About the service: Care 4 U Services (Lincoln) Limited is a domiciliary care agency. At the time of the inspection it provided personal care and support to 20 people aged 65 and over.

People’s experience of using this service: People were supported safely and protected from harm. There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to people.

Incidents and accidents were managed effectively; lessons learnt were shared with staff to reduce the risk of further occurrences.

The management of medicines was safe. We found some recording issues which were immediately dealt with by the registered manager. Risk assessments had been completed, provided detailed guidance for staff to follow and were reviewed regularly.

There were enough skilled and experienced staff to meet the needs of people who used the service. Recruitment checks were robust and new staff completed a comprehensive induction and training programme.

Health and safety checks were carried out to ensure people remained safe in their homes. Staff used personal protective equipment to prevent against cross infection.

People and their relatives said staff were kind and caring. Staff treated people with respect and dignity. People were involved in decisions about their care and encouraged by staff to be as independent as possible.

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.

Initial assessments were carried out to ensure people’s needs could be met and personalised care plans followed. Staff understood people’s likes, dislikes and preferences and people told us they were offered choices about their care.

Some people using the service required end of life care. The provider worked closely with another organisation who facilitated their specific care needs and offered advice and training for staff.

Care records clearly identified nutritional and dietary needs. People were supported to live a healthy life and staff supported people to access health care professionals when required.

A complaints system was in place and these were managed effectively. People and staff told us they felt confident to raise any concerns and felt these would be managed.

The provider had embedded quality assurance systems to monitor the quality and safety of the care provided. The provider worked in partnership with other services to support people’s care and quality of life. Regular reviews were carried out with people using the service to gather their views.

Staff told us the management team were open, honest and supportive. People told us the management team were approachable.

More information is in the full report below.

Rating at last inspection: At the last inspection the service was rated Good (published 28 June 2016). The overall rating has remained good.

Why we inspected: This was a planned inspection based on the previous rating of good.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good. If any concerning information is received we may inspect sooner.

Care 4 U Services (Lincs) Ltd provides care for people in their own homes. The service can provide care for people of all ages including people with a physical disability, special sensory needs and a learning disability. It can also provide care for people who live with dementia. At the time of our inspection the service was providing care for 45 people most of whom were older people. About one half of these people were receiving palliative medical and nursing care from healthcare professionals. The service was providing the personal care that was necessary to enable these people to remain at home at the end of their lives. The service had its office in Lincoln and covered the city and surrounding area including Sleaford, Washingborough, Welton and Saxilby.

Staff knew how to recognise and report any concerns so that people were kept safe from abuse. People were helped to avoid having accidents and they were assisted to safely use medicines. There were enough staff to enable most of the planned visits to be completed on time and background checks had been completed before new staff had been appointed.

Staff knew how to care for people in the right way and they had received all of the training and support they needed. People had been supported to eat and drink enough and they had been helped to access any healthcare services they needed. When people received palliative care staff had ensured that the personal care they provided complemented the medical and nursing care given by healthcare professionals.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This law is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

People and their relatives said that staff were kind and considerate. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had received all of the care they needed including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive and had been supported to make choices about their lives including pursuing their interests and hobbies. There were arrangements in place to quickly and fairly resolve complaints.

People had been consulted about the development of the service and regular quality checks had been completed. The service was run in an open and relaxed way, there was good team work and staff were supported to speak out if they had any concerns about poor practice. People had benefited from staff acting upon good practice guidance.

At the time of our inspection there were 32 people who received a service in their own homes. A single inspector carried out this inspection.

As part of our inspection we visited the provider’s office and looked at management records, care records and other documentation.

During our inspection we spoke with nine people who received care. We also spoke with the owner of the service, the registered manager and eight staff members who provided support for people.

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 we found, the records we looked at and what people who used the service, their relatives and staff told us.

If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

The provider had appropriate arrangements in place to help people take their medicines safely. One person told us, “There is a care plan here in my home. It tells the staff how to help me and they have really got to grips with my medication routines.”

We found staff had identified and assessed any potential risks together with the person and their representative to identify how risks could be reduced and managed. Individual risk assessments took account of the environment within people’s homes as well as their care and support needs.

People also told us they felt safe when staff visited them. One person said. “I like it that staff wear uniforms and have proper name badges with pictures so we can check on who they (staff) are.”

Is the service effective?

We found up to date and clear care plans were in place to meet people’s needs. People and staff who worked with them were involved in developing the care plans and agreeing any changes together.

One person told us, “I have found they usually turn up on time. The communication is excellent if they are late and they deal with any issues quickly. I don’t know as I would ever want to change from this service.”

Is the service caring?

We saw that people's individual needs were assessed and met. This also included people's individual choices and preferences about how they wanted to be cared for.

We spoke with people who were supported by the service and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, one person we spoke with said, “They are so caring. They stay for the time needed. I have used two different companies in the past and they aren’t a scratch on this one.” Another person said, “They (staff) can sometimes run a little late but they always ring me to confirm. The staff care about me being kept in the loop.”

Is the service responsive?

We saw people were supported to have the care they needed, when they needed it. One person told us, “The service is good. They took over about a week ago when I needed help quickly after coming out of hospital. They came to see me and we talk about what I wanted. I have a folder with my information in it and the staff check this every time.”

Where any changes to visit times or to care needs had been identified, the manager and staff acted promptly to respond to the changes provide the care and update people’s records.

The provider had a complaints policy in place to make sure complaints were investigated within the timescales set and in the right way. People knew how to make a complaint if they were unhappy and the manager responded quickly to any concerns raised with them.

Is the service well led?

The provider worked well with other agencies and services to ensure people received their care in a joined up way. The manager had a quality assurance process in place with records which showed that any shortfalls identified were addressed.

Staff were supported with supervision and provided with a set period of induction when they started to work for the agency. Staff also received regular training in subjects directly related to meeting people’s needs.

Staff said they felt supported by the management structures in place and were clear about their responsibilities and roles. This helped ensure people received a consistent service.