We carried out an inspection of CarePlus 24 Agency Domiciliary Care Agency (DCA) on 24, 29 and 30 April 2015, we found the provider had not met the regulations in relation to the safe management of medicines, and had not ensured staff were of good character and suitable to work with people who used the service. People’s personal records were not accurate and up to date. The provider did not have an effective system to regularly assess, monitor and improve the quality of service that people received. An action plan was submitted by the provider that detailed how they would meet the legal requirements by August 2015.

We undertook this inspection on 23 May 2016 to check the provider had made improvements and to confirm that legal requirements had been met. At this inspection we found improvements had been made and the provider was now meeting the regulations. We told the provider two days before our visit that we would be coming. We did this because they were also the registered manager and were sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure that they would be in.

CarePlus 24 provides personal care services to people in their own homes. At the time of our inspection three people received care from a member of staff who lived-in at their home. CarePlus 24 provides support for people who require a range of personal and care support related to personal hygiene, mobility, nutrition and continence. Some people were living with early stages of a dementia type illness or other long-term health related condition. People lived reasonably independent lives but required support to maintain this independence.

In addition to the DCA the provider also provided care staff to work in local care and nursing homes on a temporary basis. These staff are often referred to as ‘agency staff.’ This type of agency is not regulated by the Care Quality Commission (CQC) therefore was not included in our inspection although it is referred to in this report.

People were supported by staff who knew them well. Staff had a good understanding of people’s individual needs and choices. People told us they received the care they needed and wanted. They said they were involved in making their own decisions on a day to day basis.

Some people required support to take their medicines and this was done safely by staff who had received the appropriate training. Risks were well managed and people were supported to stay as safe as possible whilst maintaining their independence and lifestyle choices.

There were enough staff who had been safely recruited to look after people. Staff were introduced to people and were known to them before they supported them alone. Staff received on-going training and supervision to help them meet the needs of people who used the service. Staff told us they felt supported by the manager who was open and approachable.

People were regularly asked for their feedback through care reviews and telephone contact by the registered manager. There was a quality assurance system in place to assess and monitor the quality of the service.

We spoke with three people who used the service, one relative and three staff members. We looked at the care records for two people and we saw training records and staff files for the three staff members.

We found that people who used the service were included in the assessment, planning and delivery of their care. People we spoke with told us that staff were respectful and considerate at all times. They told us that they felt safe in the care of the staff and that the manager was always available and happy to answer any questions.

We saw that care plans were reviewed every month by the provider and that every three months there was a review which included the other professionals involved with the person who used the service.

We saw that the staff were trained in the prevention of abuse and could apply this knowledge to the people they cared for. We saw that the staff were well trained. The staff told us that they were able to ask for additional training if they felt it would further improve the care they provided. We saw that staff had regular supervision including checks on training needs.

We found that the management had systems in place to assess and monitor the quality and effectiveness of the service that they provided. Faults and incidents were logged in the person’s care records and in their file in the main office. The provider only cares for a small number of people at present but as this changes, a formal system of recording may be a consideration.

We undertook an announced inspection of Care Plus 24 Agency Domiciliary Care Agency (DCA) on the 24, 29 and 30 April 2015.

Care Plus 24 provides personal care services to people in their own homes. At the time of our inspection six people were receiving a personal care service. Three people received care from a member of staff who lived-in at their home. Three people received a number of care visits throughout the day according to their assessed needs. CarePlus 24 provides support for people who require a range of personal and care support related to personal hygiene, mobility, nutrition and continence. Some people were living with early stages of a dementia type illness or other long-term health related condition. People lived reasonably independent lives but required support to maintain this level of independence.

In addition to the DCA the provider also provided care staff to work in local care and nursing homes on a temporary basis. These staff are often referred to as ‘agency staff.’ This type of agency is not regulated by the Care Quality Commission (CQC) therefore was not included in our inspection although it is referred to in this report.

The registered manager at CarePlus 24 is also the provider. 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 were supported by staff who had a good understanding of their individual needs and choices. People told us they received the care they needed by regular staff who they knew well. They told us they were involved and able to make decisions about their day to day care. However, people’s care records did not always reflect the care they required. Care plans were not detailed and did not include all information staff may need to provide care. Care plans were not updated when people’s care needs changed.

Medicines were not always managed safely. There was limited guidance for staff about ‘as required’ (PRN) medicines. There were no risk assessments in place to support staff. Medicine Administration Record (MAR) charts were not in place for some people who required support with medicines or topical creams.

Safe recruitment practices were not in place. Criminal record checks had taken place however there was not a full employment history in place for each member of staff. This meant the provider could not demonstrate staff were of a good character and suitable to work with people who used the service.

Staff received training and support although this was not always documented. It was not clear how the provider identified what training staff required. Staff had an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) however, not all staff had received DoLS training

There were enough staff to meet people’s needs. Staff had a good understanding of safeguarding

procedures and what steps they would take if they believed someone was at risk of abuse of harm.

Risk assessments were in place and these identified both personal and environmental risks.

People were supported to maintain their own health. People were referred to their GP and supported to attend other healthcare appointments as needed.

There was a complaints policy in place, people told us their concerns were addressed appropriately but this was not recorded.

There was not an effective system in place to assess, monitor and improve the quality of the service provided; therefore the provider was not aware of all the shortfalls we found.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.