This inspection took place on 29 September 2016 and was announced. At the last inspection on 27 July 2015 we gave the provider an overall rating of Requires Improvement. We found that the provider had made changes ensuring people received consistently safe care and supported by systems that assured the provider staff were working within their policies and procedures.

The agency provides personal care for people in their own home. There were 95 people using the service when we inspected.

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 and associated Regulations about how the service is run.

People told us they felt safe and comfortable with the care staff in their home. People’s risks had been identified and plans showed the steps staff needed to take to ensure people were at low risk of harm or injury. People had their calls at a time they had requested with the required number if care staff attending. People who had support with their medicines had them administered when needed, by staff who were trained and competent to do so.

Staff had received training to ensure their skills and knowledge reflected the needs of the people they cared for. Staff were supported with regular supervisions and the management team checked that staff were working as expected. Where people needed support with their meals they told us they were happy that staff gave them a choice or provided the assistance needed to enjoy their meal.

People were involved in making decisions about their care needs on each call. People had given their consent so care staff where able to provide the care people needed or wanted. People told us they arranged their own healthcare appointments as required, however care staff would help with telephone calls and reminders if needed.

People knew the staff and told us they were provided with a personalised service in their home. Care staff spent time chatting and getting to know people while providing care. People felt the care they had received met their needs and had been able to tell staff how they wanted their care on each call. People felt the staff were considerate and supported them in maintaining their dignity.

People’s views and decisions about their care had been recorded and were changed when needed. People knew how to make a complaint and felt comfortable to do this should they need to and felt these would be dealt with. Information was provided to people who used the service should they wish to raise a complaint.

People, their family members and staff felt the management team were accessible and could speak with them to provide feedback about the service. The management team had kept their knowledge up to date and they led by example. The provider ensured regular checks were completed to monitor the quality of the care that people received and to action where improvements were needed.

We undertook an announced inspection on 27 July 2015. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes. We needed to be sure that someone would be available at the office.

The provider registered this service with us to provide personal care for people who live in their own homes. 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.

The provider’s policies and procedures had failed to keep people safe and reduce their risk of harm. This had led to a serious incident in June 2015. In response to the incident the provider had taken steps to make changes. These were ongoing at the time of our inspection, so that the risks to people’s safety and wellbeing were being assessed and monitored. Although Care staff reported they knew the steps they needed to take to prevent the risk of this happening again the changes made will need to be reviewed. This is to make sure risks to people’s safety and wellbeing were consistently and effectively managed. However although the provider had taken action to improve the safety of people who used the service. The provider needed time to test the new equipment and procedures to ensure people were kept safe.

The registered manager demonstrated that there were sufficient care staff recruited with the appropriate checks on their suitability to support people in their own homes and keep them safe.

People told us they felt supported by care staff and were able to make their own choices and decisions about their care and support. People and their relatives were involved in their care planning and how their needs were met. Care staff understood how important it was to gain consent from people they supported.

People said they liked the care staff that supported them and felt they helped them with personal care. Care staff knew details of people’s care and support needs and took into account their changing needs. They were responsive to their changing health requirements, and worked with health and social care agencies to meet those needs.

Staff were trained in medicine administration so people’s medicines were managed safely, and people were supported to manage their own medicines wherever possible. We saw that they were systems in place to audit the giving people’s medicines, so all medicines were accounted for.

Staff were trained and knew how to recognise and report any signs of abuse or harm so could help keep people safe.

The management team encouraged customer feedback through questionnaires and face to face contact. People told us that they knew how to complain, we saw from the provider’s complaint file that they had responded to complaints in a timely manner.

The leadership and the registered manager were open and transparent about the service and were keen to make improvements to ensure people were not put at unnecessary risks.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe. There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke to that they were able to contact a manager when they needed to.

A copy of the local Safeguarding policy and procedures was in place and available to staff. We looked at staff training records and saw that staff had received training on safeguarding and on the Mental Capacity Act. We spoke with three members of staff who were all able to tell us what they would do in the event of abuse being witnessed, suspected or alleged. We found the provider had taken appropriate action when abuse had been alleged.

There were enough staff to meet the needs of the 160 people cared for by Care Force. People told us they were, "Very happy with the staff" and that they, "Wouldn't be without them". Another person said, "They're excellent and they work very hard". The three members of staff we spoke with commented that the provider tried to ensure consistency of staff with one saying, "They try to keep you to the same clients because they get to know you".

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed were suitable and had the skills and experience needed to support people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to health and social care services. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of people.

The provider told us, "We go the extra mile to accommodate people". People said they were provided with regular staff who knew them well. One person said, "I wouldn't be without them".

Is the service caring?

We found that people who used the service understood the care and treatment choices available to them. We saw in care plans that people had been involved in drawing up and agreeing their plans. We visited two people in their own homes who told us they were involved in the planning and review of the service they received.

We spoke with family members of two people, who told us that care and treatment choices had been discussed with them. One staff member we spoke with told us, "Care plans are always agreed with the person or their family".

Is the service responsive?

We found the provider listened to people's views and made changes to the service provided as a result. We saw the provider made changes to the staff supporting people as a result of comments received from people and their families.

The provider had in place a system of person centred planning. This involved a written statement which was called this is me, which gave an overview of the person's life history, their likes and preferences. Records showed that people were supported in line with these plans.

People were supported to maintain relationships with their friends and relatives.

Is the service well-led?

People's views had been obtained by the provider along with the views of family representatives and staff. We found the provider took these views into account and made changes to the service provided.

Regular spot checks were carried out by the provider to ensure staff were working in accordance with people's care plans.

Staff we spoke with told us they received sufficient training and supervision to carry out their roles effectively. We looked at staff training records and saw that training was planned and provided. One staff member told us, "They support you with training" and another said, "The teamwork at Care Force is great, everyone works together well". The provider was able to provide evidence that most of the staff held vocational qualifications relevant to their role.

The provider had taken action to address areas identified for improvement by the county council following an annual contracting monitoring review carried out in 2013.

During our inspection we spoke on the telephone with three people who used the service and four relatives. We also spoke with the registered manager and five members of staff.

People were complimentary about the care and support that they received. One person told us: "They are all wonderful”. Another person said, "We are very pleased”.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had systems in place to effectively manage complaints.

We inspected the agency office and spoke on the telephone with three people who used the agency and two relatives. We found that people were able to express their views and had been involved in making decisions about their care and treatment.

People were complimentary about the care and support that they received. People said the agency was “Pretty good, pleased with it. It depends on the individual staff; I have a very high quality individual”. Another person said, “I rate the agency nine out of 10. They consider what is going on, look out for problems, and care about what happens to me”. This meant that people felt the agency were meeting their individual needs.

We found that people who used the agency were protected from the risk of abuse.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had some systems in place to regularly assess and monitor the quality of service that people received.

We visited the agency office and spoke on the telephone with people that used the agency and this included a relative of one person who used the service. We talked to people about their experience of the care and service they received from the agency. People told us that ‘overall the care was very good’. They said that the agency ‘have not let me down yet’. They are ‘very good, I would complain if not’.

‘I have a laugh and a giggle with my carer, and they are very patient and kind’.

‘I would not hesitate in recommending the agency to anyone else’.

We were told that the registered manager ‘will always sort out any issues immediately, but these occur infrequently’. The registered manager was ‘very responsive and easy to talk to’.

People told us the care staff were polite and respectful towards them and were kind and respected their dignity whilst they assisted them with personal care. They told us that staff always stayed with them for the allocated length of time.

People who used the service said that the agency had discussed their care plan with them and that they had agreed to the content. They told us that the care workers carried out the care as stated in their care plan.

We found that people received effective, safe and appropriate care, treatment and support that met their needs.