We carried out an inspection of Autonomy Care Limited on 15 and 16 December 2016. This was an announced inspection where we gave the provider 48 hours’ notice. This was because the location provides a domiciliary care service and we wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

Autonomy Care Limited provides a range of services to people in their own home including personal care, companionship, and shopping in Devizes and the surrounding areas. The regulated activity for this service was the provision of personal care and at the time of inspection 34 people were using the service under this regulated activity.

A registered manager was in place and available throughout the 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 2008 and associated Regulations about how the service is run.

Risk assessments had been completed and actions recorded to manage identified hazards and concerns. There was good documentation of some risks and clear documentation which provided guidance to staff on how to mitigate these risks. However, new risk assessments and guidance had not always been documented in people’s care records. The registered manager told us they had recently identified gaps in some care records where risk assessments and necessary supporting guidance required more information. In response to this they had delegated two senior care staff to perform regular quality checks and help to update records where documentation had not been completed.

People were protected from potential harm and abuse by staff who were aware of the different types of abuse and the actions to take if they suspected someone was at risk of harm. Staff were aware of the responsibility to report any concerns they had about people’s safety and welfare and who to report concerns to.

People said they were satisfied with the support they received with regards to their medicines however; medicines were not always managed safely. The recording of information on Medicines Administration Records (MAR) was not always consistent with other care records although in line with their recent identification of some gaps in care records the registered manager had taken action to address this prior to the inspection. In addition, gaps that were seen during the inspection were immediately addressed and current documentation was revised to correct this.

Processes were in place to ensure staff recruitment procedures were followed and staff received training and support from management to ensure they had the right knowledge and skills to meet people’s needs. The service also enabled staff to undertake nationally recognised training to help them progress in their work.

There were enough staff deployed to fully meet people’s health and social care needs. People received their care at the correct time and had support given by the same members of staff to ensure consistency of care.

Staff completed competency assessments as part of their induction followed by regular supervisions and training. Staff were knowledgeable about people’s needs and said they received the necessary training to equip them with the skills they needed to provide the care people required.

People told us staff sought their consent before providing any care or support. Staff had an awareness of the Mental Capacity Act (2005) and knew how to support people to make their own decisions.

People had access to health care professionals to make sure they received appropriate care and treatment. The service maintained accurate and up to date records of people’s healthcare and GP contacts in case they needed to contact them.

People and their relatives spoke highly of the staff and said for the managers, o

A previous manager had returned to the service and was in the process of registering as the manager with the care quality commission. The service was providing support and care to seventeen people.

As part of this inspection, we spoke with two staff, and shortly after our visit we contacted one person who used the service, and three relatives. Everyone we spoke to was complimentary about the staff and the care and support provided.

We reviewed the care plans for three people and found that they were comprehensive. They contained sections for personal care, continence, skin & physical wellbeing, with sub sections for sight, hearing, oral care, feet, dexterity, BMI (body mass index), pain, sleep, breathing, circulation, nutrition, medication, communication, mobility, syndromes and conditions, mental health and daily routines.

The provider had a medication administration procedure which was reviewed in November 2013. Staff spoken to confirmed how they would provide support to a person with their medication. Staff confirmed their knowledge of medication monitored dosage systems, with dosette boxes, and how they would prompt a person if needed, to take their medication.

We looked at staff recruitment records and found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider demonstrated a commitment to quality assurance and a robust system was in place to effectively monitor the service.

The management of Autonomy Care Limited-Devizes was being overseen by an acting manager, who is also the registered manager of another location owned by the same provider. The acting manager told us a new manager had been appointed and they would apply to register with us.

As part of this inspection, shortly after our visit we contacted two people who use the service, one relative and two members of staff. We also spoke with one social care professional. The views of services users and our findings were summed up through what people told us.

Everyone we spoke was complimentary of the staff and were satisfied with the care and support provided. One person told us “there is consistency in the staff which is very important to me. They recognise if I am not feeling well and take action such as calling my doctor. The staff ensure that I am in total control of my care and support and I have plenty of opportunities to express my views regarding the care or treatment I receive.”

Another person said “the staff encourage me to do as much for myself as possible and this enables me to stay in my own home, and be as independent as possible. New staff have been introduced gradually and have worked alongside experienced staff until I have felt confident that the new staff know me and my routine, which I value. The staff are well trained and aware of the importance of privacy and dignity, they are polite and respectful.”