The inspection took place on 4 and 5 May 2017 and was announced. We gave the assistant manager 48 hours notice of the inspection to ensure that key people we needed to meet with were available.

The service provided personal care support and domiciliary care to people living in their homes in the South Gloucestershire, Bristol and parts of the Bath and North Somerset area. At the time of our inspection a personal care service was provided to 57 people. An additional 18 people were supported with domiciliary care services. The service employed 26 care staff, three service managers and one senior carer. The service was actively recruiting additional care staff in order to meet demand to cover care packages.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was not available for this inspection however the assistant manager, service manager and office based staff supplied all the evidence and information required.

People received a service that was safe. This was because staff received safeguarding adults training and knew what to do if there were concerns about a person’s welfare. They also received moving and handling training so those people who needed assistance to move from one place to another were supported correctly. Staff were recruited following robust recruitment procedures which meant unsuitable staff could not be employed. Any risks to people’s health and welfare were assessed and then well managed in order to reduce or eliminate the risk and chance of harm. Those people who needed assistance to take their medicines were supported to do so safely.

People received an effective service. Assessments were completed prior to a service being provided to ensure staff had the necessary skills and experiences to meet peoples needs. The staff team were well trained, supervised and supported to enable them to carry out their jobs effectively. Staff were given clear instructions about the people they supported. People were provided with support to have food and drink where this had been assessed as part of their care package. People were supported to access health care services if needed.

People received a caring service. Feedback received from people who used the service, relatives and health and social care professionals was overwhelmingly positive. People were treated with kindness and respect and the staff were kind, caring and enjoyed their job. Staff spoke about the importance of having good working relationships with the people they supported and the service manager ensured compatibility of staff and people as part of their rostering duties. People were encouraged to have a say about how they were looked after and the way the service was delivered.

People received a service that was responsive to their individual care and support needs. People’s needs were assessed and then a package of care put together that met those needs. Their preferences and choices were respected. People were provided with copies of their plans and their support package was regularly reviewed. The delivery of care services was adjusted as and when needed.

People received a service that was well-led. The registered manager, assistant manager and service managers provided good leadership and management for the care staff. There were regular checks in place of the quality and safety of the service in order to identify where any improvements could be made or changes were required. The recent changes in the staffing structure had been put in place to allow the service to expand and support more people to live in their own homes.

We carried out an announced comprehensive inspection of this service on 25 August 2015. During that inspection we found breaches of legal requirements. As a result of this we undertook a focused inspection on 13 April 2016 to follow up whether action had been taken to meet the legal requirements.

This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Caring Comes 1st’ on our website at www.cqc.org.uk.

At the time of this inspection the service was providing support to 56 people who lived in their own homes. The areas they covered included South Gloucestershire and Bath and North East Somerset (BaNES).

The service has a registered manager. 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 and associated Regulations about how the service is run. At this inspection we found improvements had been made. We looked at how the service was managing support to people with their medicines and the processes in place to assess and monitor the quality of the service provided.

The improvements required in respect of the support people received with their medicines had been put in place. The records provided clear details about how people were to be supported with specific instructions for the care staff to follow. Appropriate records were kept to clearly evidence the support that had been provided.

Systems and processes had been put in place to obtain the views of people using the service, friends and families, and the staff team. Actions had been taken where improvements had been suggested.

Any accidents, incidents or complaints were monitored and analysed in order to identify themes. This enabled the registered provider and registered manager to make changes, prevent or reduce reoccurrences and drive improvements. These measures helped to monitor the quality and safety of the service.

The two breaches of regulations have been addressed.

The inspection started on 25 August 2015 and was announced. We gave the provider 48 hours notice of the inspection to ensure that the people we needed to meet with were available. This was the first inspection of this service since it was registered in April 2013.

At the time of the inspection the agency was providing support to 71 people who lived in their own homes. The areas they covered included South Gloucestershire, Bristol and Bath and North East Somerset (BaNES). The agency employed 40 care staff.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Improvements were needed with some aspects of the management of medicines. The records need to be completed properly to make it clearer and the staff needed to be provided with clearer guidance on the actions they needed to take to support people.

Improvements were needed with the systems and processes they had in place. This would enable the provider to monitor and improve the quality and safety of the service where concerns were identified.

People were safe with the care staff who supported them. Staff were recruited following thorough recruitment procedures and received training to ensure they were aware of safeguarding issues and reported any concerns. Where risks were identified management plans were put in place to manage the risk with the aim of reducing or eliminating the risk.

People received the service they expected and had agreed to receive. Staff were knowledgeable about the people they supported and received the appropriate training to enable them to undertake their roles effectively. Where identified in the assessment process, people were provided with support to have sufficient food and drink. People were supported to access health care services if needed.

People were looked after by the minimum number of care staff in order to ensure they received a consistent service. People were treated with kindness and respect and were given opportunities to have a say about the support they received and how their service was delivered.

People were provided with the service they needed and met their individual needs. Their preferences and choices were respected. They were provided with copies of their plans, knew what service was provided and when and which members of care staff were going to support them.

People and staff said the service was well-led. They were provided with opportunities to provide feedback and make suggestions. However this information needs to be used to drive forward any improvements.

We found two breaches of the regulations during our inspection. You can see what action we told the provider to take at the back of the full version of the report.