This inspection took place on 17, 21 and 24 May 2018. The inspection at the office premises on 17 May 2018 was announced but the subsequent visits to people in their homes on 21 and 24 May were not announced to the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

The previous registered manager of the service had left. The new manager had applied to register with the Care Quality Commission. 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 not receiving care and support in a consistently safe manner. This was because risks to people from receiving care and support were not managed effectively. For example risk assessments were not in place for people who required the use of a hoist with moving and handling. This put people at risk of unsafe practise for example if the wrong size sling was used. Where the service was responsible for managing people’s medicines this was not done in a safe manner. We saw examples of where medicines had been missed, or were stored inappropriately.

At the beginning of 2018 the service had missed a high number of visits. For the three weeks prior to our inspection there had been no missed visits. We discussed this with the manager and the provider’s head of quality. They told us that measures had been put in place to recruit additional staff and schedule calls effectively so that visits were not missed. However, feedback we received showed that covering all of the calls was still proving challenging for the service.

People expressed dissatisfaction to us that the service did not always send out a rota detailing the person that would be visiting them to provide their care and support. They also told us that if they did receive a rota it was often incomplete and the times that staff actually arrived varied from that on the rota. People also expressed dissatisfaction that they were not told the time care staff would call with visits being scheduled as ‘am’ call, or tea call. Not receiving an accurate rota meant people felt unsafe and their lives were disrupted when they did not receive support at the appropriate time.

People did not feel encouraged or empowered to raise concerns with the service. Incidents were described to us by people which had caused them concern but they had not felt able to raise these with the service. Where people had made a formal complaint they did not feel that this had been dealt with to their satisfaction.

Staff training was not up to date and one member of staff told us they regularly provided care and support having received no training from the service. This did not assure us that the service ensured staff had the skills and knowledge to deliver safe and effective care and support.

People were not always supported to maintain adequate nutrition. Where people required support with their nutrition effective care plans were not in place and food and fluid intake was not effectively recorded.

People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible. For example people had their medicines locked away in their homes without the appropriate procedures being followed. However, people told us that staff sought their consent before providing care and support.

We received mixed views as to whether care staff delivered care in a caring and supportive manner. Where people received support from a regular member of care staff they were complimentary but where a number of different care staff provided care and support, for example at weekends, the feedback was poor.

Car

Carewatch (Ipswich) provides personal care and support to people living in their own homes. When we inspected on 31 August 2016 and 9 September 2016 there were 129 people using the service. This was an announced inspection. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to know that someone would be available.

The registered manager had recently left their post and was in the process of cancelling their registration with the commission. 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. The provider had taken steps to recruit to the post and appointed a new manager to run the service and register with the CQC.

People we spoke with including their relatives were complimentary about the care provided. They told us they received safe and effective care by care workers who were compassionate, attentive and kind.

Systems were in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Care workers understood their roles and responsibilities in keeping people safe and actions were taken when they were concerned about people’s safety.

There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

There were sufficient numbers of care workers who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred. Care workers had developed good relationships with people who used the service and understood the need to obtain consent when providing care.

People received care and support which was planned and delivered to meet their specific needs. People and/or their representatives, where appropriate, were involved in making decisions about their care and support arrangements.

Where required people were safely supported with their dietary needs. Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

The service had an open and empowering culture. Care workers understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system in place and as a result the quality of the service continued to improve.