to the improvements required. We had also found that systems and processes had not been in place to assess, monitor and improve the quality and safety of services provided to people. We found that actions had not been taken to make the improvements required.

The service provides personal care to older people living in their own homes. At the time of our inspection there were 46 people receiving a service from the agency.

The service has 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.

The service had sent us an action plan following our inspection in July 2016 detailing the systems and processes they would be putting in place to assess, monitor and improve the quality and safety of services provided to people. This had included monthly audits of care plans and medicine records. Audits had not been completed in June, July or August 2017. The action plan had stated that a full service audit would be carried out. A process had been introduced by the provider whereby a manager from another service would complete the full audit. This had not been implemented. We were shown a process introduced in June 2017 which had been designed to capture an oversight for registered managers of people living with an assessed high risk of harm. This had not been implemented. Support and monitoring visits had been made at least weekly by the regional manager but no records were available to demonstrate how they had monitored service delivery. Their monitoring visits had not captured that processes and systems introduced to monitor and oversee that people received safe care and that regulations were being met had not been implemented.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff had provided care in people’s best interests but this had not always been recorded within the framework of the MCA. This meant that people were at risk of not having their rights upheld. We discussed this with the registered manager and on the second day of our inspection senior staff were completing MCA training.

A quality assurance survey had captured the views of people using the service and any feedback had been explored by the registered manager and actions taken where appropriate. People, their families and staff spoke positively about the management of the service and told us the registered manager was accessible, helpful and well organised. Staff understood their roles and responsibilities and felt appreciated by the service. The registered manager had shared information with CQC and other statutory organisations appropriately and in a timely way.

Assessments had been completed that identified risks to people and were regularly reviewed. People had been involved in how risks were managed. Staff understood the actions needed to minimise the risk of harm to people. Medicines had been administered safely and staff understood the process for reporting and dealing with any errors. People had been supported to access healthcare when needed. Sta

We carried out a comprehensive inspection on the 18 and 19 July 2016. When the service was last inspected in August 2014 we found that people were not receiving their medicines safely and asked the provider to take some actions. At this inspection we found improvements had been made and people were receiving their medicines safely.

The service provides personal care to older people living in their own homes. At the time of our inspection there were 58 people receiving a service from the agency.

The service had not had a registered manager in post since the 7 June 2016 and the new manager was in the process of applying to CQC for registration. 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 had not had their risks assessed other than for their moving and handling requirements. Initial care assessements, discussions with care workers and reading daily records indicated potential risks to people. A system was not in place that identified people with increased risk if they didn’t receive a visit at specified times. This meant that people’s safety, health and wellbeing were at risk as care workers did not have information on peoples identified risks or the actions they needed to take to minimise any risk. However care workers had been taking some positive actions to reduce risk to people.

Management systems and audits had not been carried out other than for medicine administration. This meant that shortfalls evidenced at this inspection in relation to people’s safety had not been identified by the provider. Information was not being collected about the effectiveness and quality of the service. The service had not always made statutory notifications to us as required. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them.

You can see what action we told the provider to take at the back of the full version of the report.

Staffing levels and deployment meant that people were not always getting a home visit at the arranged time. This had been compounded by the provider acquiring another care agency which had led to a transfer of people and staff. People and staff told us this had started to improve. Staff had been recruited safely and processes were in place to manage unsafe or poor practice.

People felt safe and were supported by staff trained to recognise signs of abuse and actions to take if they suspected a person was at risk of abuse.

People received care from staff that had received an induction and on-going training that enabled them to have the skills to carry out their roles. Some training had been specific to the people using the service and included training for health conditions such as parkinsons, strokes and dementia. Staff felt supported and received regular supervision including checks whilst in a persons home. Staff felt the new manager listened and got things done in a timely way. They described good teamwork and morale in the staff team.

Staff demonstrated how they obtain consent from people ensuring their freedom and choices were respected. People were supported appropriately with their eating and drinking. People felt staff supported them to accesss healthcare when necessary.

People and their families described staff as kind and caring and felt they had positive relationships with them. People felt involved in decisions about their care. Information was available to signpost people to advocacy services when needed. People had thier privacy and dignity respected and were supported to maintain their independence.

People had care plans that detailed how a person would li

This was a follow up inspection to assess whether required improvements had been made to practice and procedures relating to the management of medicines. We found staff did not have the required level of understanding of medicines practice and procedures.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The recording and administration of medicines was not safe. This meant that the provider could not demonstrate that the staff were able to ensure that people were able to take their medicines at the times they need them and in a safe way. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

People we spoke with were pleased with the service they received. One person told us that the, “Staff were very good”. Speaking with staff it was evident that they understood individuals’ care and support needs. We saw that care plans were based on people’s assessed needs and that risk assessments had been completed and were regularly reviewed.

Is the service caring?

People told us that they were happy with the care they received and felt their needs had been met. In people’s care plans we saw that there was information about what they needed help with and how staff should support them. One person told us that the staff “Were all good and we have not had a bad one yet” and that the staff were always “Cheerful”.

Is the service responsive?

Care plans covered all aspects of people’s care needs and were reviewed regularly. The care plans were tailored to people’s needs and detailed the assistance that people needed with their personal care, meal preparation, medicines and domestic tasks. Staff told us that they would be informed of any changes to people’s care plans and that they would always refer to individual care plans to ensure they supported people as set out in the care plans.

Is the service well-led?

The service had quality assurance systems in place. These included using a computer database to ensure that care plans and risk assessments were reviewed regularly and undertaking support visits (spot checks) to monitor staff performance. The registered manager also spoke with people on the telephone and undertook regular quality assurance audits to gather feedback from people about how the service was run.

We carried out this scheduled unannounced inspection and looked at the care plans for seven people and telephoned four of the people who received a service. We reviewed records related to the running of the service, these included complaints and comments received, duty rotas and staff files.

People's needs were assessed before the service started and a plan of care was drawn up to guide staff on how people wished to be supported. Care plans had details of what the individual was able to do themselves and where they needed help. People were involved in the assessment and care planning process. Support was provided in a way which met people's assessed needs.

The provider had suitable systems in place to protect people from harm. Care workers had received training on safeguarding vulnerable adults. The agency's policy clearly showed the process to be followed if any concerns were identified.

There were adequate numbers of care workers to support people and visits had been planned to ensure people received a consistent service. One survey respondent stated that they were "generally very pleased with the care I have received.". Another person considered all staff were "lovely and helpful."

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.