About the service:

Care Response is a domiciliary care service. At the time of the inspection the service was supporting 31 people in their own home. People supported included older people, younger people and people living with dementia.

People's experience using the service:

• People received a service that was safe. The provider had systems and processes in place to protect people from the risk of harm and abuse. Medicines were managed safely.

• People received care and support from staff who were trained sufficiently and had the right skills and knowledge, this led to good outcomes for people.

• Staff respected and promoted people's independence, dignity and privacy, staff developed caring

relationships with the people they supported.

• People's care and support met their needs and reflected their preferences.

• Management processes were in place to monitor and improve the quality of the service. There was a positive, open and empowering culture.

Rating at last inspection:

• At the last inspection the service was rated good (6 October 2016).

Why we inspected:

• This was a planned inspection to check that this service was meeting the regulations and to give them a rating.

Follow up:

• We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Care Response provides personal care to older adults, some of whom have dementia throughout Ascot, Bracknell, Old Windsor and surrounding areas. The office is located in the main street of Sunninghill just outside of Ascot, Berkshire. Staff provide care to people within an approximate 10 mile radius of the office. The service promotes the independence of people by supporting them at home. Care calls range from 15 minute ‘pop in’ visits to one hour and above. People structure these calls to suit their needs. Services provided range from assistance in the morning (including helping people get out of bed, wash, get dressed and have breakfast) shopping, preparation of food, medication prompting and assistance with evening care routines.

At the time of the inspection, there was 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 2008 and associated Regulations about how the service is run.

The most recent inspection was a desk-based review in September 2014, following outstanding non-compliance from a prior inspection on 5 February 2014. A desk-based review meant the inspector had assessed it was not necessary to perform a site visit, and instead reviewed documentation and other evidence sent by the provider. The desk-based review checked whether the service had improved in assessing and monitoring the quality of the service and supporting staff. These outcomes were found compliant at the time. A full history of the service’s inspections and reports is available on our website. This is the first inspection and rating of the location under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Act 2014.

At the time of the inspection, 54 people used the service and there were 20 staff. People received care visits in the morning, at lunch time, at supper and in the evening. The service operated from 7am to 10pm each day and people, relatives, staff and healthcare professionals could telephone the office anytime to receive support. After hours, calls were diverted to the on-call manager’s mobile telephone.

People were protected against abuse or neglect. Staff we spoke with were professional and caring and enjoyed working with people who used the service. People’s opinions of the care provided were consistently positive. There were sufficient staff to meet people’s needs at all times, and the service appropriately determined correct staff deployment. People’s medicines were administered, stored and documented appropriately.

The service was not consistently effective. Staff received induction, training, supervision and performance appraisal for their roles. The service utilised Skills for Care’s ‘Care Certificate’ for new care workers and there was evidence they had successfully completed the many components. However, we found that progress through the ‘Care Certificate’ was too rapid for new staff and there were gaps in ongoing staff supervision dates. Recruitment and selection of new staff members was robust and ensured safety for people who used the service. Consent was gained before care was commenced and people’s right to refuse care was respected by care workers. However consent was not always gained lawfully by the service from the relevant person. We made a recommendation in the report regarding gaining lawful consent.

We found staff were kind and generous. People’s comments mirrored our findings from the inspection. Staff told us they respected people’s privacy and dignity, and ensured people remained as independent as possible. People had regular opportunities to provide feedback to the service and also have their say in how things operated.

The service was responsive to people’s needs. People had the ability to share their compliments, concerns and

We spoke with five people who told us the staff "respect me" and are "helpful in every way", they told us the staff always ask "what we want" and are "regular with their timings". People told us they felt involved with formulating their care and could make any changes if they wanted to.

We reviewed the care plans for five people and saw that a wide variety of assessments are performed prior to care commencing which are considerate of both the physical and environmental needs of people within their own home. We saw that each care plan is written individually taking into account the wishes of people and the daily records reflect the care documented in the care plan.

We looked at the training of staff and found there a large majority of staff without essential training in safeguarding, mental capacity and deprivation of liberty training and the staff we spoke with had a limited understanding of procedures which enabled best interests to be safeguarded. We also found that the care records did not have essential documentation or assessments to support those people who were assessed as unable to understand and/or make decisions regarding their care.

People who use the service, their relatives and staff said people's privacy and dignity were respected when they received care. They said the service provided person centred care and we saw the information related to people's care was individual to their care, communication and social needs. People told us the service met people's care needs. However they said the service sometimes lacked continuity in staffing, punctuality and communication. People who use the service told us they thought staff were competent and had the necessary skills to care for people.

All the care workers we spoke with had received training in safeguarding vulnerable adults and whistleblowing. Care workers said they would be confident to use the whistleblowing procedures they had been trained in. Care workers had also received training in the Mental Capacity Act 2005.

Appropriate checks were undertaken before staff began work. We looked at five staff files and found they contained evidence of suitable recruitment procedures and appropriate checks which indicated staff were fit to care for vulnerable adults.

People's personal care records and other records relevant to the management of the service contained relevant information, were accessible and were stored appropriately.