We undertook an announced inspection of Care24Seven on 18 July 2017. We told the provider 24 hours before our visit that we would be coming because the location provided a domiciliary care service for people in their own homes and the registered manager and staff might be not be available to assist with the inspection if they were out visiting people. The service was last inspected on 14 July 2015, when we rated all the key questions and the service overall ‘Good’..

Care24Seven provides a range of services to people in their own home including personal care. Most people using the service were older people, although there were also some younger adults who had learning disabilities and mental health needs. At the time of our inspection 53 people were receiving personal care in their home. Most people were paying for their own care, and a small number of people were funded by their local authority.

The agency is owned by Eager Health Limited, a private organisation set up by a family.

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.

People's needs were assessed by a senior member of staff prior to receiving a service and care plans were developed from the assessments. However, some care plans did not contain the necessary information for staff to know how to support people and meet their needs and were not written in a person centred way. We have made a recommendation with regards to improving care planning to make these more person centred.

The risks to people's wellbeing and safety had been assessed, and there was information on people’s records about how to mitigate these risks.

There were procedures for safeguarding adults and the care workers were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Feedback from people and their relatives was positive. Most people said they had regular staff visiting which enabled them to build a rapport and get to know them.

People we spoke with and their relatives said that they were happy with the level of care they were receiving from the service.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act 2005 (MCA) and told us that all staff had received training on this. People had consented to their care and support and had their capacity assessed prior to receiving a service from Care24Seven.

There were systems in place to ensure that people received their medicines safely and the staff had received training in the management of medicines.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff’s absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

People's health and nutritional needs had been assessed, recorded and were being monitored.

Care staff received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

There were systems in place to monitor and assess the quality and effectiveness of the service, and the provider ensured that areas for improvement were identified and addressed.

People, staff and relatives told us that the registered manager and senior team were approachable and supportive. There was a clear management structure, and they encouraged an open and transparent culture within the service. People an

The inspection took place on 14 July 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service we needed to be sure that someone would be in. We last inspected the service on 17 September 2014 when we did not identify any breaches of Regulation.

Care24seven is a domiciliary care agency providing personal care and support to people who live in their own homes. The majority were older people, although there were some younger adults who had learning disabilities and mental health needs. The agency is owned by Eager Health Ltd, a private organisation set up by a family. The directors (also the owners of the organisation) were involved in the day to day management and worked alongside the 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.

Some of the things people told us about the agency were, ‘’I am very happy’’, ‘’I am extremely happy with the service and the care she receives’’ and ‘’Yes it is a good service, nothing could be improved, we are very satisfied”.

There were appropriate procedures for safeguarding people. The staff were aware of these and had received relevant training.

The risks people were exposed to had been assessed and there was information about how these risks could be minimised.

The agency employed enough staff to meet people’s needs and keep them safe. The recruitment procedures included checks on staff suitability.

People were supported to receive their medicines in a safe way.

People had consented to their care and treatment and this had been recorded.

The staff were well trained and supported so that they could safely meet people’s needs.

People’s healthcare and nutritional needs had been assessed and were monitored and met.

People had good relationships with the staff. They said the staff were kind and caring. Their privacy and dignity were respected and they were able to make choices.

People’s needs were assessed and care was planned and delivered to meet these needs. People were involved in planning their own care.

There was an appropriate complaints procedure and people knew how to make a complaint. They felt these were taken seriously and investigated.

The agency was a family run business and there was a positive culture where people and staff felt supported.

There were appropriate systems for monitoring the quality of the service.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

There were 38 people receiving the regulated activity of personal care at the time of our visit. We spoke with four people who used the service and two relatives. We spoke with the provider and two members of staff. We reviewed care records for people who used the service and records relating to the management of the service, which included four staff files.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us and the records we looked at.

Is the service safe?

The relatives we spoke with told us they felt their family member was safe with care workers. There were good recruitment procedures in place, ensuring the safety of people receiving care was fully considered. Staff experience and expertise was fully considered and there had been staff training in the past year, which included safeguarding adults.

There were up to date care plans in place for each person and there was evidence potential or actual risks had been assessed and plans put in place to manage such risks. Care plans included details of health professionals involved in the delivery of each person’s care.

Is the service effective?

People who used the service were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A member of staff told us, "I always ask what the client would like me to do." We saw records, which indicated staff were being observed by the provider to ensure they were caring for people with dignity.

Is the service caring?

Staff told us how they cared for the people who used the service, working to meet the needs of people as individuals. A person who used the service told us, "My care worker is very caring, accommodating, friendly and honest.” Another person told us, “We are very pleased with them.”

Is the service responsive?

People’s individual needs had been assessed by suitably experienced staff. The staff we spoke with were aware of the needs of people who used the service and how to meet their care needs. The relatives we spoke with told us they were aware of how to make a complaint. The provider told us two complaints had been made in the past year and they had been investigated.

Is the service well-led?

Staff told us they had regular meetings with the provider and also had spot checks. Written feedback had not been obtained from people who used the service in recent years; however people who used the service were asked for verbal feedback during quality assurance checks.

On this occasion we did not talk to people who use the service as we inspected Care24Seven to follow up on a Warning Notice we served on the provider in relation to the management of medicines. This was due to us finding at our inspection on the 22 May 2013 that the service did not have appropriate arrangements in place for the management, safe handling and administration of medicines that were prescribed for people.

At the inspection in May 2013 we also found that care workers did not receive a comprehensive induction, training and supervisions to ensure they were skilled and competent to provide care and support to people who use the service.

Our findings from this inspection were that the provider had taken appropriate steps to ensure that people who use the service were protected from the risks associated with medicines. Similarly, people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We carried out this inspection because our last inspection on the 17 January 2013 showed that the provider was not complying with two Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was due to the lack of appropriate arrangements for the management of medicines and lack of induction and training for care workers who provided care and support to people.

During this inspection we found that the provider had not made the improvements we asked them to make to ensure that risks to people were minimised, and for people to receive safe and appropriate care. They did not have appropriate arrangements in place for the management, safe handling and administration of medicines that were prescribed for people. Care workers did not receive a comprehensive induction, training and supervisions to ensure they were skilled and competent to provide care and support to people who use the service.

The provider had not met the compliance actions and had failed to ensure that risks to people were minimised. This is being followed up and we will report on any action when it is complete

During this inspection we spoke with five care workers and eight people who use the service or their relatives over the telephone. Some people told us they had support that was specific to a particular need, such as help with a shower or companionship, whereas other people had live-in care workers who provided them with constant support.

Relatives said that the staff were committed in their work and showed a respectful attitude towards people who use the service. People told us that they liked the staff who supported them as they were reliable and treated them kindly. Where people had live-in packages of care, or were suppported with companionship, there was a dedicated team of care workers who provided this.

People we spoke with said they felt the care workers and office staff listened to them and took action regarding any concerns they had. People told us that the office staff were responsive to their requests and any changes to support requirements were met promptly.