The inspection took place on 26 July and 1 August 2018 and was announced. At the last inspection we rated the service overall as ‘Requires improvement’ at this inspection we saw the required improvements had been made.

This service provides care at home to older adults and younger adults living with a range of health conditions and needs to live independently in the community within the Alfreton area. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, thirty people were receiving personal care as part of their care package.

C and S Homecare had a registered manager in post, who was also the owner and provider in partnership with their husband. 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 received a service which was safe. We saw that staff understood how to keep people safe and knew how to report any concerns. Risk assessments had been completed to cover all aspects for people’s care, including any equipment they required to support them when transferring. People received consistent staff who had received the appropriate recruitment checks. Staff knew how to handle medicine safety and to reduce the risks of infection.

The latest guidance was available to support staff to understand specific conditions. Staff had received induction and ongoing training for their role. When people received support with meals this was done through choice and dietary needs. People’s health care was monitored supported in this area when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they had established positive relationships and this made all the difference to the care they received. Respect and dignity had been maintained along with supporting people to remain as independent as they were able to be.

There was a responsive approach to people’s needs. The hours of support were flexible to meet people’s needs on a week by week basis. The care plans were detailed and included information in relation to people’s equality needs and information access. When complaints to the service had been received they were investigated and responded to formally with an apology and an outcome.

The service was supported by a registered manager who understand the regulations and ensured we received notifications and information in relation to these. People’s views had been obtained through a questionnaire and when they received a review of their care.

A range of audits had been used in relation to care plans and medicines management. Staff felt supported and enjoyed working for this provider. Partnerships had been established to support the needs of people’s making the links with health and social care professionals.

This inspection took place on 23 and 26 June 2017 and was announced. C&S Homecare Limited is registered to provide personal care to people living in their own homes. At the time of our inspection, 53 people were receiving personal care.

The service was last inspected on 6 and 7 January 2016, when we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have systems in place to assess, monitor and improve the quality and safety of the service. The provider sent us their action plan, and on this inspection, we found improvements had been made.

The service had a registered manager in post at the time of our inspection, who was present during our inspection. 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 not consistently protected from the risk of avoidable harm. Risks associated with people’s health needs were not always identified to enable appropriate measures to be taken to minimise risk of avoidable harm. The provider’s auditing systems did not identify this shortfall to enable action to be taken. On this inspection, the registered manager took immediate action to address this.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. However, the systems had not identified several issues in relation to the quality of record-keeping. Again, the registered manager took immediate action to address this.

People were happy with staff who provided their personal care. They felt safe and were confident staff had the skills to provide care appropriately. People were cared for by staff who understood how to meet their individual needs, and were supported to access health and social care services when necessary. People were supported by staff in a caring way, which ensured they received personal care with dignity and respect.

The provider took action to ensure that potential staff were suitable to work with people needing personal care. Staff received supervision and had checks on their knowledge and skills. They also received training in a range of skills the provider felt necessary to meet the needs of people at the service. The provider did spot-checks on staff providing personal care to ensure care was of the quality the provider expected.

People received their medicines safely, and staff worked with health and social care professionals to ensure that people received appropriate healthcare and treatment in a timely manner.

People’s rights were upheld in relation to consent to personal care. Appropriate arrangements were in place to check whether people were able to consent to their care. The provider met the legal requirements of the Mental Capacity Act 2005 (MCA).

People were involved in their care planning and delivery. The support people received was tailored to their individual needs and wishes. People and their relatives felt confident to raise concerns in relation to the quality of care. The provider had a complaints procedure to ensure issues with quality of care were addressed.

We inspected C & S Homecare Limited because of concerns we received about aspects of practice at the service. The inspection was focussed on the areas of concern.

C & S Homecare provides personal care to people in their own homes. Care and support is provided to older people, some of whom have dementia, and also people with physical and other disabilities. As part of the inspection we spoke with the registered manager and administrator working at the service and examined records relating to the service provided.

Below is a summary of what we found.

Is the service safe?

The provider was not fully ensuring risks to peoples’ welfare and safety were identified and managed. Risks were not always identified promptly and appropriate action taken for the planning and delivering safe care.

Systems in place for responding to emergencies that could affect the delivery of peoples’ care were not fully sufficient.

The provider was not using appropriate procedures to ensure suitable staff were recruited to provide people with safe and appropriate care.

Is the service effective?

Care plans were in place at the service. Records about people’s care needs did not contain information about any diagnosed health conditions or disabilities.

Some risks that could affect people had not been adequately assessed and managed as part of the care planning process. This meant that care had not fully met people’s individual needs. The way care was planned and delivered did not ensure people were appropriately supported with their medication.

Is the service caring?

Care plans were brief and focussed on care tasks the would be completed by staff. Care planning did not always take account of people’s wishes, preferences and routines relating to their care to ensure they received personalised care that met their needs.

Is the service responsive?

The service has a complaints policy that was made available to people receiving care.

Some systems were in place for obtaining people’s views about the service provided.

Surveys about the quality of their care were sent to people every year but information was not collated and results produced.

The registered manager told us staff were consulted about practice at the service in team meetings but no records were available at the office to confirm this.

We saw systems were not in place to ensure action was taken in response to any incidents or risks that occurred.

Is the service well-led?

The registered manager did not have an effective system for identifying and managing risks or provide an overview of current concerns or areas of development at the service.

Care planning was not adequately detailed to ensure people receiving personalised care that met their needs.

Systems were not adequate for analysing incidents that could cause harm.

This was an announced inspection which took place on 6 and 7 January 2016. We gave the provider 48 hours’ notice to ensure that the registered manager was available for our inspection.

We previously carried out an inspection on 14 July 2014 in response to concerns about the service. On that inspection, we found the service had breached three regulations relating to the delivery of care: Care and welfare of people who use services, assessing and monitoring the quality of service provision, and requirements relating to workers. On this inspection we found that the provider had made some improvements in relation to these breaches.

C&S Homecare Limited is a domiciliary care service registered to provide personal care to people in their own homes. At the time of our inspection, C&S Homecare Limited was providing a service to 46 people, 34 of whom received personal care. C&S Homecare Limited provide personal care to people with a range of health conditions, including physical disabilities, dementia, Parkinson’s disease and diabetes.

The provider employed 27 staff and 26 staff were involved in providing personal care. There was a registered manager in post at the time of our inspection. 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 provider did not have a robust system in place to ensure that the quality of people’s care was audited, and steps taken to improve the service.

Risk assessments were not always in place to enable staff to identify risks associated with people’s care and take steps to minimise them.

There were enough staff available to meet people’s needs, but people did not always receive care at the times they expected. Staff were given an induction, but were not always given the training they needed to meet the needs of people they provided care for. Staff supervisions and appraisals did not always take place as planned.

People were protected from the risk of abuse. Staff understood how to recognise suspected abuse and felt confident to report concerns. The provider had policies and procedures in place to support staff to report abuse or allegations of abuse.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. However, not all staff had undertaken training in the principles of the MCA.

People were supported by staff to access healthcare professionals to maintain their health and wellbeing.

People felt supported by staff who cared for them, and who treated them with dignity and respect.

People knew how to make a complaint, and the provider demonstrated that they investigated, responded and took action to improve the service.

People who used the service, and their relatives, were given the opportunity to share their views on the quality of the service. The provider analysed this feedback to improve the quality of the service. However, the provider’s quality assurance systems did not always identify areas of poor care.

On this inspection we found a breach of Regulation 17 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 the report.