This inspection took place between 2 and 10 May 2017. The inspection involved visits to the agency’s office and conversations with people, their relatives and staff. The agency was given two working days’ notice of the inspection.

The agency provided 160 people with a domiciliary service, for approximately 1,200 hours a week. Most people were older people or people who lived with long-term medical conditions. People received a range of different support in their own homes. Some people received occasional visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including daily visits, and visits several times a day to support them with their personal care. This could include two care workers and the use of equipment to support their mobility. Some people needed support with medicines and meal preparation. The agency could also provide care workers at night, including sleeping-in duties and care workers who remained awake for some or all of the night.

Care at Home – Hastings, supplies a service to people in Hastings and surrounding rural areas. The provider is Care at Home Services (South East) Limited who provide domiciliary care services to people from different offices in the South East of England.

Care at Home – Hastings has a registered manager in post. 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.

Care at Home - Hastings was last inspected from 11 January to 1 February 2016. At that inspection, it was rated as requires improvement. At this inspection, we found the provider and registered manager had been successful in making necessary improvements

The provider had ensured the safety of people and others by developing its risk assessment and care planning processes. Staff we spoke with were aware of people’s risks and how they were to be reduced. This included among other areas, supporting people with moving safely and reducing their risk of pressure damage.

People’s safety when taking medicines had also been ensured. Care workers had clear information on people’s medicines and accurately completed records when they supported people in taking them.

People were fully involved in developing their own care plans. Staff told us people’s care plans gave them the information they needed to meet people’s needs. Where a person’s needs changed, their care plans were up-dated to reflect their current needs.

The provider had audited its recruitment processes and ensured new staff were safely recruited, to reduce risk to people as much as possible.

The provider’s systems for reviewing quality of care had been improved, to include regular audit of a wide range of areas of service provision. The opinions of both people and staff were sought, using a variety of means, and action had been taken when relevant, following comments made by people and staff.

There were no issues about missed calls due to staff shortages. People received continuity of care from the same team of care workers. People were informed of who would be visiting them and when.

People’s wishes were respected and their independence supported. People spoke warmly about the staffs' kind approach and how they respected their privacy and dignity. Staff knew how to support people if they became unwell. Where people needed support with eating and drinking, they said staff supported them in the way they needed.

This inspection took place between 11 January and 1 February 2016. The inspection involved visits to the agency’s office and telephone conversations with people, their relatives and staff, between the beginning and end dates. We also interviewed care workers at the agency’s office. The agency was given two working days’ notice of the inspection. The agency provided approximately 155 people with a domiciliary service. Most people were older people or people who lived with long-term medical conditions. People received a range of different support in their own homes. Some people received infrequent visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including daily visits, and visits several times a day, to support them with their personal care. This could include use of aids to support their mobility. Some people needed support with medicines and meals. Some people needed visits from two care workers to support them with their personal care.

Care at Home – Hastings, supplied a service to people in the town of Hastings, and rural areas around the town. The provider was Care at Home Services (South East) Limited who provided domiciliary care services to people from different offices in the South East of England.

Care at Home – Hastings had a registered manager in post. 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 agency was last inspected on 26 November 2014. No issues were identified for action at that inspection.

The provider’s systems for auditing of people’s assessments, care plans, staff files and documentation required improvement in some areas. This included ensuring that people who were at risk of pressure damage and falling had relevant assessments and care plans in place. It also included ensuring all prospective staff were fully assessed for their suitability to work with people on their own. Certain documentation required improvement, for example care plans about meeting people’s individual needs in relation to continence equipment, so staff who were unfamiliar with people had relevant information on how to meet such needs.

People told us they did not always receive a rota. The registered manager had flexible systems to provide people with such information, however this was not included in information given to people about the service or considered during care reviews.

The provider’s systems for medicines management were mixed, for example they had inconsistent systems for ensuring all people had their prescribed skin creams applied as they needed. Systems were being progressed to ensure relevant information was available on people’s files.

People said they felt safe with the service provided by the agency. Staff had been trained in safeguarding people who could be at risk of abuse and knew what to do to appropriately support people. Staff were trained in, and aware of their responsibilities under the Mental Capacity Act (2005).

People said staff showed a caring attitude, their independence was encouraged and they were respected as individuals. They said staff visited them on time and they had a stable team of care workers supporting them.

People and staff said they could raise complaints and issues of concern with managers. They said such issues were responded to in a supportive way. The registered manager regularly audited the quality of the service provided and acted on comments made by people and staff. The provider was currently developing its systems to make improvements in the auditing of the quality of the service.

Staff said their induction, ongoing training and support, like supervision, enabled them to be effective in their role. People said staff knew

We carried out this inspection to follow up on warning notices issued as a result of concerns identified at the last inspection.

We carried out an inspection at Care at Home, Hastings on 20 January 2014 and found the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We found people had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained.

Following our inspection we met with the provider on 13 May 2014 to discuss our concerns. The provider sent us an action plan that informed us they were making changes to ensure these issues had been addressed. We carried out a further inspection on 10 September 2014 and found that the provider had not achieved compliance. We met with the provider on 30 September 2014 and we issued a warning notice. This stated that the Care Quality Commission required the provider to have achieved compliance with the warning notices by 6 November 2014.

From the information gathered during the inspection 26 November 2014 we found the provider had met the requirements of the warning notices, although some of the processes required time to be fully embedded into practice.

We carried out this inspection to follow up on concerns identified at our previous inspection. Evidence gathered at this inspection showed that staff received appropriate training, supervision and appraisals.

At our previous inspection we found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We also found that people had not been protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had not been maintained. Evidence gathered at this inspection showed that the provider had not achieved compliance.

People we spoke with told us that that they were happy with the care that they received from the service. Generally people spoke of feeling safe and well cared for by good carers. One person said, “They are very good and know what they’re doing and how I want them to do things.” Staff that we spoke with demonstrated a good understanding of the care they provided to people.

We spoke with 21 people who used the service or their representative. People we spoke with told us they were generally happy with the care staff and the care they received. Comments included, “They are very thorough and I’m happy with what they do and I feel safe.” “They treat me with respect and dignity, they’re very good.”, “They are fabulous, really couldn’t be better,” and “Absolutely 100% happy, no worries at all.” Some people told us that communication with the office was not always effective. One person told us, “We tend to liaise with the carers directly as information doesn’t get through from the office.”

We looked at people's care files and saw that people's consent was gained when they commenced using the service.

We saw that care plans did not always reflect the current needs of people who used the service. This meant people were at risk of receiving inappropriate care or treatment.

Staff were aware of their responsibilities in relation to safeguarding people. Staff received training and updates that enabled them to care for people appropriately.

We saw that staff received training in accordance with the organisation’s policy. However, staff had not received regular supervision and appraisal.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

In this report the name of the registered manager appears as Susan Rosina Taylor. This person 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.

We looked at how the organisation managed medicines. We saw that people were protected against the risks associated with medicines. This was because the provider had appropriate arrangements in place to ensure people received their medication safely.

Care at Home Services (South East) Limited - Hastings had a medication audit system in place. This meant that the provider was able to assess and manage the risks associated with medication.

We looked at the training records and we saw that staff had received medication training in line with the organisations policy.

People we spoke with told us that the service they received from Care at Home Services (South East) Limited – Hastings was good. They told us that staff were kind and respectful. They told us they were consulted about their care plan and were listened to.

People told us that staff would always provide the care they needed. One person told us staff would do “whatever they were asked, as long as it was within reason”. Another person told us staff were “wonderful”.