What life is like for people using this service:

People were supported by safely recruited staff, who had the skills and knowledge to provide effective support. Staffing levels were regularly reviewed to ensure there were enough staff available to meet people’s needs. Effective care planning and risk management was in place which guided staff to provide support that met people’s needs and in line with their preferences.

People were supported by caring staff who promoted choices in a way that people understood, this meant people had control and choice over their lives. End of life planning had been completed which ensure people were supported in line with their wishes.

Effective systems were in place to monitor the service, which ensured people’s risks were mitigated and lessons were learnt when things went wrong. There was an open culture within the service. People and staff could approach the manager who acted on concerns raised to make improvements to the delivery of care.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection: Requires Improvement (report published 20 June 2017).

About the service:

Care Homes Stoke is a domiciliary care agency that was providing the regulated activity of personal care to 71 people in their own homes at the time of the inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection the service was rated requires improvement overall (in the key questions of Safe, Effective and Well Led). We found the required improvements had been made and the service has met the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through the information we receive.

The inspection was announced and took place on 16 and 17 May 2017. Car Homes Stoke provides personal care to people in their own homes. At the time of our inspection the service was supporting 117 people. We last inspected this service on the 9 November 2016 where we identified a number of concerns. This inspection was carried out to see if the provider had made improvements since the last inspection. We found some improvements had been made, however there were further improvements required.

There was a registered manager in post at the time of the inspection. 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 registered manager was also the provider.

People told us there were ongoing concerns relating to late calls and they were not consistently supported by sufficient numbers of staff to ensure their safety. The systems in place to ensure the safe management of medicines had improved however further improvements were required to the audits and checks that were completed to ensure people received their medicines as prescribed. People told us they felt safe and their risks were appropriately managed by staff. Staff had up to date information on people’s risks and how to manage them. People were supported by staff who knew how to recognise and report concerns about their safety. People were supported by staff that had been recruited safely.

People were supported by staff with the skills, knowledge and required support to provide safe and effective care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People who were supported by staff to prepare and cook meals of their choice and staff understood how to meet people’s specific dietary requirements. Where people were at risk of poor nutrition or hydration this was being monitored. People were supported to access healthcare professionals if required.

People told us staff were kind and caring and they were encouraged to make day to day decisions about their care and support. Staff respected people’s choices and promoted people’s privacy and dignity and encouraged their independence.

People were not always supported by a consistent staff team. Improvements had been made to people’s care records which now contained personal information regarding people’s specific needs and individual preferences, however not all records had been update at the time of this inspection. Most people and their relatives were invited to attend care reviews and provide their input. Staff were informed of any changes to people’s care needs to ensure they were able to provide effective support. The provider had made improvements to the complaints process and we saw complaints were documented, investigated and appropriate action taken to address concerns raised.

The provider had made progress in developing systems and processes to monitor the quality and consistency of the service. However these were not always effective at identifying the required improvements. There were processes in place to enable people and their relatives to provide feedback on the service. Staff felt supported in their roles and were confident to raise ideas or suggestions about how to improve the service or care for people. The provider understood their responsibilities to notify us of certain events such as allegations of abuse and serious injuries and had done so appropriately.

We completed an announced inspection at Care Homes Stoke Limited on 9 and 10 November 2016.

We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009.

The service is registered to provide personal to people in their own homes. At the time of our inspection 171 people were using the service. 58 members of staff were reported to be working at the service.

The service had 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 and associated Regulations about how the service is run. In this case, the registered manager was also the provider.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. Care calls were not being monitored and staff competence was not being checked. There were no audits in place to check the information contained in people’s care plans and risk assessments. This put people at risk of receiving unsafe care.

Risks to people’s health, safety and wellbeing were not identified, managed and reviewed and medicines were not managed safely.

There were insufficient staff delivering care at the service and there had been an increase in late and missed calls. This had impacted on people’s health and wellbeing.

People's care needs were not regularly reviewed. People’s care plans were not accurate and up to date which meant staff didn’t always have the information they needed to provide safe and consistent care.

The provider did not understand the requirements of the Mental Capacity Act 2005 and staff were not trained in this area of care delivery. Staff did not always understand what was meant by mental capacity.

Staff received training in order to meet people’s individual care needs and keep people safe. People’s health was monitored and managed to promote their health and wellbeing.

People were treated with dignity and staff were able to describe how they delivered care to meet people individual needs.

Effective systems were not in place to ensure concerns about the quality of care were investigated and managed to improve people’s care experiences.

The provider did not notify us of reportable incidents and events as required.