This inspection was started on Wednesday 18 July 2018 and was announced. We gave the provider 48 hours’ notice of the inspection to ensure that the provider/registered manager and office staff were available. On 19 and 20 July 2018 we made calls to people who use the service and staff to gain their views and experiences. The inspection was carried out by one adult social care inspector.

At the time of this inspection the service were providing a service to 137 people in their own homes and had 55 care staff. The service provided services to people whose care and support had been commissioned by Bristol City Council, and also people who had set up private arrangements direct with the service.

The service was last inspected in July 2017 and at that time we gave an overall rating of Requires Improvement. There was one breach of regulations because the provider’s quality assurance systems had not identified areas for improvement following a medicines error. Following that inspection the provider had submitted their improvement plan and told us what they planned to do to rectify the issue.

There was a registered manager in post. This was the registered provider. 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 home is run.

Why we have rated this service as Good.

The service provided by Avon Home Carers was safe. Staff had a good understanding of safeguarding and knew what to do if they were concerned about the welfare of a person. Risk assessments were carried out alongside care planning, including an environmental risk assessment of the person’s home. The service had sufficient care staff and only considered taking on new packages of care if they had the resources to meet people’s care and support needs. The service followed safe recruitment procedures and completed all required pre-employment checks. Medicines were managed safely with people receiving their medicines appropriately. Regular medicine audits were being carried out.

People received a service that was effective and met their care and support needs. Their needs were assessed and a care plan written detailing how the person wanted to be supported. The plans were person centred. People were very much involved in having a say about how their care was delivered.

Staff were well trained and well supported by the management team. Their work performance was regularly checked. People were always asked to give consent before being assisted by the staff and where people were living with dementia, the care staff would act in their best interests after consultation with other parties. The service worked within the principles of the Mental Capacity Act 2005.

People received a caring service. People told us they were treated in a respectful manner and this was also confirmed by relatives. People were actively encouraged to provide feedback about the service and to express their views about the way they were cared for. People could be expected to be looked after by the smallest number of care staff

People received a service that was responsive to their individual needs. Their care plans were kept under regular review and service delivery was amended as and when necessary. People were encouraged to give feedback about the service. Any complaints they made would be seen as an opportunity to make improvements.

People were provided with a safe, effective, caring and very responsive service that was well led. The provider/registered manager had strengthened the quality assurance systems to ensure any shortfalls were identified and acted upon.

Avon Home Carers is a domiciliary care service providing personal care and support to people in their own homes. At the time of our inspection 75 people were receiving personal care.

This inspection was announced. The provider was given 48 hours' notice because we wanted to make sure staff would be available to speak with us. The inspection was carried out by one adult social care inspector.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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. The registered manager was also the provider and owner of the agency.

We last inspected the service in May 2016. At that time we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registration) Regulations 2009. Following our inspection we told the provider to send us an action plan detailing how they would rectify these breaches of regulations. We received the action plan as requested. At this inspection we saw the provider had taken the action they had planned.

At the last inspection the service was rated Requires Improvement.

At this inspection we found the service remains Requires Improvement.

It was clear to us the provider/registered manager and staff had worked hard to significantly improve the quality and safety of the service provided to people.

We identified areas of the service that require improvement to ensure people receive a service that is consistently safe. The provider/registered manager must continue to monitor and take action to ensure care calls are not missed. The provider/registered manager must take action to ensure medical advice is sought and documented when errors occur in the administration of medicines.

Other aspects of the service were safe. The provider/registered manager and senior staff understood their role and responsibilities to keep people safe from harm. Risks were assessed and plans put in place to keep people safe. Checks were carried out on staff before they started work to assess their suitability to care for vulnerable people.

The service was effective in meeting people’s needs. Staff received regular supervision and the training needed to meet people’s needs. The provider/registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected.

People received a service that was caring. They were cared for and supported by staff who knew them well. Staff treated people with dignity and respect. People’s views were actively sought and they were involved in making decisions about their care and support.

The service was responsive to people’s needs. People received person centred care and support. People were encouraged to make their views known and the service responded by making changes. The provider/registered manager and senior staff welcomed comments and complaints and saw them as an opportunity to improve the care provided.

The provider/registered manager ensured effective day-to-day leadership and management of the service was in place. A quality assurance system was in place. However, this system had not resulted in corrective action being taken to ensure medical advice was sought when errors in the administration of medicines occurred.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider’s quality systems had not been operated effectively.

You can see what action we told the provider to take at the back of the full version of the report.

We undertook an announced inspection of Avon Home Carers on 3 May 2016. When the service was last inspected in March 2014 there were no breaches of the legal requirements identified.

Avon Home Carers provides personal care to people living in their own homes within the Bristol area. At the time of our inspection the service was providing personal care and support to 137 people.

A registered manager was in post at the time of 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.

The provider had not consistently ensured that accurate assessments had identified risks to people. Where risks had been identified to the service by other healthcare professionals, risk management guidance had not been produced to reduce the risk of harm to the people involved. People told us they received their medicines, but the absence of any auditing process to identify errors or shortfalls had resulted in a conflicting record going unidentified.

The provider had not always ensured they had obtained people’s consent for certain decisions as required. Decisions had been made for people between the service and the person’s family when the person had the capacity to make the decision independently. Although the provider had ensured staff were trained in the Mental Capacity Act 2005, staff knowledge was variable.

The provider had failed to notify the Commission, as required, of multiple safeguarding referrals.

In general, people felt safe with staff and that scheduled care appointments would be completed . Staff had completed training in safeguarding vulnerable adults and were knowledgeable about how to report concerns. Variable feedback was received from people about the continuity of their care. There was a system that monitored reported incidents and accidents.

People told us they received effective care from staff. The provider had a regular training programme together with a supervision and appraisal programme to support staff. People received the support they required from staff where required to meet their nutritional needs. People and their relatives commented positively about the support they received from staff. Staff would contact healthcare professionals when needed.

Staff told us they had built relationships with people and understood the needs of the people they supported. In general, people who received support and their relatives gave positive feedback about the staff that provided care and support. There was a compliments book that showed family members had communicated their thanks to the service by way of a letter or a card. The service communicated important information to people about their care and support.

The provider had a system to review people’s care needs and people told us they were involved in care reviews. People told us they received the care they needed and said that staff were responsive to their needs. There were systems in operation to ensure that daily care delivery was responsive and people’s needs were met. The provider undertook surveys to seek the views and opinions of people and there was a complaints system in operation.

People and their relatives said the office staff at the service communicated with them well and the overall feedback was positive. There were governance systems in operation, however these had only recently been introduced and had not yet commenced. This meant we could not test the robustness of these systems. Staff felt well supported in their employment and there were systems in place to communicate with staff about key matters.

This inspection was carried out by an adult social care inspector. At the time of inspection 195 people were receiving care and support from Avon Home Carers in their homes. The purpose of our inspection was to answer these key 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, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service safe?

The provider had suitable arrangements in place to protect the health, welfare and safety of the people who used the service.

During the inspection, we spoke with 13 people who used the service and their relatives. We also visited three people who used the service in their own homes.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that initial assessments of the person’s needs were carried out by the registered manager. A further assessment and a care plan were developed by the staff within the home care team. This ensured that staff were able to meet the person’s needs and deliver the care safely. One person told us “I am happy with the staff and I feel safe with the service”.

The provider ensured that confidential information was protected from unauthorised access. The provider kept an electronic record of all communications between staff, people who used the service and other agencies involved in their care. We spoke with two staff who worked in the office. They told us that all the office staff had their own passwords and log in identification. This was to ensure that only people worked at the office could gain access to confidential information.

Is the service effective?

We saw that the provider worked in co-operation with other health care professionals. A record of all contacts with all other healthcare professionals including community mental health teams, general practitioners (GP’s), physiotherapy, district nurses and care managers was available.

The assistant manager told us they sought advice from healthcare professionals if they had any concerns about people's general health and wellbeing. For example, if they had concerns about medication, staff would contact the pharmacist.

Is the service caring?

People received care suitable to the needs.

People told us they were satisfied with the care they received and were happy with the way they were treated by the staff. They also told us they were kept involved in the review of their care. One person told us “the staff are kind and caring”. Another person told us “the staff are lovely, respectful and we always have a laugh and a joke”.

Is the service responsive?

There was a complaints system available, in case anyone wished to raise a complaint.

The people we spoke with told us they had no concerns about the care they received and they would speak to the senior staff if they had any. One person told us they had raised a complaint in the past and this was resolved satisfactorily by the provider.

Is the service well-led?

The provider had an effective system in place to monitor the quality of the service to ensure people received safe and suitable care.

We saw that the provider had completed regular audits in line with their quality assurance policy. For example, we saw regular audits had been completed for the recording of medicines, care plan reviews, staff training and daily call records.

Staff were properly supervised in their work to improve and develop in their work with people who used the service. The staff we spoke with said they felt supported in their work with people who used the service. One member of staff told us “I enjoy my job. The manager has an open door policy I can call and talk to them about anything and they listen and help me out”.

During our inspection we spoke with the registered manager, the assistant manager and five members of staff in the office. We also spoke with people who used the service and relatives over the telephone after the visit ended.

People who used the service told us they were happy with the care and support provided by the agency. They told us they had been involved in assessments to decide if the service could meet their needs. One relative told us. "They are very a good agency, the carers are respectful and sensitive towards my relative who has dementia". Another relative told us, "If there is any problem they ring and let us know. I am pleased with them”.

Relatives felt people were treated with respect and their dignity was promoted. They felt people were supported to meet their care needs, whilst being enabled to maintain their independence. Staff said they were supported by the manager and were given regular opportunities to talk with them.

Staff told us they attended relevant training courses to inform and do their work efficiently and they had received regular supervision and annual appraisals.

The provider and staff were aware of their responsibilities regarding protection of vulnerable people from abuse. Staff told us they knew how to raise concerns and would not hesitate to inform the manager if they were concerned.

The provider had quality assurance systems in place to check that the quality of the service people were receiving met their needs.

People we spoke with told us they were happy with the care and support provided by the Agency. People said they were assessed by the deputy manager before they started receiving care and support. They said they were involved with developing their care and support plan and staff treated them kindly and politely. For example, one person said “I know about my care plan, it is in the blue folder in my house, they discussed it with me. I am very happy. The service is excellent. I have no complaints”.

We saw the provider had a policy on safeguarding people from abuse and staff had attended training to ensure that people who used the service were protected from the risk of abuse.

We noted the provider had an effective system in place to regularly monitor the quality of service that people received.

We found from speaking to people who used the service, staff and looking at training and supervision records that the service ensured people who used the service were cared for by staff with appropriate training and support.