Belong at Home is a domiciliary care agency (DCA) located in Atherton, Greater Manchester. The service provides personal care to people living in their own homes. At the time of the inspection the service provided care and support to 29 people.

This inspection took place on 24 and 25 July 2018 and was announced. The service was last inspected on October 2015 and received an overall rating of good. The safe domain ‘required improvement’. Medication was not always administered safely and risk assessments were not consistently completed and both areas required improvement. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw substantial improvements in both areas and each was now managed safely. Systems in place to manage and provide medicines had been reviewed to ensure that medicines were administered safely and new and comprehensive documentation for risk assessments identified and mitigated risks.

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 were secure and felt safe using the service. They told us how they valued the support they received. Surveys conducted with people who used the service and their relatives demonstrated a high level of satisfaction with the service and a reoccurring theme of the service going the extra mile to provide high quality care.

There were enough staff to meet people’s needs and the service prided itself in providing a reliable service and did not miss any visits. Recruitment was safe and methods of selecting new staff had a strong emphasis on staff values and choosing empathic people to work in the service.

A comprehensive induction and training package helped to ensure that all staff had the skills and knowledge to deliver effective care and support. This included access to good quality face to face training and a programme of ongoing learning and development. Safeguarding training was effective and staff understood their safeguarding responsibilities.

The service was proactive when addressing people’s health and social care needs and worked flexibly to ensure people’s individual preferences were met. People told us that the staff met their needs and were proactive in their approach. The service had developed impressive relationships with external health and social care organisation and this ensured that a holistic approach was taken towards people’s care and support.

The service was working within the principles of the Mental Capacity Act (MCA) and kept the individual at the centre of the decision-making process. This was in keeping with the empowering ethos of the MCA.

The service was person centred and had a strong focus on supporting people to maximise their quality of life. The service promoted independent advocacy to help safeguard people’s rights.

The service was proactive at promoting activities and access to the wider community. They were both creative and on the lookout for opportunities to enhance this aspect of people’s lives.

Privacy and dignity were respected, and people were supported by very kind, caring and compassionate staff who routinely went above and beyond what was expected of them to ¿provide people with excellent, high quality care.

Staff were extremely positive ¿about the people they supported and the management and leadership inspired them to deliver a high-quality service. The staff felt supported in their roles and could seek guidance from senior staff when they needed it.

The service was innovative and had good quality assurance systems in place to monitor performance and to drive improvement.

This inspection took place on 05 October 2015 and was announced. Belong at Home Domiciliary Care Agency Atherton provides domiciliary care services to people who live in their own home. At the time of our inspection there were 21 people using the service, with a variety of care needs, including people living with dementia.

The service was last inspected on 12 June 2013 and at the time was meeting all regulations assessed during the inspection.

During this inspection we found two breaches 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 this report.

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 were complimentary about the care and support they received. People spoke highly about the care staff and valued having care workers who were consistent and with whom they had built relationships. People and their relatives spoke positively about the skills of the care workers and felt staff were efficient and well trained.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. We reviewed a sample of recruitment records, which demonstrated that staff had been safely and effectively recruited.

The service used a matrix to monitor the training requirements of staff. This showed us that staff were trained in core subjects such as safeguarding, moving and handling, medication, dementia, nutrition and health and safety. Each member of staff we spoke with told us they were happy with the training and support available to them.

There was a positive caring culture, which was promoted by the registered manager. Staff were passionate about providing high quality care and enjoyed caring for people. Care workers felt supported by the registered manager, describing them as approachable and supportive.

People had support plans in place but they did not capture people’s histories and how people preferred their assessed needs to be met. The details in the support plans did not identify how people’s pain would be managed when it had been documented as requiring management and the medicine administration records (MAR) contained conflicting information.

We found that support plans were task orientated and not person centred but despite this,we did not consider it to impact on the care provided. Staff had developed good relationships with people and were knowledgeable about the person they supported enabling them to provide care tailored to the person.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The registered manager and care workers demonstrated a good understanding of MCA and provided examples of when consideration had been given to the legislation in reaching best interest decisions.

Quality assurance systems were not robust. The registered manager had undertaken audits in regards to the practices and records at the service to ensure people were receiving safe care. However, we found that these were not always effective. The systems had not identified gaps in the risk assessments, management of medicines or documentation pertaining to person centred care. The registered manager had also not consistently developed action plans to show how issues identified in audits were being addressed and monitored.

The registered manager demonstrated a commitment to address any issues identified in a planned and structured way.

We spoke with two people who used the service and one relative. They told us that the service was good ,reliable and flexible.

People said , “Staff don't impose upon you ,they just provide the service of my choice they give me just the right amount of support and allow me to live my life as I wish", "staff provide flexible care and support dependant on what I request."

The co-ordinator and support staff currently cover Belong at Home Wigan and Atherton sites. Staff spoken with demonstrated their understanding of peoples needs and of how to provide needs led care and support to the people who used the service.

Care records showed that people's individual needs and preferences had been taken into account and that people had been given a choice in how they wished to be cared for.

Care records showed that a person's independence was actively supported. Staff were knowledgeable about a person's care and gave examples of how they treated people with respect and dignity and promoted people's independence.

All necessary checks to safeguard people against abuse had been undertaken in the employment of staff and a regular training programme for all staff ensured they had the qualifications, skills and experience to undertake personal care.

Although Belong made available contact details of the current service users we were unable to speak with people who used the service as they were either unavailable or lacked mental capacity. However we were able to speak with five people's relatives'.

We asked them whether the people using the service had been given the choice as to the time they liked the visits to take place. They said that the timing of calls was prearranged and if they wanted to make changes they could do so by contacting the office or talking to the care workers. One person told us that staff had made sure the person needs had been fully identified before they provided care and support. Another person said that staff did exactly what had been requested. Comments included, “staff are very good and make sure they meet peoples needs”, “staff provide services of our choice.”

People told us that they and the person who used the service were involved in discussion and decisions about future care and support needs. They said that individual needs were catered for.

Everyone we spoke with said there was a care folder in the homes of people who used the service. They said these held all the details of their

assessment’s and care needs. People told us that staff carried out quality needs led care and demonstrated understanding of peoples needs. Comments included “The staff who come here are consistent, reliable and I am very satisfied with the services they provide.”” Staff have totally improved my relative’s daily life.” One person told us that the staff are well trained and use a common sense approach to provide “brilliant services”.