The inspection took place on 11 and 12 September 2018 and was announced.

Candlelight Homecare Services Wimborne area office is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Not everyone using the service receives a regulated activity; the 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.

The service was providing personal care to 35 people living in their own homes.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to if abuse was suspected.

Staffing levels were sufficient to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults.

When people were at risk staff had access to assessments and understood the actions needed to minimise avoidable harm.

The service was responsive when things went wrong, were open and reviewed practices and had a robust system in place to manage incidents.

Medicines were administered and managed safely by trained and competent staff. The registered manager carried out monthly audits of Medicine Administration Records (MAR).

People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as nurses, doctors, occupational therapists and social workers.

People were supported to have maximum choice and control of their lives and the policies and systems in the service together with staff understanding supported this practice.

The registered manager actively sought to work in partnership with other organisations to improve and nurture positive outcomes for people using the service especially within the community.

Care and support was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. Staff felt supported by the registered manager and the company.

People, their relatives and professionals described the staff as caring, kind, and compassionate. People were able to express their views about their care and felt in control of their day to day lives.

People had their dignity, privacy and independence respected and staff understood their responsibilities in relation to this.

People had their care needs met by staff who were knowledgeable about how their individual preferences.

The service had an effective complaints process and people were aware of it and knew how to make a complaint. People and their relatives told us they felt confident their concerns would be addressed. The service actively encouraged feedback from people.

Relatives and professionals had confidence in the service. The service had an open and positive culture.

Leadership was visible in the service and promoted inclusion. Staff spoke positively about the management team and felt supported by them.

There were quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and those responsible kept things up to date.

The service understood their legal responsibilities for reporting and sharing information with other services.

The inspection took place on 2 March and was announced. The inspection continued on 7 March 2016.

Our last inspection on 29 January 2015 found that people were at risk of harm as risk assessments were not completed to identify how risks could be minimised. We found that appropriate systems were not in place to gain and review consent from people who used the service in line with the Mental Capacity Act 2005. During this inspection we found that improvements had been made.

The service provided personal care to 33 people in their own home. There was a central office which had three separate offices, a training room, toilet and small kitchenette.

The service had a registered manager in place. 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, relatives, staff and health professionals told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding adults.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they choose to live their lives. Each person had a care file which also included individual assessments and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example nutrition, catheter care and stroke and Parkinson’s. We noted that the majority of staff were due a refresher in manual handling. The registered manager told us a session had been arranged and that staff due for refresher were booked onto this.

Staff told us they received regular supervisions and appraisals which were mostly carried out by the registered manager. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions; I find them useful and two way. Good opportunity to give and receive feedback”.

People had a capacity assessment in place and care files we reviewed showed evidence of best interest meetings taking place. Staff were aware of the Mental Capacity Act and training records showed that they had received training in this.

Some people are supported with cooking and preparation of meals in their home. We saw that peoples food and fluid intake was recorded in the files where appropriate. The training matrix showed that staff had attended food hygiene training.

People were supported to access healthcare appointments as and when required and staff worked followed GP and District Nurses advice when supporting people with on going care needs.

People and relatives told us that staff were caring. During home visits we observed positive interactions between staff and people.

A health professional said, “Staff are caring and mostly involve the person in decision making. They explain and talk to the person. There is an element of just getting to know the people first”. Another health professional fed back that Peoples choices and wishes were respected. They gave us an example where a carer had visited a person in their home who was not feeling well and did not want a bath that day. They said that the carer had listened to the person and respected their wishes and dignity.

Staff we observed treated people in a dignified manner throughout the course of their visit. Staff had a good understanding of people’s likes, dislikes, interests and communication needs.

People

We found systems and safeguards to ensure people experience appropriate care and support and to protect their human rights were not in place.

We found records were maintained about people's care and improvements had been made to ensure that care provided to people was always recorded effectively.

People who used the service and their representatives told us staff were reliable, generally arrived on time and provided the care and support that they needed. One person's representative told us, "We can rely on the carers." Another person told us, "Nothing is too much trouble."

Our inspection of 10 September 2012 found that people were cared for by staff who were not supported to deliver care and treatment safely and to an appropriate standard.

During this inspection we found that improvements had been made.

People told us that they thought staff were well trained and staff told us that they received sufficient support.

Staff received supervision, spot checks and appraisals. The majority of staff were up to date with training.

We asked people about their care and feedback relating to the care staff was mixed. One person told us that they were happy with some staff. People told us that there was nothing wrong with the care staff, that they were professional but that it was the managers. People did not think that all of the staff were trained.

Two people told us that some of the care staff were very good but some did not understand their needs. We were told that some staff wanted to help however when they asked other members of staff to help they did not cooperate. One person told us that they were “Happy with some staff but they do not seem to be able to keep their staff”.

People told us that they were not involved in their care planning however one person told us that they were.

People told us that the staff had missed visits, were often late and did not always stay the full length of time. They told us that they did not get a choice about what time they were visited and that the people who came were always different. One person said that they were disgusted by the service.

We spoke with people about making complaints. One person told us that they could not make a complaint because of their physical difficulties. Another person told us that they would not complain about the care staff but there were things they could complain about. One person told us that “It does not make a difference if you complain to Candlelight”.

We spoke to a person who was receiving a domiciliary care service and the family carers of two other users of the service. They each told us they were involved in agreeing the nature of care that was provided, and duration of visits. We spoke with one person in receipt of re-ablement support. They had agreed their goals for re-ablement and felt in control of the service they received. They said visiting care workers worked with them on developing their skills and respected their independence.

All the people we spoke with told us staff showed respect for their privacy and dignity in providing personal care and generally during visits. One person said “they always ask if I’m happy and if they can do any more”.

One person told us they considered some staff could use more conversation to show empathy. Another person told us staff always included chat in their visits and showed interest in their life. In a newsletter to all staff we saw guidance on use of conversation as part of providing care.

People told us that care workers were competent in carrying out the tasks required by their care plans. One person described the attention all staff showed in supporting their meal times as they preferred. People told us they saw staff referring to their care plans.

A person using the re-ablement service told us they saw the service as promoting their safety. People were satisfied with the arrangements made for protecting the security of their homes.

All the people we spoke with told us they received details in advance of planned visit times. They had different experiences of reliability of visit times. They usually received a phone call if their expected visit was going to be late.

We heard and saw evidence of people having made complaints about aspects of delivery of their care service. The service could not demonstrate that complaints were dealt with in a consistent way.

A single 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?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe receiving care from the agency. For example, one person commented, “I always feel very safe with them. There is no situation where I don’t feel safe.”

Staff were able to describe how they provided people's care in a way that ensured their safety. For example, they told us that they were aware of risks to people's welfare and knew what to do in the event of an emergency. There was regular communication between the agency and people's relatives to ensure people were safe in their own home.

Is the service effective?

The agency provided effective support to people who used the service. They did this by ensuring people received reliable care that, on the whole, met their needs and preferences.

People who used the service had confidence that care workers knew what they were doing and had the right skills, knowledge and experience to meet their individual needs. For example, one person told us, "They are all very good", while another person described how staff understood their preferred routine and followed this each day. This helped ensure they received care the way they wanted.

Staff told us they received enough information about people's needs and how to meet them. They told us that any changes in people's needs were communicated to them promptly which meant they were able to provide effective support.

Although records were maintained about people's care, we identified that some improvements were needed to ensure that care provided to people was always recorded effectively.

Is the service caring?

People who used the service spoke highly about their care workers. They told us that staff were kind, cheerful, helpful and considerate. They also told us that staff would always offer to do more for them, if required.

The staff we spoke with during our inspection clearly enjoyed their work and spoke with great affection about the people they visited. They were able to tell us about people's needs and preferences and how they ensured care was tailored to each person.

Is the service responsive?

The agency responded to changes in people's needs. We saw that the agency communicated with people's relatives about their welfare and contacted their GPs or the emergency services when they were unwell. This helped ensure that changes in people's health were identified and met.

We found that the agency was responsive to people's requests for changes in their visit times and schedules. For example, if people had asked not to receive their care from a particular care worker we found there were systems in place to ensure this was followed through. If people wanted a change in visit times we saw that the agency had tried to accommodate this. This helped ensure that people's preferences were taken into account in the provision of their care.

Is the service well-led?

We found that improvements had been made to the running of the agency since our last inspection. Staff had been recruited into management and care worker positions and their responsibilities were clearly defined. The changes made had resulted in people receiving a more reliable service that met their needs. People who used the service and staff commented positively on these improvements and told us that things were running more smoothly now.

There was a clear management structure at the agency. Although, at the time of our inspection, the agency did not have a manager who was registered with the Commission, an application had been submitted and was being processed. People who used the service were aware who to contact if they had concerns and told us that there was always someone available for them to speak to about any issues that arose. Staff also told us that managers were approachable and were always available on the telephone for advice and support. This helped ensure that people who used the service, and staff, received the support they needed.

The agency had systems in place to ensure that action was taken in response to incidents or complaints. We saw that incidents and complaints were recorded and followed up by the manager to ensure people were safe and improvements were made. There were also systems in place to cascade information to care workers to ensure that they were aware of any changes to the service and were able to provide appropriate care.

There were some procedures in place to obtain feedback from people who used the service and staff about their experience. We saw examples of how the agency had listened to people's views and taken action to improve. The company's quality assurance manager told us that a formal survey to obtain the views of people who used the service would be carried out in the autumn. This would help ensure that the company had a clear overview of the agency's performance and could use people's feedback to plan its development.