We inspected Caring 4 All on the 7 November 2016 and it was an announced inspection. Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available. Caring 4 All provides personal care to people living in the areas of Hailsham, Eastbourne and surrounding villages. At the time of this inspection they were providing personal care for 14 people. These included people living with dementia, old people and people receiving end of life care.

The last inspection of the service was carried out in July 2014. No concerns were identified with the care being provided to people at that inspection and the provider was meeting the requirements of the Health and Social Care Act 2008. There is 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 who received personal care and support from Caring 4 All told us they were happy with the service provided. One relative told us, “Overall I would say first class we are very happy.” One person told us, “Excellent so far, no ifs or buts, even if I ring at short notice they will do things for me.” Another relative told us, “They have made things far easier for us and they brighten her day.”

Care workers received essential training on medicine management and people confirmed they received their medicines when required at each care call. Care workers demonstrated a firm awareness of how to administer medicines safely. However, medicines risk assessments were not in place. We have made a recommendation about the implementation of robust medicine management risk assessments.

Training schedules confirmed care workers had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Care workers told us how they gained consent from people before delivering care. Consent forms were in place for people to sign to indicate their consent to the package of care, care plan and sharing of information. However, where relatives were signing consent forms, the provider was unable to demonstrate that they had appropriate authority to do so. Where bed rails were in situ, the provider had not considered if the person consented to the bed rails of whether the bed rails were implemented in the person’s best interest. We have made a recommendation about mental capacity assessments and following the code of practice.

A robust quality assurance framework was not in place. The provider was not completing internal audits. Systems to monitor if care workers were staying the allocated times at care calls was not effective. Where care workers were not staying the allocated time, documentation failed to record the reason why. For example, although a care call was funded for 45 minutes, documentation reflected the care workers only stayed 15 minutes. People and their relatives raised no concerns over the timings of care calls and care workers not staying the allocated time. However, we have made a recommendation about a robust quality assurance framework which governs the running of the care agency.

People and their relatives told us care workers were respectful and treated people with dignity, kindness and respect. They told us care staff went above and beyond to ensure they were happy and well. People's privacy was maintained. Care workers had a firm understanding of respecting people within their own home and providing them with choice and control. One person told us, “They are very friendly and I am not made to feel like nuisance they are very caring and patient with me.” Another person told us, “They are very encouraging to me and respect my independence because I try and do what I can and when I am down in the dumps

Our inspection team was made up of one adult social care inspector. We spoke with staff, looked at documentation and records and spoke with four people who use the service. The service served a client base of between 16 to 25 clients.

The evidence we gathered enabled us to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people's needs? Is the service well-led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people's needs had been appropriately assessed before they were provided with care support. We saw evidence of this in care files. This meant that staff had the information they needed about people's care needs and were able to provide safe care.

There were sufficient numbers of experienced and competent staff available to meet people's personal care needs. We saw documentation that showed staff had been appropriately trained and received the managerial support they needed to do their job. Staff had all received training in the protection of vulnerable adults and they knew how to report concerns about poor care or respond to allegations of abuse. This meant that people were protected from the risk of neglect or unsafe care.

Suitable arrangements were in place to respond to emergencies, with the manager always being available 'on call' to support staff to manage the situation safely and in a timely way.

Is the service effective?

Staff had received the information, training and managerial support they needed to do their job effectively. There were arrangements in place that ensured staff had the most up-to-date information about people's care needs. This meant staff had a good knowledge of each person's preferences they were able to provide effective care.

Is the service caring?

All the people we spoke with said the staff were friendly, helpful, and conscientious. People were provided with support at a level which encouraged independence and ensured their individual needs were met. On person said, "The carers are all very pleasant and helpful. They have a good manner about them which I appreciate." Another person said that the care staff had always been "respectful" when doing their job.

Is the service responsive to people's needs?

We saw that there was enough staff available to meet the needs of the people. This was also confirmed by the people that we spoke to. People said the service was reliable and flexible. The service reviewed people's care plans to ensure they were up to date.

We found that staff had a good understanding of how to support people in a way that respected each person as an individual, each with their own needs and preferences for how they wished to receive their care and support.

Is the service well-led?

The provider continually monitored areas of risk in the service and made checks on quality. This included visiting people who used the service to ask what their views were of the service provided.

The manager ensured that people's care was planned. Staff understood people's needs because they followed people's risk assessments and care plans. Systems were in place to monitor quality and safety. The manager ensured that staff were recruited with the right skills and experience for the client group they cared for. Staff received an induction when they started with the organisation. Staffs received on –going training and were supervised by the manager. The provider had not had any complaints, accidents or incidents made to them.

At the time of inspection there were 14 staff looking after between 25 and 30 clients. The majority of these were suffering from terminal illnesses. People we spoke with were clear about what service they required. They told us they were fully involved in compiling their care package and were always consulted fully before any changes were made.

People we spoke with told us their needs were fully assessed and they were “Very satisfied” with the care and support they received. One person told us, “They often stay longer than required” and another said, “My wife really looks forward to their visits”.

We spoke with staff and examined the provider’s safeguarding policy. People were protected from the possibility of abuse because staff had received appropriate training and there were procedures regarding safeguarding vulnerable adults in place.

We examined staff files and found that there were robust recruitment, assessment and induction processes in place for new staff.

We found that there were effective systems in place to regularly assess and monitor the quality of service that people received.

People we spoke with were full of praise for the quality of the care and support they or their loved ones received. One person said the staff were “very efficient” and they would “thoroughly recommend” the agency. Another said that the staff “go above and beyond the call of duty.”

The staff we spoke with felt well supported by the manager and we saw that all had received mandatory training.

There were systems in place to ensure continuing high standards including client questionnaires and regular staff meetings.