The inspection took place on 24 June 2016 and the inspection announced.

We gave the provider 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their homes; we needed to be sure that someone would be available at the office. A registered provider was in charge when we inspected the service. Registered providers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. This service was not required to have a registered manager in post. The service supported fourteen people with care in their home when we inspected.

People felt safe with staff in their home. People knew the staff supporting them and felt reassured by having regular contact with the same staff. Where people required support to take their medicines, they received support to take these. The provider undertook regular checks to ensure people received their medicines as they should.

People were supported by staff that had access to support and supervision from the provider. Staff felt able to request training should they require support. People felt confident that staff would seek support from other medical professionals if they needed it.

Staff received training that was regularly reviewed and updated. Staff were able to access further training if they required this. People liked and knew the staff supporting them because the same staff regularly attended their calls. Staff had developed an understanding of people’s specific needs over time. Staff spoke with relatives in order to develop a relationship with families to understand people’s needs better. People’s care needs and preferences were known to staff and people felt confident that staff understood their needs. People were given choices about the meals and drinks staff prepared for them.

People’s privacy and dignity were respected in ways that were important and individual to them. Relatives understood the process for complaining if they needed to complain and felt assured their concerns would be responded to. The registered provider had a system for recording and responding to complaints.

People felt comfortable contacting the office and discuss issues important to them and speak with one of the management team. The registered provider undertook some of the calls to people to assure themselves of the quality of care being delivered. They also felt this gave them regular contact with people. People’s records were regularly checked and reviewed. The provider was in the process of improving their record keeping further to help them maintain records that were easier to follow.

Bess Care were providing a service to 18 people.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with the 10 people who use the service, three relatives of people, one member of staff and the registered manager . We also reviewed records relating to the management of the home which included 11 care plans.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Care plans were regularly reviewed. There were effective recruitment and selection procedures. Staff records showed that all staff were trained in the needs of people who used the service. There were enough suitably trained and skilled staff to meet the needs of people who used the service this included training in safeguarding vulnerable adults. The member of staff we spoke with said training was available and it gave them the necessary knowledge and understanding for their role.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person who used the service said, "I have no complaints whatsoever. They do exactly what I need." Another person said, "It's fine, I have no complaints."

Is the service caring?

People were supported by caring staff. People told us they were well cared for by the service and that it adapted to their needs. Family members were invited to help develop the plans of care.

Is the service responsive?

People’s needs had been assessed before care started. Complaints were dealt with well and people knew how to make complaints. The people we spoke with all confirmed care plans were available in their homes and told us that they had been involved in their development.

Is the service well-led?

The service had a system in place to obtain the views of people using the service. There was a system for recording formal and informal complaints. Staff were subject to spot checks.

We carried out this inspection to review the care of people who used the service. At our last inspection in January 2103 we found that improvements to the service were required. Following this the provider sent us an action plan on how improvements were to be made. We reviewed this as part of this inspection.

Bess Care were providing a service to 16 people. We spoke with three members of staff, the registered manager and the care manager. Following the inspection we spoke with six people who used the service and three family members.

The people we spoke with were complementary of the staff. We were told care staff were courteous, polite and they treated people with respect. One person who used the service said, “The staff are very nice. They are very polite, I have no complaints”.

Copies of care plans that were kept in people’s homes were available in the office. The staff we spoke with told us care plans gave them the necessary information for the delivery of care. The people we spoke with all confirmed care plans were available in their homes and they had been involved in their development.

We asked staff about the training provided by Bess Care, this included safeguard training (protecting vulnerable adults). All of the staff we spoke with said training was available and it gave them the necessary knowledge and understanding for their role.

People who used the service and family members we spoke with said they were asked for feedback regarding the quality of the service provided.

We had previously inspected this service in August 2012. During this inspection we had identified non compliance in three areas. The provider had produced an action plan. We carried out this inspection to review the action plan and to check on the care and welfare of people using this service.

During the inspection we looked at staff training. The training matrix identified that 50% of the staff employed at Bess Care had received training in safeguarding (protecting vulnerable adults). During our last inspection the staff we spoke with, although not all trained, said they knew what to do if they had any concerns that people may be at risk of abuse. The provider informed us that the remaining staff were scheduled to receive training in February 2013

Annual appraisals for staff were not in place. A system had been introduced for staff supervisions. Only two of the 13 staff employed at Bess Care had received supervisions or one to one meetings with the manager.

We were told the manager talked to people using the service and their families regularly in order to gain feedback directly on the quality of the service. A formal system was in place for collecting feedback from people using the service.

Following the visit we contacted eight people who used the service, family members and spoke with four members of staff. The people we spoke with were generally happy with the quality of support they received. People told us that they had regular care staff and knew what time to expect them. Staff confirmed they regularly visited the same people, some staff said they would call ahead if they were running late. We looked at care plans which gave staff the necessary information to deliver care.

Few staff working at the service that had received training in protecting vulnerable adults from risk of abuse. All the staff we spoke with, although not all trained, said they knew what to do if they had any concerns that people may be at risk of abuse. They agreed they could raise concerns with the manager and senior staff and that their concerns would be listened to.

We viewed some staff files during our visit and found that the organisation had a suitable process for recruitment. The manager told us all staff employed by Bess Care where subjected to appropriate checks prior to commencing their role. Gaps had been identified in staff supervisions and training.

There was no formal system in place for collecting and evaluating feedback from people using the service. We were told the manager talked to people using the service and their families regularly in order to gain feedback directly on the quality of the service.