This inspection took place on 12 December 2018 and was announced.

We gave the service 48 hours’ notice of our intention to inspect, as the service provides domiciliary care, and managers and staff are often working in the community, so we wanted to be sure someone would be available to speak to us.

Care Connect is a domiciliary care agency. They provide support in people’s own homes. At the time of our inspection Care Connect were supporting over 40 people in the Sefton area.

The service was last inspected in December 2017 and was rated as Requires Improvement overall.

Care Connect provides personal care to people living in their own houses and flats in the community as well as specialist housing. It provides a service to older adults and younger disabled adults. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks relating to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There was 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.

Everyone we spoke with said they felt safe with the care they received from staff at Care Connect.

There was a variety of risk assessments in place to help keep people safe, however, we found some of these required additional detail.

Staff were being recruited safely. Each staff member had a disclosure and barring service (DBS) check completed before they started this.

Medication was being administered safely to people in their own homes.

Rotas were completed electronically and sent to staff every week. Staff confirmed they had no concerns with their rotas and were often scheduled to visit the same people. There were enough staff to cover calls.

Incidents and accident were documented when they occurred and the registered manager audited these for evidence of any patterns or trends.

Training took place and covered a range of subjects. All training took place in the registered office and was conducted by the in-house training manager who was a qualified trainer. Each new member of the care team who had never worked in health and social care before were expected to complete the Care Certificate.

Supervision for staff took place regularly. Some supervision were due in December 2018.

Records clearly indicated where people had provided their consent to receive care and support from Care Connect and in other instances, where people did not have capacity, decisions were appropriately made in the persons ‘best interest’ and in the least restrictive way as possible.

People confirmed they were supported with their nutrition and hydration needs by the staff.

Everyone we spoke with said they were well cared for by Care Connect. People told us that staff were considerate and mindful of their privacy and dignity. Care plans reflected choice and dignity.

All confidential and sensitive information was securely stored and protected in line with General Data Protection Regulation (GDPR).

Information recorded in the care plans we viewed was person-centred. Care plans contained information about what to do on each call and how the person liked their care routine to be carried out. We saw that some of the care plans would further benefit further personalised information which we discussed with the registered manager at the time of our inspection.

People were getting care which was responsive to their needs. We saw that staff were completing food charts and recording fluid intake for people who required support with their dietary needs

Complaints were documented and responded to appropriately. The complaints policy had been made available to peopl

This inspection took place on 14 November 2017.

Care Connect UK Limited is a large domiciliary care agency based in Blundellsands. The service supports approximately 500 people in their own homes in the Sefton area of Merseyside.

The service was last inspected in November 2015 and was rated Good. At this inspection we rated the service Requires Improvement.

We received mixed responses regarding whether the service supported people to feel safe, particularly in respect of staff allocation and how this was communicated to people. People told us they did not always receive advance notice of who would be supporting them, and at what times, which made some people concerned. We have made a recommendation regarding this.

There had been recent changes to the management structure at the service following the departure of the last registered manager in May 2017. Their replacement left in August 2017. The current manager was appointed on the 30 October 2017 and was not yet registered with the Care Quality Commission. 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 received a number of comments regarding the lack of communication and organisation at the service, specifically in relation to office based staff.

There was a lack of audits being completed at provider level which meant that the issues around poor communication and staff rostering had not been effectively managed in the absence of a consistent registered manager. We have made a recommendation regarding this.

People who used the service told us they felt safe when receiving care and support from care staff.

The registered provider had experienced operational issues in respect of staff recruitment which had impacted upon their ability to meet the demands of their contract with the local authority. Nevertheless, the registered provider ensured all existing referrals were managed safely as a priority and that sufficient numbers of staff were allocated to meet people’s needs.

There were processes in place to ensure that staff were recruited safely. This included a satisfactory DBS check and two references.

People told us they were happy with the support they received with their medication. Staff were trained in medication administration and there were regular audits completed in respect of Medication Administration Records to check their accuracy. Errors had been identified and actions were taken in response.

Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures.

Accidents and incidents were recorded and appropriate action was taken to address any issues identified.

Staff were assisted in their role through induction, supervisions, observations and an annual appraisal. Staff also felt confident to raise any issues or support needs informally.

The manager provided us with a staff training plan and this showed staff received training to ensure they had the skills and knowledge to support people effectively.

The service operated within the principles of the Mental Capacity Act 2005 (MCA). People told us that consent was sought and staff offered them choice before providing care.

Staff encouraged people’s independence whilst providing assistance and prompts where necessary.

People spoke highly of the individual carers who supported them. People described the carers as “fantastic”, “caring” and “respectful.”

The majority of people told us that carers stayed for the allocated time and had sufficient time to complete the necessary tasks and have a chat.

Care files contained succinct information about people’s routine and preferences. A breakdown of each person’

The inspection took place on 24 September 2015 and was announced. The provider was given 48 hours’ notice. This is in line with our current guidance for inspecting domiciliary care agencies.

Care Connect UK Limited provides personal care and support to approximately 500 people in their own homes in the Sefton area of Merseyside.

The service 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.

People who used the services of the agency told us they felt safe when receiving care and support. This included support with personal care, help with meals and also with medication.

Staff understood how to recognise abuse and how to report concerns or allegations. There were processes in place to help make sure people were protected from the risk of abuse.

Risk assessments and support plans had been completed to protect people from the risk of harm. Assessments had been completed for everyone who was receiving a service to help ensure people’s needs were met. Risk management plans were implemented and followed by staff to help ensure people received safe and effective care.

People told us care staff supported them with their medication at a time when they needed to take it. They said this was in accordance with their wishes and needs. Medication was recorded correctly. The medication administration records we viewed were clearly presented to show the treatment people had received. Medicines were safely administered by suitably trained staff.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. We found

Disclosure and Barring Services (DBS) checks had been carried out prior to new members of staff working. DBS checks consist of a check on people’s criminal record and a check to see if they have been placed on a list for people who are barred from working with vulnerable adults. This assists employers to make safer decisions about the recruitment of staff.

Care staff had training and support through induction, a programme of training, supervision and appraisal. Staffing levels were determined by the number of people using the service and their individual needs. People told us that they received care from a regular team which they felt was very important. Two relief care staff had been recruited to cover emergencies, sickness, annual leave and to help provide extra support where needed.

People‘s care needs were assessed. The care records we looked at showed that a range of assessments had been completed depending on people’s individual needs. Records were regularly reviewed which helped to ensure the information written in them was current. Support plans had been completed to guide staff as to what people required and what they could do for themselves.

People’s care needs were recorded in a plan of care in an individual care file. The care plans recorded details around people’s routines, preferences and level of care and support they required. This helped to enable staff to support people to meet their individual needs. With regards to people making their own decisions, people we spoke with informed us they were able to do so and were involved as much as possible regarding decisions about their welfare.

People who used the services of the agency were complimentary regarding staff; they told us all staff were kind and considerate and that they were treated with dignity. Staff understood what people’s care needs were. Staff supported people’s independence in their home.

A complaints procedure was in place and details of how to make a complaint had been provided to people who used the service. People we spoke with knew how to raise a complaint.

People who used the services of the agency were able to provide feedback about the quality of the service.

Systems were in place to monitor the quality of the service provided. This included audits (checks) on areas such as, care documents, medicine administration and also meetings with people to ensure they were happy with the care provided.

This visit was carried out to look at the agency’s polices for recording medicines handling.

At this visit we found action had been taken to address the record keeping issues identified at our previous visit. However, because the changes had only been recently implemented it was not possible to assess how well they were embedded into practice at the service, or to assess the effectiveness of any monitoring.

We spoke to some people and their relatives about the service that they received. They told us they were happy with the way staff supported them and the tasks they carried out for them.

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. Those we spoke with said the staff knew what support they required and did everything that was needed for them.

Staff we spoke with had received relevant training and understood how to report abuse they were aware of.

We asked people who used the service and their relatives about the skills of the support workers. They told us the staff worked very hard and knew how to do their job.

We spoke to people and their relatives about the service they received with regards to

their involvement in the quality of the service. They told us they completed a questionnaire each year and were able to contact the manager if they ever had a problem with the service from Care Connect.

We spoke with four people who received a service and also with two relatives of the people we visited. The people we spoke with told us about their views and experiences of the service Care Connect provided. They told us they were happy with the way staff supported them and the tasks they carried out for them.

Their comments included: “They don’t rush me; they know what I can do.”,”The staff are very good.” and “They (Care Connect) provide an excellent service.”

All the people we spoke with told us they valued the same care workers attending to provide consistent support. There were two people who were not regularly receiving support from the same staff. One person had recently started receiving a service and had several staff visiting them in one week. Another person received a service every day but had one day were different staff attended. We spoke with the provider who was aware of the situation and were trying to find consistent staff to visit both people. People told us that on occasions their regular carers didn’t attend but they knew in advance, as they were sent a rota. They said they had usually met the staff before so the staff knew what to do.

People who received a service told us the staff knew what support they required and did everything that was needed for them. We looked at six care records in the office and a further two in the homes of the people we visited. We found them to contain relevant and current information about the person’s needs.