This inspection took place on 14 October 2016 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because we wanted to make sure staff would be available to answer any questions we had or provide information that we needed. We also wanted the provider to ask people who used the service if we could contact them. At our last inspection in May 2014, we found that the service was fully compliant in the areas we inspected.

The service is registered to provide personal care and support to people in their own homes. At the time of the inspection the service was providing support and personal care to 69 people in their own homes.

As there is an individual provider for this service, there is no need for a registered manager. It is the responsibility of the individual provider to demonstrate the competency required to carry on the regulated activity and to manage it where there is no 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.

The day to day running of the service was carried out by the care co-ordinator.

People felt safe when staff entered their home and were confident that staff knew how to support them. Staff were aware of how to keep people safe and were aware of the risks to people.

People usually received their care on time and told us if staff were running late they were notified of this.

Recruitment processes were in place in order to reduce the risk of suitable people being employed by the service.

Staff were provided with the training and information required in order to support people to take their medicines safely.

Staff understood the importance of obtaining people’s consent prior to supporting them but not all had received training in the Mental Capacity Act (2005).

People were supported by staff who felt well trained and supported in their role.

Staff were aware of people’s dietary requirements and support was provided for those people who required it. Staff were aware of people’s healthcare needs and supported people to access healthcare services where necessary.

People spoke positively about the staff who supported them and described them as kind and caring. Staff supported people in a way that maintained their privacy and dignity and encouraged them to maintain their independence. People were involved in the planning of their care and were supported to make their own decisions.

People’s care records provided staff with the information they needed regarded people’s likes, dislikes, preferences and personal history. Staff were aware of what was important to people and how they liked to be supported. Efforts were made to accommodate any changes in people’s packages of care and to provide flexible support.

There was a complaints process in place and people were confident that if they did raise any concerns, that they would be dealt with appropriately.

People and staff spoke positively about the service and considered it to be well led. Staff were encouraged to raise any concerns they may have and felt supported in their role.

The provider was not aware of their responsibilities with regard to notifying the commission of events they are required to by law. Audits took place but had failed to identify that risk assessments were not updated in a timely manner.

On the day of our visit we spoke with three staff and the provider. Following our visit we spoke with ten people using the service, and six staff on the telephone.

People told us that their needs were being met. One person told us, "I have no worries about the service I get the staff are lovely’’. Another person told us, Staff are very polite and help me with what I want which is important’’. This meant people's care was provided to them as they wanted.

People’s care and health needs were planned and met in a personalised way. All staff spoken with told us they had the information they needed to care for people because they always asked them how they wanted their care. This meant people were involved in how staff supported them.

Staff spoken with told us that they needed more practical training and more staff meetings so they were more supported.

We saw that when complaints were made they were not recorded to show what the complaint was about or what action had been taken. This meant the provider was not able to identify where improvements were required and that show people’s views were listened to.

We saw that accurate records were not kept in relation to people’s call times. This meant the provider could not be sure people received their care at a time they wanted.

During our inspection, we spoke with five people using the service, five staff, one relative and the provider. The visit was unannounced so that the provider did not know we were coming.

All of the people using the service we spoke to told us they were happy with the service provided and they felt involved in their care. All five people told us that all aspects of their care were discussed with them. One person told us, "I receive personal care. The care staff respect my privacy and maintain my dignity". This meant care was provided to people in a way that they wanted.

People spoke with told us the staff were friendly, treated them with respect and always asked their opinion. One person told us “staff never impose what they want and always listen to what I want’’. Staff spoken with were able to tell us about people's needs and told us that they had received a range of training. This means staff should have the knowledge and skills to support people in the way they choose.

There were systems in place to monitor how the service was provided by involving people using the service. This means improvements were made if required.

People using the service told us they knew who to contact if they had any concerns. We saw records that showed us complaints and concerns were investigated. This meant if people raised any concerns, the appropriate action would be taken taken.

Most people we spoke with who received personal care from the agency were happy with the quality of care received. We did receive some negative comments about the agency and the standards of care staff practices.

People told us that the agency had carried out an assessment before the service started and that they had a copy of the care and support plan in their home. Most people told us they were satisfied with their care plan but one person had raised concerns. We were told that the care plan did not contain accurate, up to date information. People we spoke with were confident that they could raise concerns if they were not happy with the care being received.

People told us that overall, they were happy with the support they received and that it made a difference to their everyday living. People told us that they were treated with respect and that care staff maintained their privacy and dignity. They told us that regular care staff completed the care and support they required. One person was not happy with the standards of care and the length of time care staff spent with them, when their regular care staff were not available. On occasions when care staff were delayed, people told us that they would usually be advised of the delay and when to expect the call.

We reviewed the care and support plans of people who use the service. We found that care plans did not set out what tasks needed to be completed and when, or what the needs of people were.

We spoke with a total of 30 service users and relatives on the telephone during our visits to the agency. The majority of people we spoke with who receive personal care from the agency were not satisfied with the service that was being provided by Care 4 U. We were told that care staff frequently failed to turn up for calls and failed to complete all the care tasks. In some cases, people felt that the care staff were not honest.

We did speak with some people who told us that they were happy with the service that was being provided. They told us that they liked their care staff and found that the care was good.

During our inspection process we spoke by telephone with ten people who used the service or their relatives and we conducted face to face discussions with six staff. We spoke with a further three staff on the telephone following our visit, the provider and Birmingham City Commissioning. We did this to give us an overview of the experiences that people had, to determine the standard of care provided and the satisfaction of the people who used the service. Our conversations with people helped us to answer our five questions we always ask.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All the people we spoke with told us that they felt safe with the staff that supported them. One person told us, I have no problem with the staff that comes to me, they make sure everything is secure before they leave and I am alright.’’ Another person told us, “I am always happy with the girls that care for me.

All the staff that we spoke with confirmed that they had received training on how to protect people and understood what safeguarding people meant. In addition they received updated training when required.

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes. This is a domiciliary service. No one using this service was subjected to an application to deprive them of their liberty.

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receiving care and were able to make informed decisions. Staff spoken with understood about people making decisions and how to respect rights. For example, supporting people to make choices about their care.

All the people we spoke with told us that staff talked to them about their care and they always gave their consent to being supported. One person that we spoke with said, “We do things together and the carers do what I want them to do and I do what I can.”

All the people spoken with told us and records sampled showed that they received their medication when needed and as prescribed by their GP. There were safe systems in place for the recording and administration of medication.

Is the care effective?

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people were able influence the care they received.

All staff spoken with were able to give us tell how they supported people and gave them choices about their care. One member of staff said, “I ask them about what they want at each call. I give them choices.” People told us that they were supported by the same staff on most care calls which meant people received continuity of care from staff they felt comfortable with.

Is the service caring?

People told us they were happy with the care they received. We saw from daily records sampled that where staff had concerns about people’s health, additional visits were made and advice sought from healthcare professionals. One person told us, “The staff are wonderful. They really care for me and are always helpful. They get the doctor or my relative if I am unwell.” Another person told us, “They are respectful. I wouldn’t have them in the house if they were ever rude to me.”

Is the service responsive?

People told us that staff did what they wanted them to do. They told us that if their care workers were going to be late they were kept informed either by the care staff or the office. One person told us, “If my carers are going to be late they always let me know but it doesn’t happen much.”

Records sampled showed that there were systems in place to gather the views of people so that the service was developed taking into consideration the views of staff and people who received a service. All people that we spoke with told us they were happy with the service and had not needed to make any complaints.

Is the service well led?

We saw that the service had a staffing structure that enabled the service to be managed appropriately. This included a manager that had been registered with us and was responsible for the running of the service. People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.

Staff told us they were clear about their roles and responsibilities and received regular newsletters or had frequent staff meetings. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Records showed that regular spot checks on staff practices were carried out by senior staff . This involved supervising staff to ensure safe care practices. Records showed that training was regular and up to date. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.

We saw that the provider sought feedback from people who used the service regularly by telephone people or visiting them. A senior member of staff told us, “If concerns are identified then action is taken immediately. This meant people were not left frustrated with issues that they may have in relation to the service provided. One person told us, “Any worries or issues they (staff) are straight out.”