Better Healthcare Services (Ipswich) provides a personal care service for people living in their own homes. At the time of this announced inspection of 29 September 2017, there were ten people who used the service. We gave the service 48 hours’ notice of our inspection to make sure that the manager was available to facilitate the inspection.

At our last inspection of 2 March 2015, the service was rated Good. At this inspection, we found the service remained Good.

There was a manager in post at the time of our inspection, but they were not registered. They had submitted their application to become the registered manager and were awaiting their fit person interview. 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 service continued to provide a safe service to people. This included systems designed to minimise the risks to people, including from abuse. There were enough staff to cover people’s planned care visits. Robust recruitment procedures were in place and contributed to protecting people from unsuitable staff. Where people required support with their medicines, this was done safely.

Staff were trained and supported to meet people’s needs. Staff understood the principles of the Mental Capacity Act 2005. Staff supported people to have maximum choice and control of their lives and staff cared for them in the least restrictive way possible, the policies and systems in the service supported this practice. Systems were in place to enable people to eat and drink enough, where they required help to do this. People were supported to have access to health professionals if they needed this support.

Care staff had good relationships with people who used the service. Staff listened to and acted upon people’s views about how they wanted to be supported.

People received care and support that was planned and delivered to meet their individual needs. A complaints procedure was in place and complaints were dealt with and used to improve the service.

There was an open and empowering culture throughout the service and quality assurance systems supported the management team to identify shortfalls and address them promptly. As a result, the quality of the service continued to improve.

Further information is in the detailed findings below.

Better Healthcare Services (Ipswich) provides personal care support to people living in their own homes. When we inspected on 2 March 2015 there were 30 people using the domiciliary care service. This was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service.

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.

There were systems in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Care workers understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

There were sufficient numbers of care workers who were trained and supported to meet the needs of the people who used the service. Care workers had good relationships with people who used the service.

Where people required assistance with their dietary needs there were systems in place to provide this support safely. Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

People or their representatives, where appropriate, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

Care workers understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed. As a result the quality of the service continued to improve.

We did not speak with the people who used the service during our inspection.

The purpose of this inspection was to check that improvements had been made following our inspection of 17 June 2013. This told us that the service had responded to our concerns in a timely manner.

During this inspection we found that improvements had been made. Staff recruitment records that were seen showed that the appropriate checks were made to ensure that people who used the service were protected by the provider's recruitment procedures and processes. People were provided with care and support by care workers who were trained and supported to meet their needs safely. Processes were in place to monitor and assess the service that people were provided with.

We spoke with six people who used the service who told us that they were happy with the service they were provided with. One person said, "I get on very well with them (care workers). They are all very good." Another person said, "I have never had cause to worry about them." Another said, "They are quite good really." Another said, "I get regular carers, they always turn up and never let me down. I am very pleased."

We spoke with four people's relatives who told us that they were satisfied with the service that their relatives were provided with. One person's relative told us, "The carers are brilliant." Another person's relative said, "My (person) has regular carers, (person) gets on really well with (care worker)." Another person's relative told us that when they had raised concerns with the service, actions were taken to address their concern.

We looked at the care records of 10 people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.

There were enough qualified, skilled and experienced staff to meet people’s needs. We saw the recruitment records of 13 care workers and found that the recruitment processes did not provide robust checks on the conduct of care workers in their previous employment to ensure that people were supported by care workers who were suitable to work with vulnerable people. We also found that care workers were not provided with adequate levels of supervision.

We had the opportunity to talk with three of the people who use the service. All of the people we spoke with were happy with the care they received. They told us that they were supported in the way they wanted to be and were able to make their own minds up about the decisions they took regarding their care. They were complimentary about the people who supported them.