This inspection took place on 19 and 25 May 2017 and was announced. Carers Sitting Service is registered to provide personal care to people living in their own homes. At the time of our inspection, eleven people were receiving personal care.

The service was last inspected on 26 and 28 April 2016, when they were rated as Requires Improvement. On that inspection we found a breach of Regulation 12 and a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found care and safe treatment was not being provided in a safe way because the provider was not assessing risks, and was not ensuring the safe management of medicines. We also found the provider did not have systems to effectively assess, monitor and improve the quality of the service. Following our inspection the provider told us about the action they were taking to address to rectify the breaches. On this inspection we found improvements had been made.

The service did not have a registered manager in post at the time of our inspection. 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 protected from the risk of abuse and avoidable harm. People’s needs were assessed, and risks to people’s safety from their health condition and environment were identified and mitigated. Appropriate protective measures were put in place to minimise the risk of avoidable harm. Care plans were reviewed with people and updated to meet their changing needs and preferences. People’s medicines were managed safely.

People were happy with staff who provided their personal care. They were cared for by sufficient numbers of staff who were suitably skilled, experienced and knowledgeable about people’s care needs. People were also supported by staff in a caring, respectful way, which ensured their dignity.

The provider took action to ensure that staff were suitable to work with people before they provided care. Staff were trained, supervised and supported to provide people’s care.

Appropriate arrangements were in place to assess whether people were able to consent to their care. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA).

People were supported to be involved in their care planning and delivery. People’s care was tailored to meet their individual needs and wishes. People, their relatives, and staff felt able to raise concerns or suggestions in relation to the quality of care. The provider had a complaints procedure to ensure that any issues with quality of care were addressed.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. This included seeking and responding to feedback from people to inform the standard of care. Checks were undertaken on all aspects of care provision so that action could be taken to improve people’s experience of care when required.

This inspection took place on 26 and 28 April 2016 and was announced. Carers Sitting Service is registered to provide personal care to people living in their own homes. At the time of our inspection, 12 people were receiving personal care. Carers Sitting Service also provides a short respite service for family and friends who care for people in their own homes. For example, by cleaning, support with shopping, and sitting with a person so that family carers can attend appointments. These activities are not regulated, and are not inspected by the Care Quality Commission.

The service had a registered manager in post at the time of our inspection. 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, but risks associated with personal care were not adequately identified. Appropriate protective measures were not put in place to minimise the risk of avoidable harm. Care plans were not reviewed and updated regularly to reflect people’s changing needs.

The provider could not assure themselves that medicines were being managed in accordance with current regulations and guidance. Care plans were unclear about the level of support people needed with medicines, and there was no system in place to ensure that people received medicines as prescribed.

The provider could not demonstrate that all staff received training to ensure they had up to date skills and knowledge to provide effective care. Staff felt supported but they had not received regular one to one supervision. Most staff had not had one-to-one supervision with their manager in the last year, and over half the staff had not had an annual appraisal in the last year. The registered manager and deputy manager had received training in the Mental Capacity Act 2005 (MCA), but care staff had not undertaken any training in relation to capacity and consent.

The provider did not have adequate systems in place to monitor and review the quality of care people received. The local authority had identified concerns about risk assessments, quality of information in care plans, training and staff supervision and medication auditing. The provider was aware of these concerns, but had not undertaken the work required to resolve the issues.

Safe recruitment procedures were followed and appropriate pre-employment checks were made. Checks were undertaken to ensure new staff were safe to work in the care sector.

People were able to make their own choices about their personal care, and were involved in planning and reviewing their care. There were enough staff to meet people’s personal care needs at the time when they needed support.

People were happy and comfortable with staff and said they felt safe. Staff were trained and understood how to recognise abuse, and were confident to raise concerns.

There was a complaints process in place, and people were encouraged to express their views about the service. People and relatives felt confident to make suggestions for improvement of care or raise concerns.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

On the day of this inspection there were ten people using a service that included personal care. We spoke with one person who used the service and three family members of three more people. We spoke with the manager, care co-ordinator and two support workers. We looked at four care records. All people spoke positively about the service and the staff. One person said, “I cannot fault the service, it is outstanding.” Another person said, “I am very pleased with the service.”

We found that every person had a service user agreement and person centred plan. These had been signed by either the person or their family member to record their consent. This demonstrated that people had agreed to the care and support they received.

People’s needs were assessed and person centred plans developed. This was done in agreement with the people and their family. People told us that they had copies of the documents in their home. This meant that staff had access to information they needed to meet people’s needs.

Safeguarding procedures were in place and staff had received adult protection training. The provider had responded appropriately to an allegation of abuse and people were pleased with the response that was taken. This meant that people were protected from the risk of abuse.

We found adequate staffing levels to meet people’s needs. People told us that the staff were punctual polite and friendly. People felt safe and comfortable when staff were in their homes and felt that staff had the skills and knowledge to meet their needs. People’s gender preferences for support staff were respected and met. This demonstrated that there was sufficient staff with appropriate knowledge and skills to meet people’s needs and promote diversity.

Systems were in place to seek the views of people and / or their families. Additional spot checks were to be incorporated to ensure that people continued to receive a quality, safe service.

We spoke to one person who used the service and two relatives. Everyone gave us a consistent account of visits being made to talk to people about their needs before the service commenced. We were told that the manager or their Deputy always introduced staff to the person before they began visiting.

One person told us they had an information pack about the service with essential contact details and phone numbers. They told us the pack contained a complaints procedure so knew how to do this but had not ever had to. People we spoke with knew staff at the office by name and gave us examples where short notice visits had been arranged when unforeseen circumstances had arisen.

A range of positive comments were included on the surveys, these included; “I don’t know what I would do without the service”, “the service is excellent throughout”. One relative considered the person receiving a service was “well cared for”. Another person said “I am more than happy and I would be lonely without the service”, “staff couldn’t be more helpful if they tried”.

On the day of this inspection there were 8 people using a service that included personal care. We spoke by telephone with one person and a representative of two other people. We chose these people to reflect a range of needs and circumstances – such as, people new to the service and those with high levels of dependency. We spoke with these people to find out their views on how they were being supported by the agency. We also spoke with the manager, three support workers, and we read the care plans of three people. This was to find out more information on the quality of service provided by this agency.

The people we spoke with all agreed that their privacy and dignity was respected by the agency’s support workers. One person’s representative told us, “[Staff] knock before walking into the bathroom [when the person is bathing].”

All the people had been involved in drawing up their care plans and they felt that their needs were well understood by the agency’s support workers. They all confirmed that staff encouraged them to be as independent as possible and told us that staff listened to them and acted on what they said. They confirmed that staff were reliable.

People felt that staff were recruited safely and our observations supported this. People were very positive about the quality of the service they received. One person told us, “I wish I could have found them sooner…amazing service. “