About the service:

This service is a domiciliary care agency which provides personal care to people living in their own homes. At the time of our visit 42 people were being supported with personal care.

People’s experience of using this service:

At the last inspection visit we made a recommendation to improve recruitment processes within the service. At this inspection we found the registered manager had not acted upon the advice and consistently implemented safe recruitment processes. We looked at the recruitment of four members of staff and found appropriate checks had not been followed. Two records did not have a full employment history on their application form. There was no evidence this had been discussed at interview or a satisfactory written explanation sought.

The registered provider used a variety of methods to assess and monitor the quality of the service. However, we found auditing systems were not always effective and had failed to identify concerns regarding the safe recruitment of staffing. Recruitment file audits had taken place but had not identified the concerns we found.

People told us they felt safe with the support they received from the staff. People told us they were supported by staff who knew and consistently met their needs. Staffing levels were reviewed to ensure there were enough staff to provide a flexible and responsive care.

Staff were aware of their responsibilities in reporting and responding to abuse and said they would not hesitate in reporting any unsafe or abusive practice. Staff told us the registered manager understood the importance of creating a culture where people were free from abuse and harassment.

People’s care and support had been planned in partnership with them. People felt consulted and listened to about how their care would be delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and relatives told us they were more than happy with the service provided. They told us staff were committed, kind, caring and reliable.

People said they were consulted with about all aspects of their care and support. They said they could raise any concerns with the management team and were confident they would be dealt with professionally and in a timely manner.

People said they received effective health care with positive outcomes. They said the staff at the service liaised with health professionals to ensure their health needs were met. We saw evidence of multi-agency working to meet people’s health care needs.

When people required support with managing their medicines we saw good practice guidance was followed.

Rating at last inspection:

At the last inspection visit the registered provider was rated good. The report was published 04 May 2016.

Why we inspected:

This was a planned and scheduled inspection.

Enforcement:

Please see the action we have told the provider to take’ section towards the end of the report.

Follow up:

We have requested an action plan from the registered provider as to how they plan to address the breach in regulation and make improvements to the service.

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 25 February 2016 and was announced. Care 4U provides a personal care service to 10 people living in their own home. The people using the service all had personal care needs relating to their age or physical ill health.

There was a registered manager in post. Due to planned annual leave they were unable to be present at the inspection, and had arranged for senior staff from within the organisation to be available at the time of 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 2008 and associated Regulations about how the service is run.

People being supported by Care 4U reported that they felt safe.

People were supported by adequate numbers of staff, however recruitment records did not show that the required checks were always undertaken before new staff started work.

Risks that people experienced or were exposed to had been identified and assessed. Staff were able to describe the action they took to work in line with risk assessments and to keep people safe.

Staff had been trained to administer and manage medicines safely. This ensured people received the required medicines in the correct dose.

Staff had been provided with support and training to meet people’s needs. People told us they had confidence in the staff that supported them.

The staff were aware of the principles of the Mental Capacity Act 2005, and were able to describe ways they sought consent and worked in ways which promoted people’s independence.

When people needed help with food and drinks, or maintaining good health, this was part of the person’s care plan. Staff we spoke with were able to describe the support they provided with this, and people we spoke with were satisfied.

People and their relatives told us that staff worked with kindness and compassion.

The inspection identified ways in which the agency was providing a tailored individual service to each of the people it was supporting. People’s needs were kept under review and their support plan changed and developed to reflect changes in their well-being or circumstances.

There had been no formal complaints made, but there was a policy that would ensure any received in the future would be identified, recorded and investigated. People told us how the agency sought feedback from them, and ways they had or could share concerns or make suggestions if they needed to.

The agency was well led. There was a registered manager who was aware of her responsibilities to provide care that would meet people’s needs and which complied with the requirements of the law.

We gave short notice of our inspection so that we were able to make a judgement about the service provided. At the time of our inspection 14 people were using the service and 10 of these people received personal care. To determine the standard of care provided and the satisfaction of people using the service we spoke with three people who used the service, three relatives of people who used the service, four staff and the manager of the service.

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people's individual needs had been assessed and that there were enough suitably trained staff to support and care for people.

People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

We saw that when people needed help and support taking their medicines systems were in place that ensured this was done safely.

The provider had arrangements in place to deal with out of hours emergencies. This meant that people would always be able to get the support they needed when the office was closed.

The manager regularly monitored the quality of the service to ensure it was safe.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. People said that their care plans were up to date and reflected their current needs.

It was clear from speaking with staff they had a good understanding of people's care and support needs and they knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

Is the service caring?

We spoke with three people being supported by the service and three relatives. We asked them for their opinions about the staff that supported them and their family members. Feedback from people was positive. One person told us, "I always know I’m going to get my night care, they always arrive." Another person said, "We work everything between us. I am involved in every aspect of my care" One relative told us, "We are really pleased and happy with them."

When speaking with staff it was clear that they genuinely cared for the people they supported.

People who used the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people's care plans and risk assessments were reviewed on a regular basis to ensure that their changing needs were planned for.

People knew how to make a complaint if they were unhappy. They were confident that if they raised any issues with the manager of the service they would be addressed. One person told us, "They are excellent sort things out straight away.”

Is the service well-led?

The registered manager had been in post some time. It was clear from our discussions with the manager they were experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There was a system in place to monitor the quality of the service provided to ensure it was safe.

At the time of our inspection 13 people were using the service and 11 of these people were receiving personal care. We spoke with a person using the service, the relatives of two people and the staff that were supporting them.

People told us that they were happy with the quality of care provided and that it made a positive difference to their lives. They told us that care and support was provided that met their care and support needs. A relative told us “Carers don’t rush and they always stay the correct length of time.”

People using the service had opportunities to express their views about the service they received from the provider. They told us that they were involved in the planning of their care and support needs. This was so that they could maintain their preferred daily routines.

People told us that staff had a good understanding of their care needs and that they supported them in a safe and respectful manner. A person using the service told us “I am very happy with the agency. They have never let me down. I feel very blessed that the agency staff have been so caring. They have walked in snow and ice to get to me.”

People told us that they were confident that they could raise concerns if they were not happy with the care and support they received. A person using the service told us “I made a complaint a few years ago and the agency dealt with it very quickly and appropriately.”

Effective arrangements were in place for the recruitment and selection of new staff. People using the service were in involved in this process. This meant that they had a choice of who supported them.

Twelve people were receiving personal care from the agency at the time of our inspection. This ranged from support once or twice a month, to a live in care service. We spoke with one person using the agency, a relative and two staff members. Other people were unable to communicate with us by telephone.

People told us that they were happy with the quality of care received and that it made a difference to their lives. They told us “I am very satisfied with the service. They have got better and better;”, “Staff always turn up, even if the weather is bad I know that they will arrive;” and “I have three very good carers. They are conscientious and take extra care of me when I am not well.”

During our review, we asked local authority staff involved in monitoring the agency about the quality of the service the agency provided. They did not raise any concerns about the service provided.

People who use the service told us that they were consulted and involved in making decisions about the service provided to them by the agency including introductions to the care workers who would be supporting them. A person who used the agency told us they had been introduced to the care workers who would be supporting them. In another person’s care records we saw that it was noted, ‘We will arrange for you to meet care worker, if you are not happy we will change over’.

People using the service told us that staff respected their privacy and dignity, and were encouraged and supported to maintain their independence.

People spoken with and their representatives were able to confirm that they knew what their plan of care said and confirmed they were in agreement. Comments included,

‘’ The manager worked hard to make care plans more bespoke for me,’’ ‘’ Carers are meeting my needs,’’ ‘’Seems to be happy with their care’’ and ‘’ Care provided was excellent and was necessary’’. A person stated if they wanted any changes to their care they would simply call Keith or Laura who would ‘fit in’ with the person’s needs.

Care workers spoken with were aware of how to recognise potential abuse, and they told us they wouldn’t hesitate to report any issues to the manager. People were positive about how staff cared for them.

Majority of the people spoken with confirmed that there was a good continuity of care. A person who used the service said that they were really pleased as the management team had worked really hard in matching care workers to them, ‘’Care staff were more suited in terms of their personality and cultural background’’.

People told us that if they had concerns they are confident that the management team and staff would act to put things right.