About the service: Carepoint Limited t/a Alternative Care - Suite 1 Parkside House is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection, 91 people were using the service.

People’s experience of using this service: The provider displayed a commitment to providing high quality person-centred care. However, we identified significant shortfalls with the leadership of the service. The provider did not have systems in place to check the safety and quality of the service provided; complete and accurate records were not always in place. The issues we found during our inspection had not been identified by the provider.

Information was not available to help guide staff about the support people needed to manage risks or specific health conditions. Safeguarding concerns had not always been reported and responded to appropriately and thorough recruitment processes had not always been followed. We have made a recommendation regarding safe recruitment processes.

Staff received an induction and shadowing opportunities when they joined the service, however this was not recorded. Staff had not been fully supported in their role. Regular supervisions and observation of practice had not taken place.

Medicines were recorded and administered safely. People were clearly at the heart of the service. Staff treated them with dignity and respect and their independence was promoted. People were supported by a consistent team of staff who were familiar with their likes, dislikes and preferences. Staff understood the importance of knowing people’s abilities and working with them to achieve positive outcomes; this level of information was not recorded in people’s care files.

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. Choices people made were respected although consent was not recorded.

People felt they were listened to and their views respected. People told us the service was responsive to their needs and the support provided had improved their well-being. They were asked to provide feedback on the service provided and had regular visits from office staff.

People and staff spoke positively of the management team. The provider and staff team were passionate about providing a caring service but accepted there were significant shortfalls with records.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection: Good (report published 26 July 2016).

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

Enforcement: We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around good governance and safeguarding service users from improper treatment and abuse. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least good.

This inspection took place on 19 May 2016 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because we wanted to make sure care staff would be available to answer any questions we had or provide information that we needed. We also wanted the registered manager to ask people who used the service if we could contact them.

The service is registered to provide personal care and support to people in their own homes. The service provides support to younger and older people, people living with a dementia type illness, people with a learning disability, mental health issues, physical disabilities and or a sensory impairment. At the time of the inspection the service was providing support and personal care to 190 people in their own homes.

At our last inspection on 10 April 2014, the service was meeting all of the regulations that we assessed.

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 were supported by care staff who had received training in how to recognise possible signs of abuse and how to report any concerns. Staff were aware of their responsibilities in this area and what actions they should take to keep people safe from harm. Staff were aware of the risks to people on a daily basis and how to manage those risks.

People were supported to take their medication safely.

Staff were recruited safely and received an induction and opportunities to shadow colleagues prior to commencing in post. Staff benefitted from regular training to ensure they had the skills to meet the needs of the people they supported. Staff understood the importance of obtaining people’s consent prior to supporting them with their care needs.

Staff were aware of people’s nutrition and health care needs and supported people appropriately.

People were supported by care staff who were kind and caring. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People were involved in the planning of their care and staff delivered care in line with what was considered to be people’s preferences and wishes. People’s care needs were regularly reviewed and care staff kept up to date with any changes in their care or support.

There was a system in place for investigating and recording complaints and people were confident that if they did have any concerns, that they would be dealt with appropriately. The management and staff group were described as supportive and people considered the service to be well led.

Medication audits had not taken place and other audits had failed to identify some of areas that came to light during the inspection. Care plan paperwork did not always reflect the most up to date information regarding people who were supported by the service.

Communication systems between care staff and the office staff were not as effective as they could be.

People were happy to recommend the service to others, based on their own positive experiences. Responses received from completed questionnaires, demonstrated that people were happy with the service they received.

Staff felt listened to, well supported and able to contribute to the running of the service.

Efforts were regularly made to obtain feedback from people who used the service, in order to improve the quality of the service to people.

Our inspection was carried out at the agency's office. On the day of our inspection visit we were told that Alternative Care was providing support to 200 people. During our inspection we looked at 18 care records and spoke with the care manager and senior care worker. We later spoke with five staff and ten people that used the service or their relative / representative.

People and their relatives were involved in their care. One relative told us, "We have been very pleased with the agency and feel they meet our relative's needs."

Care plans and risk assessments were in place to support people's needs. One person told us, "I am happy with the carers that visit me."

Arrangements ensured that people were safeguarded against the risk of harm. One person told us, "I feel safe with the carers that come into my house."

We saw that systems were in place to audit and monitor the quality of the service being provided.

Our inspection was unannounced which meant that no one knew we would be visiting. On the day of our inspection the agency was providing support to 201 people. During our visit , we looked at 16 care records and spoke with the manager and the care manager. We later spoke with six care staff and 11 people that used the service and / or their representatives.

People were involved in their care and were encouraged to do things for themselves as far as possible.

Care Plans and some risk assessments were in place so that staff had the information they needed to meet people's needs. However from those sampled, we found they were task orientated and not personalised. Some staff told us, "They could be more detailed about the person". This meant that staff did not have all the information needed to take a person centred approach to meet people's needs.

Arrangements were in place to ensure people were safeguarded from harm.

Staff were supported, supervised and trained in their roles. One staff member told us, "I like working for the company, we have a good team".

We saw the organisation had a system in place so that people could make complaints about the service that they receieved and these were acted upon appropriately. One person using the service told us, "Everything is fine at the moment, I have no complaints".

We saw some systems of audit in place but these were not robust and did not effectively assess and monitor the quality of service provision.

We visited the offices of Carepoint Limited /Alternative Care to look at records. We spoke with the registered manager, the deputy manager and five staff. On the day of the inspection the service supported around 150 people. We spoke with five people who received care and sent questionnaires to 45 people and / or their relatives to ask them about their experience.

Below is a summary of what we found.

Is the service safe?

Everyone that we spoke with said that they felt safe with the staff that supported them. One person told us, “I am always happy with the girls that care for me. They are very gentle. They make sure I am safe and that I have my pendant alarm on when they leave. They always check that my door is locked as they go.”

The provider had policies and procedures in place to protect people from harm. All the staff that we spoke with confirmed that they had received training on how to protect people and understood what safeguarding people meant. Staff training for protecting vulnerable adults had been completed and their training was up to date. This meant staff had the skills and knowledge to keep people safe from abuse.

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes. This is a domiciliary service. No one using this service was subjected to a Deprivation of liberty safeguard.

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receiving care and were able to make informed decisions. The registered manager told us and records showed that all staff had received DoLS and Mental Capacity Act 2005 training. This ensured that staff understood their responsibilities and the provider had taken the appropriate action to ensure that the rights of people were protected.

Everyone that we spoke with told us that their care worker talked to them about their care and they always give their consent to being supported. One person that we spoke with said, “We do things together and the carers do what I want them to do and I do what I can.”

All the people spoken with told us and records sampled showed that they received their medication when it was needed as prescribed by their GP. There were safe systems in place for the recording and administration of medication.

Is the care effective?

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people were able influence the care they received.

All staff spoken with were able to give us good detail about the support they provided to people. One member of staff said, “I ask them about what they want at each call. I give them choices.” People told us that they were supported by the same staff on most care calls which meant people received continuity of care from staff they felt comfortable with.

We saw that people’s cultural, dietary and linguistic needs were met by staff with the appropriate skills. For example, we saw that people were supported by care staff that were matched to their needs and understood their language or cultural requirements. One person said, “I have received care from them for a long time, I am happy with the care. I could never live at home without them.”

Is the service caring?

People told us they were happy with the care they received. We saw from daily records sampled that where staff had concerns about people’s health, additional visits were made and advice sought from healthcare professionals. We saw that people’s involvement with other healthcare professionals was recorded and their advice was followed. We saw records which showed and people spoken with told us that staff often visited them if they were admitted to hospital. One person told us, “The staff are wonderful. They really care for me and are always helpful. They get the doctor or my relative if I am unwell.” Another person told us, “They are respectful. I wouldn’t have them in the house if they were ever rude to me.”

Is the service responsive?

People told us that staff did what they wanted them to do. They told us that if their care workers were going to be late they were kept informed either by the care staff or the office. One person told us, “If my carers are going to be late they always let me know but it doesn’t happen much.” A relative told us, “The service is excellent. They are very good with mum. They are regular and pleasant; they talk to her and treat her well and with respect and kindness. I can trust them.”

Records sampled showed that there were systems in place to gather the views of people so that the service was developed taking into consideration the views of staff and people who received a service. Records showed that two complaints had been received by the provider since our last inspection in April 2013. We saw that these were investigated in a timely way. People told us that they were aware of who they should contact if they were unhappy about the service provided. People spoken with told us they were happy with the service and had not needed to make any complaints.

Is the service well led?

We saw that the service had a staffing structure that enabled the service to be managed appropriately. This included a manager that had been registered with us and was responsible for the running of the service. People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.

The provider had a robust quality assurance system and records sampled showed that any identified problems or opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

We saw that there was a system in place to record, monitor or analyse accidents so that lessons could be learnt and actions taken to avoid reoccurrence of avoidable accidents.

There was a system in place to monitor any falls that people had to identify any themes or trends to their falls. Records sampled showed that referrals were made to other healthcare professionals and their advice was followed to avoid re occurrences.

Staff told us they were clear about their roles and responsibilities and received regular newsletters or had frequent staff meetings. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Records showed that regular spot checks on staff practices were by carried out by the manager. We sampled the findings and saw that they were detailed and feedback was provided to staff following these checks. Records showed that supervision and staff training was regular and up to date. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.