Care Staff Services Ltd is a domiciliary care agency. It provides personal care to people living with dementia; older people and younger adults living in their own houses in Slough and Buckinghamshire. The service was providing a regulated activity to 19 adults who were using the service at the time of our visit.

The service has 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.

This is the first inspection under Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives felt staff were caring, kind and listened to what they had to say. A person commented, “All carers are very friendly. They talk with me and we have a joke.”

People received care from staff that made them and those close to them, feel like they mattered. Staff had established good working relationships with people and their families’. Staff encouraged people to be independent and care records contained information about their personal circumstances and how they wished to be supported. People and their relatives said staff treated them with respect and protected their dignity.

People felt safe when receiving care and support from staff. Safe recruitment practices were in place and people were kept safe from infection. There were safe administration of medicines. We have made a recommendation for the service ensure their medicine policy is updated to reflect NICE (National for Institute for Health and Care Excellence) medicine guidance. Staff were aware of their responsibilities to protect people from abuse and had attended the relevant training. However; staff did not have access to the service’s safeguarding adult’s policy and the local authority’s specific procedures for reporting and managing safeguarding matters. We have made a recommendation for the service to ensure these policies are easily accessible to staff.

This meant the service did not have appropriate records to assess identified risks and the impact it had on people using the service.

People were supported to have maximum choice and control of their lives. However, we found senior staff had limited understanding of the MCA and its code of practice.

Staff were not always appropriately inducted; trained and supervised. We found staff did not always receive training; learning and development to enable them to fulfil the requirements of their role. Staff worked within the principles of the Equality Act 2010 to make sure their work practice did not discriminate against people. Peoples’ nutritional needs were met and they had access to other health services.

People and their relative felt the care delivered was responsive and met their specific needs. A relative commented, “I explained what we wanted and they (staff) have followed this.”

People had their needs assessed before and shortly after they joined the service. Care records were person-centred and recorded peoples’ needs and preferences. This did not include their preferences for end of life care. We recommend the service seek current guidance and best practice in relation to people’s end of life preferences and wishes and staff training.

People knew how to raise concerns. We found the service responded to complaints appropriately. The service was not aware of the accessible information standard and their legal responsibility to meet it. We have made a recommendation for the service to seek current guidance and best practice in order to be compliant with the Accessible Information Standard.

People and their relatives felt the service was well-led and staff spoke positively about the support they received from management. People were given the opportunity to express their opinions about