Care 1st Homecare 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 adults of all ages.

Not everyone using Care 1st Homecare receives regulated activity; 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.

People continued to be kept safe and risks were minimised. Staff knew what actions to take to protect people from abuse. There continued to be suitable systems in place to identify and manage risk. Regular assessments had been carried out. Care records were in place which clearly set out their individual needs and preferences.

Visits were well planned and staff supported people in sufficient numbers to meet their needs and keep them safe. People were supported to manage their medicines safely.

Staff were properly trained and had their skills regularly checked. Staff had the competency and understanding to ensure people received the care and support they required. Staff knew how to provide this in the way people wished to be supported.

People were supported to maintain good physical health and wellbeing. People were assisted to access health care services when they needed them. People were asked for their consent before any care was given and were encouraged to make decisions and choices in their daily life.

People had a clear and informative care plan in place; a copy was kept in the person's home and at the office. The care plans provided useful guidance about each person's care needs and were updated regularly to make sure they were accurate and up to date. The people we spoke with also said an initial assessment was completed when they first started using the service. This enabled staff to be clear about the level of care people needed.

People were sent satisfaction questionnaires to find out their views of the service. This enabled the service to continually improve based on feedback from people and anything that could be changed. There was a range of quality checking processes in place. These were to monitor and improve the service.

Staff told us the management was approachable, responsive and listened to any ideas for areas of improvement.

We carried out a focused unannounced inspection of Care 1st Homecare on 20 July 2017. Prior to this inspection, we had received allegations of concern about the health, safety and welfare of people using the service.

We undertook this focused inspection to ensure that people using the service were safe, and receiving a service that effectively met their needs. This report only covers our findings in relation to these areas. When we last inspected Care 1st Homecare, in April 2016 we rated the service as ‘Good’. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Care 1st Homecare on our website at www.cqc.org.

Care 1st Homecare provides personal care to people in their own homes. We gave the service 48 hours' notice of the inspection. This was to ensure that people who used the service were available to meet with us. It was also so that the registered manager and staff would be available to speak with us. At this inspection we found the service remained Good.

There was a registered manager for the service. 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 protected from harm because the provider had systems in place to minimise risks to them from abuse. People spoke very highly about the staff who visited them. People told us the staff were always kind and caring towards them. People and relatives also said that staff interacted in a positive and warm way towards them.

People were supported with their care needs by a team of staff who were properly monitored and supervised at work. People further benefited because they were supported by staff that had been well trained to understand how to provide effective care that met their needs.

We undertook an inspection on the 13 April 2016 and called people who used the service and relatives the following day. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. The last full inspection took place on 7 January 2015 and there were no breaches of the legal requirements. The service was rated as 'requires improvement'.

Care 1st provides personal care to people living in their own homes in the Bristol and South Gloucestershire area. At the time of our inspection the service was providing personal care and support to approximately 300 people.

The provider is also the 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.

Medicines were generally managed safely but there were areas of administration which required further development.

The service used the CM2000 system which is a database which allows the service to electronically monitor calls. Between the period of 14 March and 3 April 2016 the service made 8060 calls out of 8065 planned calls. 81.45% of calls were made within 30 minutes of the planned time. 49.71% of actual visits made were equal to or in excess of the planned time. This meant that people were not receiving the appropriate allocated time.

The provider operated safe recruitment procedures and ensured all pre-employment requirements were completed. Staff had received appropriate training to identify and respond to suspected abuse.

Staff received training to enable them to carry out their roles. Staff spoke positively about the training they received and felt they were able to provide good care as a result of the training. An induction process was completed by staff newly employed at the service.

People in the main felt they received good care from staff and that staff were confident and knowledgeable when providing their care. Some concerns were expressed regarding communication difficulties where English was not the carer’s first language.

People’s rights were being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

Records showed that staff liaised with other healthcare professionals when it was appropriate to do so. This helped to ensure that there was good communication and sharing of information about the person’s care needs.

People generally spoke positively about the staff and told us they were caring, kind and compassionate.

People told us the service was in the main responsive to their needs. People said they generally saw the same staff, except at times of holiday or sickness. They appreciated this continuity and the consistency of care it provided. In most cases we saw that there were systems in place to ensure that staff were matched to the needs of the person they supported.

There were systems in place to respond to complaints and this was set out in a written policy. We saw that the concerns outlined in the complaints had been responded to comprehensively and with openness and transparency, Apologies were made when the service had not performed as expected.

There were systems in place to monitor the quality of the service provided by the agency. To ensure continuous improvement where issues of concern have been identified by the service such as punctuality and an increase in complaints the management team has a service improvement plan in place. The plan identifies the actions they need to take; what does completion look like; the responsible officer and timescale for completion. We noted that actions taken inclu

We carried out an announced inspection of this service on 7 January 2015. 48 hours notice was given of this inspection. This was to ensure that the registered manager was available. The last full inspection took place in May 2014 when two breaches of regulations were found. We returned to the agency in September 2014 and found that action had been taken and the regulations were being met.

Care 1st is a large domiciliary care agency that operates in Bristol and South Gloucestershire. The agency provides a service to approximately 300 people in the region who require personal care.

A registered manager was in post at the time of the 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 and associated Regulations about how the service is run.

People received effective support from staff who were trained and whose performance was monitored. Staff worked with other healthcare professionals when required to ensure that people were supported in a way that met their needs. However people reported that communication was inconsistent when care staff were running late. The impact of this varied for people, but for some this led to anxiety and worry.

People told us they felt safe in the company of staff from the agency. Staff had received training to help them identify the signs of potential abuse and told us they would feel confident and able to report any concerns.

There were risk assessments in place to ensure that people were cared for in a safe way. These included guidance for staff on people who may be a risk of self neglect or malnutrition.

There were systems in place to support people with their medicines safely. Changes had recently been made to improve how medicines were administered. A member of staff had been recruited with specific responsibility to review people's support in relation to medicines.

Where people required support with their meals, information about their likes and preferences were included in their support plans.

Staff recorded in daily notes when meals had been provided for the person. Staff were aware of the Mental Capacity Act 2005 and received training in this. Procedures were in place to make best interests decisions on behalf of a person who lacked capacity when necessary.

People reported that staff were kind and caring. People had opportunity to contribute and voice their opinions about the care they received. People told us that they were treated with dignity and respect.

Support plans were in place to guide staff in meeting people's needs. These were regularly reviewed to ensure they were up to date and amended when a person's needs changed. People were positive about the care they received.

There were systems in place to respond to complaints. We saw examples of formal complaints that had been responded to with transparency and promptly.

The service was well led, however improvements could be made. There were systems in place to monitor the quality of the service, however these did not always give accurate information about the number of missed visits and the impact they had on people. There were clear expectations in place about the standards expected of staff. Disciplinary procedures were in place to manage staff who had fallen short of the standards expected of them.

During our inspections we set out to answer a number of key questions about a service: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During this inspection we looked at the arrangements being made for safeguarding people who use the service and for medicines. This helped us to answer the question ‘Is the service safe?’

Is the service safe?

At our inspection in May 2014, we found that people weren't fully protected from the risks of abuse because recording of incidents was not always accurate. Notifications were not always made to the Care Quality Commission when they should be.

We returned to the service in September 2014 and found that improvements had been made. Staff had received training in when incidents would need to be reported and the procedures for managing safeguarding incidents had been discussed in a staff meeting. We viewed recording of incidents that demonstrated staff had acted promptly in response to concerns about people they supported.

At our inspection in May 2014, we also found that people were not fully protected in relation to the management of medicines due to the way in which medication was being recorded. When we returned to the service in September 2014, we found that improvements had been made. Paperwork had been reviewed so that it was easier to use and staff were receiving refresher training in medication to reduce the risks of errors occurring.

As part of our inspection we spoke with 12 people directly about their experiences, or the experiences of their relatives. We also received feedback questionnaires from 16 people who used the service and 14 friends or relatives. Overall, the feedback we received suggested that people were satisfied with the care and support they received. We did hear some individual concerns about communication difficulties with the office and occasional late visits. These individual concerns were fedback to the manager.

We viewed a sample of five people's care files and saw that care plans were in place for a variety of needs. Brief risk assessments were in place, and senior staff had identified that improvements were required in this area. We viewed the new paperwork that was to be used.

People reported feeling safe in the company of care staff. Staff were aware of their responsibilities to safeguard people they supported and had received training in this area. Staff told us that they were well supported and received training to support them in their roles.

There were systems in place to monitor the service and this included gathering the views of people using the service and acting on complaints and concerns.

This inspection was undertaken by an Adult Social Care Inspector and a Pharmacist Inspector. We looked at five standards during this inspection and set out to answer these key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our visit to the office, two home visits when we met with the people who used the service and with members of the staff and management team. Please read the full report if you want to see the evidence supporting our summary.

Is the service caring?

People that we spoke with as part of our inspection told us that they were happy with the support they received from the agency. We received a number of positive comments in relation to staff such as “very knowledgeable and pleasant people” and “most of the girls are brilliant”.

We visited two people in their homes and saw that they appeared at ease in the presence of care staff. Staff were respectful and interacted pleasantly.

Is the service responsive?

The provider had systems in place to manage complaints and we saw examples of some that had been responded to appropriately. People who used the service and their relatives told us that they felt able to bring any concerns to the attention of staff and these were acted upon. One relative commented “I do feel I can pick up the phone and speak with a coordinator”. Another person told us about problems they’d had at the beginning of their care package with care staff not always attending. These issues had been discussed with the agency and subsequently resolved.

We saw records of staff calling the office for further advice when they were concerned about a person they were supporting. This had led to other professionals being contacted to ensure the welfare of the individual.

Is the service safe?

Staff that we spoke with told us that they had training to help them carry out their roles. This included elements of their role such as moving and handling and safeguarding. This would help ensure that people who used the service were safe. Staff told us that they felt able to request further training if needed and gave examples when such requests had been acted upon promptly.

People that we spoke with told us they felt safe with the staff who came to support them and trusted them. We visited two people in their home and saw that staff were respectful and polite in their manner.

Staff confirmed that a supervisor would occasionally attend one of their appointments with them to carry out a ‘spot check’ (an unannounced visit) in order to check how they were performing. We viewed records of these visits in staff files.

We found that people weren’t fully protected from the risks associated with medications because the provider did not have appropriate arrangements in place for the recording of medicines.

Is the service effective?

People’s packages of care were reviewed regularly to ensure that they were meeting the person’s needs. These reviews allowed people to give their opinions on the care they received and for the agency to make changes as required.

Is the service well led?

There were systems in place to monitor the quality and safety of the service provided. This included an ‘office audit’ that looked at a sample of care records to see that all necessary information was present.

The provider used computer data to monitor the level of missed visits and to ensure that these were accounted for with an explanation.