The inspection of Ashwood Care took place on 10,11,12,13 April 2018 and was announced.

At our last inspection in April 2017 we found breaches of Regulation 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in Good Governance and Personal Care which related to fit and proper persons employed, staff supervision and training and quality assurance systems to assess, monitor and improve the quality and safety of the service. Following that inspection we asked the provider to complete an action plan to identify what they would do and by when to improve the key questions- Is the service safe, effective, well led.

The action plan submitted identified the service had implemented robust recruitment and selection processes, updated training and personal development systems and commenced a quality monitoring procedure. At this inspection, we found that all the required improvements had been made.

Ashwood care is a domiciliary care agency based in the Padgate area of Warrington. It provides personal care to people living in their own houses and flats in the community. The services provided include care and support provision for older people, people with a physical or learning disability, people living with dementia, children and end of life care.

At the time of our inspection, the service offered support to 60 people who lived in the Warrington area.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

Recruitment processes were robust and ensured that staff were of suitable character to work with vulnerable people. All staff had been subject to a check by the disclosure and baring service (DBS) and had also been required to provide two references.

Discussions with staff members identified that they felt happy and supported in their roles. They told us that the registered manager was supportive and they felt that they could contact her and the office staff at any time.

Staff had received the training they required to carry out their roles effectively and new staff had also been supported to undertake a period of induction. This helped ensure that staff had the skills they needed to support people.

Records showed that staff carried out their home visits at the agreed time.

Systems were in place to check the quality and safety of the service. The registered manager also sought feedback from people informally on a regular basis and on a formal basis annually. All the feedback we viewed was positive. Spot checks and observations were carried out with staff to ensure that the standards of care were maintained.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and knew how to respond to and report any concerns they may have.

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.

Care records contained personalised information about people’s needs which helped ensure that staff had access to up-to-date and accurate information around people’s support needs. This helped ensure that people received the correct level of support.

Medication administration records (MAR) sheets held details of types of medication and the times they were to be given. However although all records viewed held details of the administration of medication there were some inconsistencies in the recording such as gaps being left on the MAR sheets when medication was not required. This was discussed with the registered manager and refresher training was immediately arranged for all staff to ensure they were compliant

The inspection took place on 18,19, 20 April 2017. This was an announced inspection and we telephoned the service to give them notice of our visit. This was to ensure that someone would be available at the office to provide us with the necessary information to carry out an inspection. This was the first inspection of the service since it registered with The Care Quality Commission in 2015 at its current location.

The agency office is located in Padgate Business Park in the Padgate area of Warrington and is accessed via the ground floor.

Ashwood Care provides care and support to people in their own homes. They work with people who are elderly, disabled or have additional needs to help them remain independent at home. At the time of the inspection there were 70 people using the service. .

The service has a registered manager who has dual registration to manage the Warrington and Wigan branches of Ashwood care. 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.

We found breaches of the regulations in relation to fit and proper persons employed, staff supervision and training and good governance. You can see what action we have told the provider to take at the back of the full version of this report.

Staff recruitment processes were not robust. We found the recruitment policy in place was out of date and the provider had not carried out consistent pre-employment checks on prospective staff to ensure they were suitable and safe to work with people.

Staff told us they had access to on-going training and support. They were knowledgeable about their roles and responsibilities. We saw that mandatory training had been provided but some training had not been updated within the required timescales and staff supervision was limited.

The service requested feedback from people who use the service via quality assurance questionnaires. However we were unable to access information to show that all the feedback received had been acted upon.

The service did not have a functional business continuity plan. Quality checks had not been robustly completed to ensure that all parts of the service ran in the right way. Senior staff had not been provided with training and support to enable them to undertake their respective roles in the recruitment, supervision and support of staff or in the methods used to ensure the quality of the service.

People had access to the complaints procedure and their feedback was mixed. They told us that they knew how to make a complaint should they need to. However some people said that the service did not always act upon their concerns especially if they requested a change to times of visits.

People told us they were safe. Risk assessments identified the risks to people and how these could be minimised. Sufficient numbers of staff were available to meet people's needs.

People told us that their medicines were provided appropriately. However we identified the need for people’s medicine administration records to include clearer information about the doses and times of the medicines given by staff.

People were involved in decisions about their care and how their needs would be met. Managers and staff had received training on the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005..

Staff knew how to respond to people's needs in a way that promoted their individual preferences and choices regarding their care. Where necessary people’s nutritional needs were well met and they had access to a range of professionals in the community for advice, treatment and support.

People were treated with dignity and respect. Staff understood people's preferences, likes and dislikes regarding their care and support needs.

Care