This announced inspection took place on 26 June 2017. During our previous inspection we found breaches in regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we found improvements had been made to all these areas.

Appleberry Care provides care to adults and children in their own homes. These include people with learning and/or physical disabilities as well as older people. At the time of the inspection there were 31 people using the service. Of these 31 people ten were receiving personal care.

The service had a registered manager in place. 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.

During this inspection we found the service to be safe. The registered manager was aware of the improvements needed to ensure medicines were administered and recorded safely. Following the inspection the service had been offered support in this area from a reputable source. We made a recommendation about medicines.

People’s needs had been assessed, and care plans and risk assessments were in place to ensure as far as possible people’s needs were met. Where changes in people’s needs occurred, records were altered and staff informed.

Recruitment systems were in place to ensure people employed by the service were safe to work with children and adults.

There were sufficient numbers of staff to meet people’s needs. Staff were able to carry out their required roles safely as they were not rushed and had sufficient time to spend with people.

Staff were trained in how to protect people from abuse, along with training in other areas of care, for example health and safety and medicines.

Staff spoke positively about the registered manager and office staff. They told us they were supported and received supervision and training to enable them to carry out their roles. The registered manager was accessible and responded quickly when staff required support or advice.

Staff were aware of the Mental Capacity Act 2005 but at the time of our inspection there was no one using the service that this applied to.

Staff were described as caring, and professional. People and their relatives spoke positively about their relationships with staff. We were told the staff appeared to be skilled and knowledgeable in how to meet people’s needs and how to support them.

Staff showed respect to people and protected people’s dignity and privacy. They communicated effectively with people and their relatives. They understood the importance of enabling people to be as independent as possible.

People and staff told us the registered manager had made improvements to the service since our last inspection. The registered manager had reviewed care plans and risk assessments, they had ensured these were accessible to people and staff.

The registered manager had met with people to review their care and had carried out telephone consultations with people to receive feedback on the care they had provided. From this information improvements had been made. Additional administrative staff had been employed to assist with the running of the service. We received positive feedback from people and staff regarding the administrative staff.

The registered manager had introduced competency checks on staff, and had increased the regularity with which staff received supervision and support.

This announced inspection took place on the 08, 09 and 10 February 2016. Appleberry care is a domiciliary care service providing care to children and adults in their own homes. At the time of the inspection they were providing care to 38 people. As part of meeting the registration requirements Appleberry Care had a registered manager in place.

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’s relative’s views of the service provided was very positive. They told us the staff were trained and knew how to care for people. The management were accessible and were approachable and supportive. Staff were kind, caring and professional. However, we found a number of areas we were concerned about.

We found staff’s knowledge or skills were not assessed by the registered manager following training. Checks on staff competency did not always take place and where staff worked with people with specific conditions, specialist training was not provided.

Staff did not receive regular supervision, some staff had received supervision once in the last year. The registered manager told us they had frequent contact with staff, but there was no documentation to verify this.

People’s needs were assessed prior to care being provided, but not everyone had an up to date care plan that accurately reflected their needs. Some risks we identified in the care plans had not been assessed. Care plans and risk assessments were not always available in people’s homes for staff to refer to. This placed people at risk of inconsistent care.

Administration of medicines was not recorded in a safe way. Records did not include the full name, dosage, route, time and signature of the staff member administering the medicine. There were no risk assessments in place for medicines and no protocols for PRN (as required) medicines.

Staff were aware of the indicators of abuse, but records were not available to demonstrate the provider had taken the correct action in relation to an allegation of abuse that had occurred. We have made a recommendation about safeguarding people from abuse.

Staff had a basic understanding of the Mental Capacity Act 2005 (MCA), but the registered manager was not fully aware of how the 2014 Supreme Court judgement applied to Appleberry Care. We have made a recommendation about MCA.

People were supported to maintain their health and access appropriate healthcare support. Staff understood how to support people with food and drinks in order to maintain good health.

We received very positive feedback about the caring attitude of staff. This was supported by actions the staff had taken to ensure people’s needs were met. These included collecting items for the person from shops and pharmacies. One staff member attended school with a child to support them with their swimming and supported them and their family whilst the child was in hospital. Other staff had amended their holiday dates to ensure any disruption to the care being provided was minimised.

Staff understood how to protect people’s privacy and dignity. They were able to give examples of how they showed respect for people and their families. Family members recognised and commented in a positive way about this aspect of care. The care plans we read also acknowledged people’s preferences and choices. Some care plans were regularly reviewed and the person and their relative was part of the review process. Not all care plans were regularly reviewed.

One complaint had been made to the provider in the past year; this had been dealt with professionally by the registered manager. Staff knew how to respond to complaints.

During the inspection we were made aware of a safeguarding concern the provi