About the service: Care Relief Team Limited is a domiciliary care service providing care for people who need care at home. The service is managed from an office in Dunston, on the outskirts of Chesterfield, and covers northern Derbyshire. The service is registered to provide personal care. At the time of our inspection there were 300 people using the service.

People’s experience of using this service:

People were safeguarded from the risk of abuse. Staff we spoke with knew what action to take if abuse was suspected. Risks associated with people’s care had been identified and managed so that people were supported to keep safe. People’s medicines were managed in a safe way and errors were identified and actioned through the audit process. Accidents and incidents were identified and recorded and trends and patterns were identified. Lessons were learned when things went wrong.

People’s needs were assessed and care was delivered in line with people’s choices. Staff received training and support to enable them to carry out their role effectively. People who required support to eat and drink were assisted to maintain a balanced diet.

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 we spoke with were very complimentary about the care workers. People told us the care workers were kind, caring, compassionate, friendly and approachable.

People’s care records were person-centred and detailed how people required their care delivering. Complaints were dealt with appropriately and in line with the provider’s policy.

The provider had a system in place to monitor the quality of service people received and to take action when required. Quality surveys were completed and actions taken to develop the service.

More information is in the full report.

Rating at last inspection: Good (report published 6 May 2016)

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Care Relief Team Limited is a domiciliary care service providing care for disabled adults who need care at home. The service is managed from an office at Dunston, on the outskirts of Chesterfield, and covers northern Derbyshire. The service is registered to provide personal care.

We carried out this inspection on 8 March 2016. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure that the registered manager, or someone who could act on their behalf, would be available to support our inspection.

At our last inspection of this service on 28 August 2013, we found that the service was compliant with the regulations and no concerns were identified.

A registered manager was 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.

Staff were appropriately recruited, trained and supported. They had all undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. Communication was effective and regular meetings were held to discuss issues and share best practice. Staff understood their roles and responsibilities and spoke enthusiastically about the work they did and the people they cared for.

The provider had detailed policies and procedures relating to medicine management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicine training was updated appropriately.

Staff knew the people they were supporting and provided a personalised service and used effective systems for gaining consent. Individual care plans, based on a full assessment of need, were in place detailing how people wished to be supported. This helped ensure that personal care was provided in a structured and consistent manner. Risk assessments were also in place to effectively identify and manage potential risks.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Systems were in place to effectively monitor the safety and quality of the service and to gather the views and experiences of people and their relatives. The service was flexible and responded positively to any issues or concerns raised. People and their relatives told us they were confident that any concerns they might have would be listened to, taken seriously and acted upon.

We received the views of 26 people who use the service: by questionnaire and/or telephone. Most people thought their needs were understood by their support workers. One person said of staff, “They’re pretty good. They treat me and my home with respect.” The records we read showed that support workers were aware of people’s needs and the potential risks to which they were exposed.

Most of the people who we had contact with felt that support workers were competent and did a good job. One person said, “I wouldn’t be able to manage without them.” Those people who required assistance from staff in administering their medicines described safe practice from support workers.

People’s views on the service they received were being sought by the agency and these views were acted on. We saw records which showed that people, and their support workers, were being sent annual satisfaction questionnaires. Responses from these were generally positive.

We spoke by telephone with four people who use the service. They all agreed that their privacy and dignity was respected by the agency’s support workers. One person told us, “[Staff] leave me to speak to visitors quietly.”

Three of the people had been involved in drawing up their care plans. They all felt that their needs were well understood by the agency’s support workers. Also, they all confirmed that staff encouraged them to be as independent as possible and told us that staff listened to them and acted on what they said. They confirmed that staff were reliable.

Those people who required assistance from staff in administering their medicines described safe practice from support workers. Although people felt safe we found evidence of poor medicine recording practices and these are detailed in this report.

People felt that staff were recruited safely and our observations supported this. People were, generally, positive about the quality of the service they received. One person said it was, “Very good.”

As part of this inspection we spoke by telephone to a good number of people who were supported by the agency and saw staff from the various ‘patches’ in small groups throughout the inspection at the office. We also spoke with the agency’s operational managers and some of the care coordinators who told us about their work.

All of the people we spoke to described very positive relations with the staff who provided support and care, and good relations with the agency’s office based coordinator and management staff. They told us that staff worked sensitively and carefully and that ‘they are very respectful of privacy and dignity’ and that ‘they work to keep me independent’. We were also told about the flexibility of the arrangements being made and how the agency was responsive to requests to change things. Staff told us that ‘it’s about everybody working to a consistent pattern but the overall service must have flexibility to respond to what people want’.

Patterns of care delivery worked well for the people being supported and a number we spoke to required help using specialist equipment. This was managed well and they told us that ‘although the care plans are detailed my husband trained the staff in how to use the hoist and everybody has settled into the routine of the care that is needed’ and that ‘the staff help each other with the equipment and I make sure that it’s not uncomfortable’. Everybody is given a care plan and told us how ‘the care plans and assessments are particularly useful to get started quickly’.

People told us in general terms about their confidence in the agency’s staff to work safely and the staff that we spoke to all told us that they had received proper training about abuse of vulnerable people and they demonstrated an understanding about their responsibilities to report any concerns. We were told by staff that they had access to very high levels levels of training and qualification generally, and that this commenced as soon as they started work at the agency. They told us that they felt well supported to carry out their work properly and that support from the office team was ‘always available and very responsive’.