About the service:

Care Associates Ltd is a domiciliary care agency. It is registered to provide personal care to people in their own homes, including, older people, people with mental health problems, and people living with dementia. At the time of this inspection the service supported 80 people.

People’s experience of using this service:

• People’s needs were assessed to ensure they could be met by the service.

• People felt safe and were protected from avoidable harm.

• Staff knew about the risks associated with people’s care and understood how to keep people safe.

• Staff supported people to take their medicines safely and followed best practice guidance to prevent and control the spread of infection.

• Most people received care calls at consistent times, from staff they knew, who stayed for the length of time agreed.

• People made their own decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

• Staff were recruited safely and received the support and training they needed to be effective in their roles.

• Staff respected people’s rights to privacy and dignity and promoted their independence.

• Where needed people were supported to meet their nutritional needs and to maintain their health and well-being.

• People received information about the service in a way they could understand.

• People were involved in planning and agreeing their care. Care plans contained the information staff needed to provide personalised care.

• People, and their relatives were regularly consulted about the care provided.

• The managers had developed good relationships with health and social care professionals which improved outcomes for people.

• Systems were in place to manage and respond to any complaints or concerns raised.

• The provider had effective and responsive processes for assessing and monitoring the quality of the service. But these had not always been implemented consistently.

Rating at last inspection: Requires Improvement overall with a breach of Regulation 18, Notifications. The last inspection report was published on 14 March 2018.

This was a planned inspection based on the date and the rating of the previous inspection. The overall rating for the service has changed to Good. Improvements had been made since the last inspection and the provider was no longer in breach of the regulations. Quality assurance processes required further improvement and the ‘well led’ key question remains ‘Requires Improvement’.

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

We inspected Care Associates on 24 January 2018. The inspection visit was announced. We gave the provider 24 hours' notice that we would be inspecting the service so we could be sure the registered manager and staff were available to speak with us.

Care Associates is a domiciliary care agency that provides personal care and support to people living in their own homes. Care staff call at people’s homes to provide personal care and support at set times agreed with them. At the time of our inspection there were 80 people who received personal care through Care Associates.

There was an experienced registered manager in post. A requirement of the service’s registration is that they have a 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. We refer to the registered manager as the manager in the body of this report.

Our last inspection took place in June 2016 when the provider was given a rating of Good overall, with the area of ’Well-led’ being rated as Requires Improvement. This was because we found record keeping could have been more robust, and audits and monitoring procedures did not always highlight where areas required improvement.

At this inspection we found the service was rated Requires Improvement overall, as it continued to be rated as Requires Improvement in ‘Well-led’ and areas in ‘Safe’ also required improvement. We found the manager had delayed notifying CQC of a recent safeguarding incident that occurred at the service. The recording of mental capacity and decision making required improvement, and some paper care records were not always kept up to date. In addition medicine auditing procedures could have been more detailed to ensure people always received their medicines. Auditing procedures needed to be more robust to ensure areas for improvement were identified.

Since our previous inspection in June 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

At the time of our inspection visit we found the registered manager understood their responsibilities to notify us of important events as they should. However, the manager had not notified CQC in a timely way about a safeguarding concern that occurred at the service in June 2017. We found although the manager had notified us, this was around 4 weeks after the event in July 2017. We found this was a breach in Regulation 18 Health and Social Care Act 2008 (Registration) Regulations 2009 (Part 4) Notification of incidents.

The registered manager and care staff understood the principles of the Mental Capacity Act (MCA) and how to put this into practice. Care staff told us they gained people’s consent before giving care. However, records required improvement to record where people needed support to make decisions about their care.

The provider had processes to monitor the quality of the service and to understand the experiences of people who used the service. This included regular communication with people and staff and audit checks. However, we found audits could have been more robust to ensure the manager identified areas that required improvement, such as medicines audits and the completeness of paper records held in the office.

People felt safe when supported by care staff. There were processes to minimise risks to people’s safety which included information about people’

We inspected this service on 2 and 3 June 2016. This was an announced inspection and we telephoned 48 hours' prior to our visit in order to arrange access to the information we needed. This included making arrangements for us to meet with staff who worked for the agency.

Our last inspection took place on 12 August 2013 when the provider was found to be meeting the legal requirements we looked at.

Care Associates is a domiciliary care agency that provides personal care and support to people living in their own homes. Care workers call at people’s homes to provide personal care and support at set times agreed with them. At the time of our inspection there were 102 people who received personal care through Care Associates.

During the inspection we met with 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.

People felt safe when supported by care workers who understood how to protect people from abuse. There were processes to minimise risks to people’s safety which included information about risks in care plans. All care workers had been provided with a staff handbook containing the policies of Care Associates to support them to provide safe and effective care to people.

Care workers received training on how to manage medicines so they could safely support people to take them. People supported with medicines confirmed they were able to take their medicines at regular intervals as prescribed.

Checks were carried out prior to care workers starting work to ensure their suitability to work with people who used the service. New care workers completed induction training and shadowed more experienced care workers to help develop their skills and knowledge before supporting people independently. This ensured they were able to meet people’s needs effectively.

People received a service based on their personal needs and care workers usually arrived to carry out their care and support within the timeframes agreed. Care workers knew what to do and said they always attempted to let people know if they were delayed. People were positive about the care they received and were complimentary of the care workers that supported them. People told us care workers always maintained their privacy and dignity and supported them, where possible, to retain their independence. They commented that care workers were respectful, caring, and kind.

Changes in people’s needs were identified and reported to the ‘office’ so that arrangements could be made to review care arrangements where necessary and ensure people’s needs were met.

People’s nutritional needs were met by the service where appropriate. People who were reliant on care workers to assist with meal preparation said they were offered a choice of meals and drinks whenever this was possible.

The registered manager and care workers understood the principles of the Mental Capacity Act (MCA) and how to put these into practice. Care workers told us they gained people’s consent before giving care.

The provider had processes in place to monitor the quality of the service and to understand the experiences of people who used the service. This included regular communication with people and staff, service satisfaction surveys and audit checks. The results of the most recent survey people had completed showed a high level of satisfaction of the service. People knew how to raise concerns if needed. Complaints received had been investigated and responded to in a timely manner.

We found that records were not always sufficiently detailed or accurate to demonstrate person centred care and to show outcomes of quality checks.

Care Associates is a domiciliary care agency registered to provide personal care to people within their own homes. At the time we visited they were supporting 125 people. Most of these were elderly people.

We found that people were happy with the care and support they were receiving. People told us: “The quality of care I am receiving is better than adequate…” “I am happy with the care.” “We have had a few bad times regarding X’s health and they have been excellent. If we didn’t have them as a lifeline, we would have struggled.”

We saw there were quality monitoring systems in place to assess people’s views of the service. These checks included asking people if they were receiving the care and support they expected. We saw that actions were being identified as a result of these quality checks and were being addressed as appropriate.

People were positive about the staff supporting them. They told us: “I find the carers are all professional and caring.” “They are always polite, they are always good to me.” We saw that staff were subject to on-going training to make sure they maintained their skills to care for people safely.

People told us if they had any concerns they felt comfortable to raise these with the agency. We saw systems were in place to manage complaints and a complaint received, had been managed appropriately.

We spoke with two people using the service and two relatives of people receiving support from Care Associates. People were positive in their comments about the service. They told us: “I am very satisfied.” “They do really well considering two (care staff) are needed per call. They are really good.“ “We are happy with the care, they are good.”

We saw that people received varying levels of support depending on their needs. Some people had one visit per day and some people had multiple visits at varying times each day to meet their needs. The support provided included help with personal hygiene, continence care, mobility, nutritional care, meal preparation and administration of medicine.

People told us they were happy with the staff that supported them. We were told: “The carers are good at what they do.” “They are always on time, if not it’s rare. At the weekends they are a bit short.”

We saw that people were given opportunities to comment on the quality of services they received. Records showed a high level of satisfaction. Where any comments relating to improvements were made, action plans had been developed to address these.