This announced inspection took place on 27 November 2018. We gave 24 hours' notice of our intention to visit the provider’s office to make sure people we needed to speak with were available. At the time of our inspection 68 people were receiving support from the service.

Bespoke Care & Support Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults living in the Huddersfield area. Everyone using Bespoke Care & Support Services was in receipt of the regulated activity of 'personal care’; help with tasks related to personal hygiene and eating. Where relevant, we also take into account any wider social care provided.

Bespoke Care & Support Services was last inspected on 9 September 2017. At that time, it was rated requires improvement overall and was in breach of regulations in relation to staff's access to training and supervision and good governance. At this inspection, we found improvements had been made in these areas and the provider was no longer in breach of regulations.

On the day of our inspection a registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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’s compliance with the Mental Capacity Act 2005 (MCA) was inconsistent. The registered manager had a good understanding of how to support people who required best interest decisions made on their behalf however the record keeping and staff’s understanding around this area required improvement. We recommended the provider researches and implements best practice guidance to ensure specific decisions made in people's best interest are appropriately recorded.

Staff had completed safeguarding adults training and knew how to keep people safe and report concerns. People's medicines were safely managed.

People told us they felt safe due to the support they received from staff. Staff had a good understanding of how to support people safely and knew what to do if they had concerns about

people's safety.

Staff were recruited safely. There were enough staff to provide people with the care and support they needed.

People and their relatives felt staff had appropriate skills and were competent. Staff had a good understanding of the people they supported and had access to ongoing training and supervision to support and improve their practice.

People told us they received a service that made a difference to their lives. Positive relationships had developed between people and staff. People and their relatives told us staff were consistently kind, caring and compassionate.

People were supported to have a balanced diet that met their individual dietary needs. They were supported to access healthcare services to maintain their health.

People were involved in their care. They were treated with respect and their dignity and privacy was maintained.

People’s needs in relation to the protected characteristics under the Equalities Act 2010, were considered in the planning of their care. People's communication needs were assessed

People told us they would feel comfortable to raise issues or concerns and that the management team and staff were friendly and approachable. The registered manager appropriately investigated complaints and incidents

People, their relatives and staff were complimentary about the leadership and management of the service. There were several systems in place to monitor the quality of care.

This inspection took place on 6 September 2017 and was announced. We spoke with staff providing this service on the telephone the following week. The service was registered in 2013 to provide personal care and support to people in their own home. The service was inspected previously in April 2015 and met all the regulations. On the day of our inspection 44 people were receiving support.

The service had a registered manager. 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.

Staff had received training in safeguarding adults and children. They demonstrated a good understanding of how to recognise abuse and ensure people were safeguarded. They knew the procedure to follow to report any concerns and they were confident management would act on concerns about a colleague’s performance if they arose.

The registered manager recruited staff with the values and behaviours to be able to provide person centred care. However, we found one person had commenced in employment before their necessary checks had been completed. We have made a recommendation about the management checks for new staff.

Risk assessments were in place in relation to the environment and for people using the service. Moving and handling plans were detailed and contained guidance for staff to follow to keep people safe from harm.

People’s medicines were administered by staff who had been trained in the management of medicines although not all staff told us they had their competency to administer medicines checked. The registered provider operated an electronic medicines management system which gave them up to date information when people’s medicines had been administered and alerted them when people’s medicines had not been administered. Staff training, supervision and appraisal was not up to date to evidence staff were supported to fulfil their roles and to maintain their skills and competence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; although the policies and systems in the service did not always support this practice. Staff were able to describe how they would support people to make decisions if they lacked capacity and how they would act in their best interests when providing care. They had not all completed training in the Mental Capacity Act 2005 and were not aware of the principles of the act. Our discussions with staff confirmed they upheld people’s rights and they supported people to make choices in their daily lives.

People who used the service and their relatives spoke highly about staff and told us they were caring. They said staff were respectful at all times and ensured their privacy was maintained. Staff had time to sit and chat and people did not feel rushed during their care and support. People received care that met their needs, choices and preferences and they were involved in the review of their service.

The culture of the organisation was positive and staff told us they wanted to provide the best service possible. Staff felt supported by the management team. All staff told us how much they enjoyed their role and how supportive their colleagues were.

There was a lack of systems and processed including regular audits which meant the registered provider was unable to identify where quality and safety needed to improve. Up to date nationally recognised guidance had not been implemented by the registered manager.

There was a focus on keeping people using the service happy, and the registered provider sought people's views when their care was reviewed. There was no satisfaction survey completed to compile and analyse the information gained about the service which wou

The inspection took place on 28 April 2015 and was announced. The provider was given 48 hours’ notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies.

The service was set up in 2013 and provided care and support to people in their own home. On the day of our inspection 16 people were receiving support.

The service had a registered manager. 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.

Staff had all undertaken training in safeguarding vulnerable adults and all the staff we spoke with were able to describe what actions they would take if they suspected abuse.

Risk assessments were clear and associated risk reduction plans were detailed and easy to follow.

Staff understood the principles of the Mental Capacity Act 2005 and were able to describe how they would support people to make decisions and if they lacked capacity how they would act in their best interests when providing care.

People who used the service and their relatives told us staff were caring. They told us staff did not rush them and they had time to chat. They told us the staff were respectful at all times and ensured their privacy was maintained.

People received care that met their needs, choices and preferences and they were involved in the review of their service.

People knew who to complain to and had every confidence that any concerns would be acted on and resolved.

The culture of the organisation was good and staff felt supported by a management team that was experienced and who listened to them.

The service had not yet completed a whole service audit which they had planned to do in June 2015 but individual audits were undertaken to ensure the quality of the service was  monitored.