Care 4 U - 466 Melton Road is a domiciliary care agency providing personal care for people in their own homes. The service provides personal care for older people and younger adults. At the time of the inspection, the branch manager stated 80 people were provided with personal care from the service. This was a comprehensive inspection.

The inspection took place on 14 and 18 September. The inspection was announced because we wanted to make sure that the registered manager was available at the time of the inspection.

At our last comprehensive inspection in May 2016 we rated the service as 'Good'. On this inspection improvements were needed to ensure that people were comprehensively safe, that the service was effective, responsive and that quality assurance systems were effective in driving improvements in the service. Because of these issues, the overall rating for this inspection has reduced to 'Requires Improvement.'

A registered manager was in post. This is a condition of the registration of 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 and associated Regulations about how the service is run.

We identified concerns about a number of issues. A requirement notice has been issued due to a breach of regulation in relation to the service not meeting the requirement for good governance.

Staff was not deployed in a way that would always provide people with the safe personal care they needed. Risk assessments were not always comprehensively in place to protect people from risks to their health and welfare.

Not all staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives.

Staff had largely received training to ensure they had skills and knowledge to meet people's needs, though training on a number of other relevant issues had not yet been provided and an effective check on whether staff were competent following training was not always in place.

Care plans did not always contain detailed information individual to the people using the service, to ensure that their needs were always met.

People and relatives were not always confident that concerns had been followed up. They were not always satisfied with how the service was run.

Some staff members said they had not been fully supported in their work by management.

Management had not carried out comprehensive audits to check that the service was meeting people's needs and to ensure people were provided with a quality service.

People and relatives told us that most staff were friendly, kind, positive and caring and said they had been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans were available to people and staff, which helped to deliver a service to meet people’s care needs.

Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

Most people and their relatives told us that they thought staff provided safe personal care.

Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

People and relatives told us that medicines had been supplied so that people could take their medicine safely.

We carried out this inspection on 21 January 2016.

At the time of our inspection there were 60 people using the service.

Care 4 U – 466 Melton Road (referred to as Care 4 U in this report) is a domiciliary care service providing care and support to people living in their own homes. The service provides care and support to people living in Leicester and Leicestershire. The service specialises in supporting older and younger adults including people with dementia, learning disabilities, mental health needs, physical disabilities, and sensory impairments. Care 4 U’s offices are situated in Leicester and have level access and on-site parking.

The service had two registered managers. These are people who have registered with the Care Quality Commission to manage a 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 using the service and relatives said the staff had a caring approach and valued the people they supported. They worked with people in a caring way and provided them with company and conversation if people wanted this. Where possible people had regular staff who they had the opportunity to get to know.

The service had an established staff team. Some staff members had worked there for a number of years. This meant that people had continuity of care and could get to know the staff who supported them. Staff were punctual and stayed for the time they were meant to. If people needed two staff to support them to ensure their needs could be met then these were provided.

Staff knew what to do to minimise risk to the people they supported. They followed risk assessments and took expert advice in order to keep people safe. They also used their initiative if new situations arose where they had to protect people from harm.

All the staff we spoke with were enthusiastic about working for the service and dedicated to the people they supported. Records showed they were safely recruited and had the skills and knowledge they needed to provide effective care.

People using the service and relatives told us they were satisfied with the way staff prepared and served food. Staff supported people to choose their meals and made sure they had plenty to drink. If people were on particular diets staff made sure these were followed.

Staff supported people to stay healthy and access healthcare services if they needed to. They had a good understanding of the medical needs of the people they supported. Staff took prompt action if they were concerned about the health of people they were supporting.

People using the service and relatives told us staff arrived on time and stayed for the full duration of their calls. Staff told us they learnt about people’s needs by reading their care plans and discussing them with the people they supported. Care plans were personalised and told staff how the person using the service wanted their care provided.

The service provided care to some people whose first language was not English. Records showed that their communication needs were met, where possible, by multilingual staff who were knowledgeable about local cultures. This helped to ensure that the service provided appropriate care to people from black and minority ethnic backgrounds.

The service had an open and caring culture. People using the service and relatives spoke positively about how it was managed. Staff told us they liked working for the service and felt valued as employees.

All aspects of the service were audited by the management team to help ensure it was running smoothly. The service was subject to continual improvement. People using the service, relatives, and staff were encouraged to share their views on the service. The management team listened to people and acted on what they said, making changes where necessary.

We recently undertook an inspection visit to Care 4 U - 466 Melton Road. We spoke with five people who used the service and reviewed five people’s care records. We spoke with three relatives of people who received care and support from the service. We spoke with four staff supporting people and reviewed their training records. We also reviewed the records in relation to the management of the service. We considered all the evidence we had gathered under the outcomes we inspected.

Is the service safe?

People who used the service told us that they felt safe with the care staff who supported them. They were confident that the care staff were trained to look after them. One person said “I’m quite happy with my carers and I have no complaints.” Another person explained that they were supported by a team of care staff because they needed several calls each day, said “I feel safe with my carers, they know what to do especially as I’m an expert in being hoisted.”

Relatives we spoke with also praised the care staff that looked after their family member. One relative whose family member had only recently started to use the service told us that they found the care staff were caring. They said, “So far it’s good, … [person using the service] really likes him [care staff], he’s always on time and does everything that’s needed.” Another relative said “As a family we know she [person using the service] is safe now and she can continue living in her own home.”

Care staff we spoke with showed a good understanding of each person’s needs and how they wished to be supported. Support plans and risk assessments were personalised and provided the care staff with the guidance to help keep people safe.

Is the service effective?

People told us they were satisfied with the care and support they received. One person explained that they had used this service for many years and were supported by a team of regular care staff. Another person said, “It’s a very good service. The times are flexible to suit me and the carer knows what to do.”

People’s care needs were identified and measures put in place to minimise risks. People’s care was reviewed regularly to help ensure any new needs could be met properly and risks managed. Care records and staff training records we looked at showed that people’s care needs were met by trained staff.

Care staff understood the needs of people they supported. They received up to date information about people’s needs and could refer to the up to date support plans kept in people’s own homes.

Care staff told us they were well supported and were trained to deliver care and support safely. Practical training was provided in the use of specific equipment to help support people, such as a hoist and a stand aid amongst others. Personal protective equipment was available for care staff to use including disposable gloves and aprons. This helped to ensure care and support provided was in line with the infection control procedures and protected the health, safety and wellbeing of everyone.

Is the service caring?

People told us that they were happy with most of the care staff and the support they received. They found care staff were kind, caring and that they were treated with respect. One person said, “Most of my carers are very caring. There was one that I was unhappy with and the office stopped sending her when I told them.”

Relatives also expressed no concerns about the care staff or the support provided to their family member. One relative said, “He [care staff] is very caring towards my …. [person using the service] and you always hear them both laughing, which is a good sign.”

Is this service responsive?

People’s needs had been assessed before the care arrangements started. This helped to make sure that the service would be able to provide the care and support they needed. People’s care needs were regularly reviewed to help ensure any new needs would be met reliably.

The provider had systems in place to support care staff and people who used the service in the event of an emergency. An ‘on-call’ service operated outside of the normal office hours, which meant that a manager or a senior staff member was available to support staff and to deal with any queries that arose.

Is this service well led?

People received a ‘service user welcome pack’ that included a copy of the provider’s statement of purpose. These documents explained the aims and objectives of the service, what people could expect from the service themselves and how to make a complaint. This helped to assure the provider that people were fully informed about the service.

The provider had a range of systems in place to assure themselves that the quality of care and support provided was monitored. Audits and checks were carried out routinely. The provider took account of all complaints, compliments and learnt lessons from incidents to help prevent it from happening again. Satisfaction surveys had been used. This provided people who used the service and their relatives with an opportunity to share their views about the support they received and enabled the provider to monitor the quality of service being provided.

Care staff received support to carry out their job role effectively, safely and reliably because they were trained. Care staff were confident to approach the manager if they had any concerns. A care staff explained that they were new to care work and found the training was valuable to enable them to be confident to provide the care and support people needed. They said “It’s so nice to get positive feedback from people because you’ve made a difference to their life.”

We spoke with five people who used the service, two relatives, two carers, and two managers as part of our inspection.

People we spoke with told us they were satisfied with the care and support being provided and that their choices were respected. Staff had a good understanding of the needs of people who used the service and said they felt valued and supported in their roles. People we spoke with were complimentary about the carers and office staff and felt comfortable with the care being provided.

We looked at the records of five people who used the service and found care plans provided clear guidance to carers about how the persons’ care should be delivered. The provider may find it useful to note that moving and handling risk assessments were not always updated to reflect changes to the person’s needs.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people and we found there were sufficient numbers of suitably experienced and trained staff to meet the needs of people using the service.

The service had an appropriate quality assurance system.

We spoke with people who use the service and asked them about the care they received. People we spoke with were positive about their experiences. They said they knew which carers were coming and that they were always on time. People also said that carers were aware of what care and support they required and were able to support them in a way that met their needs. People said that the communication from the office was excellent and they were always kept informed of any changes.

We looked at feedback from people using the service that had been obtained from an annual questionnaire. This asked people for their views and comments about the service received. Most comments were positive and included: - “I have been very pleased with the service provided by Care 4 U staff” and “very happy with service provided, steady improvements being made”.

We found that the service was compliant with the essential standards of quality and safety that we inspected.