About the service: Bespoke Care Cheshire Ltd is a Domiciliary Care Agency providing personal care to adults with physical and mental health needs. At the time of the inspection they were supporting 36 individuals.

People’s experience of using this service:

We found a breach in regulation 17 as the registered provider needed to better evidence the checks and audits that were in place to determine the quality of the care. The Quality Assurance systems had not highlighted the shortfalls we found in the record keeping of medicines or care plans. Polices and procedures had not been brought up to date to reflect current best practice and legislation.

We have made a recommendation about the management of medication. People were safely supported with their medicines but improvements were needed to record keeping to ensure that this was safe.

Care records contained information staff required to provide a personal and effective service to people. A regular review of people’s care was undertaken to ensure all of their support needs were met in line with the person’s wishes. However, daily notes indicated that care plans did not always reflect all the support that staff were providing.

People who used the service and their relatives were extremely positive about the impact it had on their lives: enabling them to remain safe, healthy and as independent as possible within their own homes. They said that staff were kind, patient, knowledgeable, considerate and competent.

The registered manager worked in partnership with health and care professionals and the local community to ensure support was sufficient and coordinated.

Staff received robust induction, on-going training and support so that they could be effective in their roles.

Rating at last inspection: This service was rating Good at the last inspection (report published October 2016).

Why we inspected: This was a planned inspection based upon the previous rating.

Enforcement: Please see the ‘action we have told provider to take’ section towards the end of the report.

Follow up: We will request an action plan from the provider setting out how they intend to make improvements. We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this service on 5 and 6 October 2016 and we gave short notice to the registered provider prior to our visit. This was to ensure that key people were available during the inspection.

Bespoke Care Cheshire Limited is a domiciliary care agency that is registered to provide personal care to people in their own homes. The office is situated behind a small parade of shops near to Ellesmere Port town centre. There is limited car parking in the area. There are currently 41 people who use this service and who are supported by a staff team of 23.

The previous inspection was undertaken on 19 June 2014 and the service met the regulations we assessed at that time.

There was a registered manager in place at this service, who was also the co-owner with the nominated individual. The registered manager had been registered for four years. 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 registered manager and nominated individual both work on a day to day basis within the service and also work “hands on” to support care workers within the community.

People told us they were happy with the service provided and that the staff were kind, caring and friendly. People said “The service is excellent”, “The staff are great”, “The staff are flexible if I need to change the call time”, “The staff are very good”, “They look after me well” and “The staff are brilliant”.

Staff told us they enjoyed working at the service and providing support to people within the community. They said they were well supported by the owners and that they valued the “hands on” support given.

Care plans were well documented and up to date. They gave clear guidance to the staff team. Risk assessments were undertaken for a variety of tasks which included moving and handling, the environment and challenging behaviour. These were reviewed regularly and up to date. The management of medication was safe.

Staff were aware of how to report a safeguarding concern. They were aware of the policies and procedures available to safeguard people from harm and told us they would not hesitate to report any concerns to the owners.

Staff had received a range of training that included moving and handling, safeguarding, medication, health and safety and infection control. A range of other training was available for the staff team to access such as dementia awareness, pressure area care and challenging behaviour. Staff told us that the training was good. Staff had access to supervision sessions and were invited to attend regular staff meetings.

Staff recruitment files showed that robust recruitment processes were in place. Staff attended an induction process prior to working alone in the community. Staff told us that they worked alongside an experienced staff member before going out alone. They confirmed the induction process was good and that they had the information they needed to perform their role.

People had access to information about the service that included the statement of purpose and a brochure, however most people telephoned the service and spoke to the owners to obtain verbal information about the service. An initial home visit was undertaken by one of the owners prior to the service starting.

A complaints policy was available and each person had a copy within their care folder. Processes were in place to deal with any complaints received.

Quality assurance processes were in place which included observations of staff to ensure that care and support standards were being maintained, reviews of people’s care and an annual questionnaire for people who used the service. Audits were undertaken in relation to the service provided and these monitored the services safety and effect

During our inspection visit we gathered evidence to help us answer the five questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with four people who used the service and five relatives. We also spoke with the two managers of the service, three members of care staff and looked at records.

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

Is the service safe?

All the people we spoke with told us they felt the care provided by Bespoke Care Cheshire Ltd was safe. Comments people made to us included, “I wouldn’t change anything about the service I receive. Staff listen to you and I always feel safe with them”, “They [staff] keep my mum safe. I trust them implicitly” and “I feel safe when I go out as they treat my mum as if she were their own”.

Care records provided staff with information about the individual needs of people. Information included areas of risk and what staff would need to do to keep people safe.

People had their medicines at the time they needed them and in a safe way.

Is the service effective?

People’s needs were assessed by a manager from Bespoke Care Cheshire Ltd before the service started. This was to ensure the service was able to provide the care and support people wanted.

To ensure that safe and effective care was provided, staff continued to update their skills and knowledge with regular training and updates.

Is the service caring?

All the people we spoke with were complimentary about the care provided by the service. We were told, “Staff are caring and competent”, “Staff seem skilled and knowledgeable” and “Staff are very friendly and helpful”.

It was clear from our discussions with staff that they knew people well and had a good understanding of their care and support needs.

Is the service responsive to people’s needs?

People told us the service provided by Bespoke Care Cheshire Ltd was flexible. One person told us, “They [staff] come at a time to suit me. I know I can change things if I want to”. Another person commented, “We’ve had to alter the days on which staff come because of hospital appointments and they’ve always been able to accommodate this”.

All the people we spoke with told us they knew how to make a complaint and felt they would be listened to if they raised any concerns.

Is the service well led?

The service had a manager who was registered with the Care Quality Commission and was qualified to undertake the role. They were supported in the day to day running of the service by another manager.

All the people we spoke with were complimentary about the managers of the service. They told us they were approachable and always willing to accommodate any requests for changes in the service provided.

Quality assurance processes were in place for the service. These included the managers working closely with staff to ensure they had the necessary knowledge and skills for their role. People were also asked regularly for their comments about the service they received.

We found that people were able to express their views and were involved in the care planning process. We spoke with three people who used the service and they confirmed they had been involved in the implementation of their care plans. We found that people were supported with independence and personal care needs.

Comments from people who used the service included, "The staff are lovely", "I feel very safe with them", "The staff do a good job" and "I look forward to seeing them."

We looked at three care records and all had care plans and moving and handling risk assessments in place. Risk assessments for the environment need to be developed and implemented.

We have received no concerns about the service.

We found that the provider had documents in place which should ensure that effective systems would be in place in relation to the recruitment and training of staff. We spoke with two staff members who said, "I only started last month but I am really enjoying the job", "The manager has put me on NVQ level III and a medication course which i should be starting soon" and "The senior management team are very good."