About the service:

Audley Care Ltd – Audley Care Clevedon is a domiciliary care agency, providing services to older adults and people with physical disabilities and complex health needs. At the time of our inspection 38 people received personal care from the service.

Not everyone using the service receives the regulated service of personal care. CQC only inspects the personal care service provided to people, that is help with tasks related to personal hygiene and eating. Where personal care is provided to people, we also take account of any wider social care provided.

People’s experience of using this service:

Staff were exceptionally caring. Everyone we spoke with was extremely complimentary about staff and the service. People told us they would not hesitate to recommend the service. There was a strongly embedded culture within the service of treating people with dignity, respect, compassion and love.

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.

People’s healthcare needs were being met and medicines were being managed safely. Staff knew people very well, including their likes, dislikes and care needs. Staff supported people to access activities in the local community and care village.

People told us they felt safe and staff had been trained to recognise and report suspected abuse. A complaints procedure was in place and people knew how to complain.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate identified risks.

Staff were mostly recruited safely although we found the required amount of references had not been obtained in one candidate's recruitment profile. There were enough staff to take care of people. Staff were receiving appropriate training and updates. Staff told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision and appraisal where they could discuss their ongoing development needs.

The provider had effective systems in place to monitor the quality of care provided and acted to make improvements when issues were identified. People and staff praised the registered manager and the management team. They told us they were approachable and supportive.

The service met the characteristics of ‘Good’ in all domains. More information is in the full report.

Rating at last inspection: The service was rated good at our last inspection in September 2016.

Why we inspected:

This was a planned inspection based on the rating at our last inspection. At this inspection we found the service remained good in all domains.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

On the 7, 8 and 15 July 2016 we inspected Audley Care Ilkley. At the time of our inspection, there were 22 people using the service. This was an unannounced inspection.

Audley Care provides care and support services for people living in their own homes. It is based in Ilkely and supports people who live in the surrounding area. There is good disabled access to the Audley Care office with parking also available.

The service had a registered manager in place 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 and associated Regulations about how the service is run. The registered manager was present throughout the inspection.

People were complimentary about the service they received. They said they had developed a good relationship with staff and felt safe, as staff knew them well. They said staff arrived on time or rang them if they were running late.

People told us they never felt rushed and enjoyed their time with staff. They said staff promoted their privacy and dignity and supported them in a caring manner.

People were aware of how to make a complaint and would confidently raise any issues of concern or abuse, if required.

Staff supported or prompted people with their medicines in a safe way, although appropriate documentation was not always completed.

The service regularly asked people their opinion of the service and were fully involved in the development of their care plan. People told us the service was responsive to their needs and their visit took place at a time which was convenient to them. They said the office staff were flexible and able to change their visit at short notice if needed.

Peoples care records were person centred and created around their needs. Regular reviews were completed to reflect people’s current support needs. People told us they received their care in line with their requirements and said staff knew them well.

Any risks had been identified and risk assessments formulated when working with people. These records made it clear where risks were and how to minimise risks. Environmental assessments were completed before people came to use the service.

Staff told us the consistency of visits enabled them to develop relationships and know people's likes and dislikes. They said they were given sufficient time to travel from one person to another and had adequate time within each visit to support people effectively. They said this meant they were rarely rushing or running late for visits.

Staff told us they had the required training to do their job effectively but could ask for additional support if they were not sure about a particular topic. Staff told us they were very well supported and received regular informal and formal support from the management team.

The service was well managed with clear leadership. The registered manager had developed a range of systems since their appointment and was committed to improving the service further.

There were enough staff to support people effectively with focused recruitment taking place to accommodate new care packages. People were given consistency through the allocation of their visits. Regular audits, telephone interviews or visits to people were effectively monitoring service provision.

We set out to answer our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff we spoke with understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary and mobility needs had been identified in people’s care plans when required.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People said; “Staff are very good with the care they provide.” Another said, “I have no complaints about the staff.”

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People using the service and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint about the care but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

If you wish to see the evidence supporting our summary please read the full report.

People told us they were happy with the care provided and were involved with their care and support needs. Everyone we spoke with told us their dignity was respected and confidentiality was always maintained. People had contributed their preferences and their experiences were taken into account in relation to how care was delivered. One person told us, “I feel involved in my care and they always ask me if I want anything.”

People experienced care and support that met their needs and protected their rights. People’s care plans contained a good level of information that ensured their needs were being met. Two people we spoke with told us they were happy with the care and support they received. One person told us, “The care is good and they understand my needs.”

People who used the service were protected against risks because the provider had made suitable arrangements. All staff had received training in abuse awareness and protecting vulnerable adults. The people we spoke with told us they felt safe when at the service.

People were treated by staff who were supported to deliver care safely and to an appropriate standard. Staff had a programme of on going training, supervision and appraisal.

There were quality monitoring programmes in place, which included people giving feedback about their care and support. This provided a good overview of the quality of the services provided.

We inspected the agency office and spoke with three people who used the service. People who used the service said they were very satisfied with the treatment and support provided by the agency. They also said the staff were polite, on time and friendly. People told us staff treated them with respect and courtesy. One person said, "Staff are really good here" and another one said, "I can say no if I don't want something."

People told us they were well cared for. One person said, "I get the same carers working with me everyday." People who used the service said the management team were good and were approachable if they brought any concerns to their attention.

We looked at three care files and found people were given appropriate information and were involved in making decisions about their care and treatment. As part of the care files we checked peoples medication where applicable, Medication Administration Records (MAR) and care plans with risk assessments.

We looked at three staff files and spoke to three staff and could see staff were recruited in an appropriate manor and held suitable qualifications to carry out the role in a safe and respectful manor.

Everyone we spoke to on the day of inspection was aware how to complain and we saw an up to date complaints policy in the office.