This inspection took place on 1, 3, 8 and 9 November 2016 and was announced. Care at Home is a domiciliary care service which provides personal care and support to people with physical needs as well as people who have mental health problems, sensory impairments and learning disabilities. The care and support is provided to people who live in their own homes and also to people who live in supported living accommodation. The level and amount of support people need is determined by their own personal needs.

A registered manager was in place as required by their conditions of registration. 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.

People and their relatives were overwhelmingly positive about the caring nature and approach of staff. People told us they were supported by staff who were kind and compassionate. Staff understood their responsibility to protect people from harm and abuse. They had been trained to recognise and report safeguarding concerns. Systems were in place to ensure people were safeguarded from abuse such as financial abuse. The service had worked openly and cooperatively with other agencies when safeguarding concerns had arisen.

People’s level of support was varied and tailored to their needs. People’s support plans gave staff adequate information about their preferences and how they wished to be supported. People were encouraged and supported to have control of their lives and make decisions about the care. However, the details of people’s mental capacity assessment and consent to receive personal care were not always evident for some people who lived in supported living accommodation.

People’s risks were assessed and monitored. Staff had considered other ways to ensure people benefited from living a meaningful life and managing their risks. Arrangements were in place to make sure people received their medicines appropriately and safely. People’s care records showed relevant health and social care professionals were involved with people’s care when required.

People were supported by appropriate numbers of staff who arrived on time. Staff stayed for the designated amount of time to deliver the care and support people required. Systems such as spot checks were in place to monitor the time keeping and the competencies of staff. Effective recruitment systems were in place to ensure people were supported by staff who were of good character and had a reputable employment background.

People were supported to plan and prepare their meals according to their abilities and level of independence. Some people enjoyed eating out or having a take-away.

Systems were in place to monitor and check the training and skills of staff. Staff’s abilities and care practices were regularly observed. Staff had been provided with an appropriate level of training or support to be able to meet the needs of the people in their care; however some staff had not received update training in some subjects. The managers responded and booked staff on to the appropriate courses. Staff received regular formal and informal support to carry out their role.

Since our last inspection the registered manager had spent time with the managers, staff and people who lived in supported living homes. They had developed a good insight into the service being provided. Managers met with staff regularly to provide support. Staff felt confident in the managers abilities

Monitoring systems were in place to ensure the service was operating effectively and safely. Any identified shortfalls had been acted on. People’s views and opinions were listened to. There were opportunities for people to raise concerns. Complaints were investigated and acted on by the manager.

In this report the name of one of the registered managers appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individuals name from our register.

People who used the service were involved at every stage of their assessment. We saw evidence that people and where appropriate their relatives were involved in developing their care plans and risk assessments.

We saw positive feedback from people in the satisfaction survey that had recently been sent out. We also spoke to two relatives and one person who used the service. Several people had made comments about wanting the provider to improve the consistency of the carers attending to them. The provider might like to note these comments. Other comments included “they could do with being more consistent with the carers, but overall I am very satisfied with the care they have provided to my wife”. “I have no cause for concern, they keep me updated as necessary and I am very pleased with the care provided”.

This inspection took place on 8, 12, 13, 14 and 21 October 2015 and was announced. Care at Home is a domiciliary care service which provides personal care and support to people with physical needs as well as people who have mental health problems, sensory impairments and learning disabilities. The care and support is provided to people who live in their own homes and also to people who live in shared accommodation known as supportive living. The level and amount of support people need is determined by their own personal needs.

A registered manager was in place as required by their conditions of registration. 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.

People who received personal care in their own homes were well cared for and told us they felt safe amongst staff. Most people had been involved in planning for their care. However people’s care records did not always reflect their needs and risks. The details of the lawful consent to receive care were not always evident when people could not make a decision about their care and support for themselves.

People’s care records were task orientated. They provided staff with guidance on how they should be supported but did not always focus people’s needs, choices and preferences. Adequate guidance for staff to manage people’s health and well-being risks when supporting people in their own homes were not always in place.

People were positive about the care they received and complimented staff. Staff encouraged them to make choices and retain their independence in daily living skills. However some people felt staff did not always arrive on time for their visit or stay for the agreed amount of time. Most relatives were positive about the care their loved ones received from the service. They told us staff acted on any concerns or issues raised with them.

People who lived in shared accommodation and received personal care complimented staff about the care they received. Relatives also praised the approach of staff and told us they could always speak to staff if they had any concerns. The rights of people who were unable to make important decisions about their health and well-being were protected.

People told us staff were kind and caring. They were supported to make choices about their lives such as helping to plan, shop and prepare meals. People were being encouraged to become independent and gain confidence in their abilities. Staff were knowledgeable about their needs, wishes and preferences. Appropriate referrals were made to specialist services and health care professionals if people’s needs changed.

All staff who supported people with their personal care were well mainly well trained to carry out their role. New staff told us they were provided with adequate support and training. All staff were confident in recognising and reporting any signs of abuse and were comfortable that any concerns raised to senior staff would be dealt with immediately. Any shortfalls in staff knowledge and skill base were being addressed.

Most people and their relatives were confident that any issues or concerns about their care would be addressed immediately. Recent restructuring of the management of the service gave the registered manager and senior staff new responsibilities. The registered manager was planning to make improvements to the service and gain a better understanding of the diversity of the service being provided. The service was being regularly monitored and audited to ensure people received good care.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.