What life is like for people using this service:

Staff understood their responsibilities to support people to have maximum choice and control of their lives and supported them in the least restrictive way possible. However, the provider needed to improve their recording system to consistently show how people had consented to their care.

Whilst the provider had improved the effectiveness of their quality assurance systems, checks of care plans needed to be improved to ensure they were accurate and reflected people’s preferences.

People were involved in decisions about their care and were happy that staff respected their individual routines. However, the provider had not always followed the Accessible Information Standards by ensuring that people with a sensory loss received information about their care and support in a format that met their needs.

People were supported by caring, friendly and respectful staff. Staff knew people and their families well, respected their privacy and dignity and promoted their wellbeing. Staff listened to people and encouraged them to maintain their independence. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access other health services.

People were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. Risks associated with people’s care and support were managed safely. When needed, people received support to take their medicines as prescribed.

People and their relatives knew how to raise concerns and complaints and were encouraged to give feedback on how the service could be improved. Staff felt supported and valued by the provider and were involved in the development of the service. This promoted a caring and inclusive culture within the service.

More information is available in the full report below.

Rating at last inspection: Requires Improvement (Last report published 17 February 2017)

About the service: AR1 Homecare is a domiciliary care service that was providing personal and nursing care to people living in Biddulph and surrounding areas in North Staffordshire.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection the service was rated Requires Improvement overall (in the key questions of Effective and Well Led). At this inspection, we found the provider was now meeting the legal requirements but there were areas that required further improvement. The overall rating for the service has improved to Good (in the key questions of Safe, Effective, Caring, and Responsive).

Follow up:

Going forward we will continue to monitor this service and will revisit in line with our inspection schedule for services rated Good.

We inspected this service on 20 and 21 December 2016. This was an announced inspection and we telephoned 48 hours’ prior to our inspection in order to arrange home visits with people who use the service. At the last inspection on 18 June 2015, the provider was meeting the standards that we checked.

AR1 Homecare Limited provides personal care and support to people living in their own homes in Tunstall and the surrounding areas. At the time of our visit, approximately 38 people were receiving a regulated service. 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.

People’s capacity to make decisions was not always considered and improvements were needed where people lacked the capacity to make certain decisions for themselves. However, people told us that the staff sought their consent before providing care. The provider’s quality and safety checks were not always effective in identifying shortfalls to ensure improvements could be made.

People we spoke with told us they felt safe and looked forward to the staff visiting. Staff recognised their responsibilities to protect people from abuse and were confident the provider would take action if they raised any concerns. Risks to people were assessed and managed to keep people safe whilst promoting their independence. People received support to take their medicines when needed.

People had a copy of their care plan which detailed how they wanted to be supported and reviews were carried out to ensure their care remained relevant. People’s needs and preferences were met when they were supported with meals and the provider ensured people accessed the support of other health professionals when their needs changed.

There were sufficient staff to meet people’s needs and checks were made to confirm staff were suitable to work with people in their own homes. The support was flexible and responsive to changes in people’s needs. People received care and support from staff who were trained and supported in their role and knew how people liked things done.

People were treated with care and kindness by staff who enjoyed their work and were motivated to ensure people had a good quality of life. People received personalised support and were happy with how the staff supported them. Staff respected people’s privacy and dignity, promoted their independence and supported them follow their interests and maintain links with the local community.

People felt comfortable raising any concerns and were confident they would be responded to. People told us the service was well managed and they were encouraged to give their opinions on how things could be improved. Staff felt supported and valued by the provider and manager.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This report indicates that there are two registered managers for the location. Our record showed that Karen Jones and Claire Jackson were Registered Managers, but the provider told us that Karen Jones was no longer in post. We will remove Karen Jones’ name from our records when we receive the required documents notifying us that she is no longer the Registered Manager.

During this inspection, we looked at how care and support was provided to people. We spoke with two people who used the service and a residential home warden, where some of the people who used the service lived. We looked at the care records of three people who used the service and spoke to a relative of one of the people, to enable us understand the care provided to them. We spoke with three care staff, the Registered Manager and the Provider.

At the time of our inspection, 18 people were receiving care from the provider.

Is the service safe?

People who used the service told us that they were happy with the care they received. One person said, “I’m very happy with them”. The residential home warden we spoke with said, “I trust them in here, otherwise I wouldn’t have them”.

We saw from records that all the staff received training as part of their induction, including training in safeguarding vulnerable adults. We saw that the provider had procedures in place to ensure that staff were competent enough to work with vulnerable adults before they started working independently.

Staff we spoke with described how they ensured that the people they provided care to were kept safe. One staff member we spoke with said, “If there’s any change, we record it in the care plan and we have to read the care plan before we start doing anything, to make sure nothing has changed”.

The provider had robust recruitment procedures in place to ensure that people were cared for by suitably qualified staff. There was an induction and training programme provided for newly recruited staff which meant they were supported to provide safe and appropriate care to people.

Is the service effective?

People's care records were person centred and the provider ensured that people were involved in drawing up their support plans.

People we spoke with told us that staff always obtained their consent before they providing them with personal care.

We saw agreements that were signed by people who used the service, in all the records we looked at. For example, we saw that people who used the service had signed to agree on the level of support they expected to receive, that information relating to their care could be shared with other professionals and that staff could support them with their medication. This meant that people had given consent to their care and treatment.

Staff members we spoke with told us that they were well supported by their managers. One member of staff, “If I have a concern, I just go to the office and talk to them”. We saw that staff had regular supervision and training to ensure that people received safe and effective care.

Is the service caring?

People were supported by kind, attentive and friendly staff. All the people we spoke with told us that they were happy with the care and treatment provided. A relative of a person who used the service told us, “I’m very happy with them. They come on time every time”.

Staff we spoke with told us they enjoyed going out to support people in their homes. The provider told us that staff are encouraged to spend time talking with people during visits and checking on people’s wellbeing and not just going in to provide personal care. One staff member said, “I love helping; it is difficult sometimes but I find it very rewarding”.

The residential home warden told us that staff were very caring and supportive. The warden said, “The girls have excellent manners; they are very patient and the residents themselves and the relatives are very, very happy with the flexibility in the care they provide”.

Is the service responsive?

The provider ensured that a full assessment of people’s needs and support plans were in place prior to care staff beginning to provide care at people’s homes.

Records we looked at confirmed that people’s preferences, interests and diverse needs were recorded and care and support was provided in accordance with people’s wishes. We saw records to demonstrate that people were care for by the same carer most of the time.

The service worked well with other agencies and services to make sure care was joined up and effective. We saw records to demonstrate the involvement of other health and social care professionals in the care of people.

Is the service well led?

The provider was involved in the day-to-day running of the service. The provider told us that they sometimes went out to provide care and to get to know the people who used the service more.

The provider carried out spot checks to ensure that people who used the service received safe care. Staff we spoke with told us that the provider carried out spot checks and we saw records which confirmed what we were told.

Staff we spoke with told us that their managers were very approachable and took into to consideration their personal circumstances when allocating their work load A staff member said, “They’re very good in getting things sorted. I have quite a lot of support”. This helped to ensure that people received a good quality service at all times.

We saw that the provider had systems in place to regularly monitor the quality of services being provided. We saw that people’s care records were reviewed and updated regularly. We saw from the records that the provider acted on concerns raised by people who used the service and took appropriate actions to ensure that their needs were met.

We noted that the provider ensured that there were copies of risk assessments and risk management plans in the office as well as people’s homes to ensure adequate information was always available so they could see that people received safe and appropriate care.