About the service:

Caring Companions is a small domiciliary care service that provides support and personal care to older people in their owns homes within the St Helens area. At the time of our inspection the service was supporting three people with personal care.

What life is like for people using this service:

At the previous inspection the registered provider was in breach of regulation relating to governance. At that time they had no clear systems and processes in place to show that regular checks and reviews had taken place on records or staff observation. During this inspection, improvements had been made.

The registered manager had implemented new systems to record any checks that had been completed on people’s care records, daily logs and medication administration records. They had also completed regular observations on staff competency to deliver effective person-centred care. Some staff observations had not been recorded, however staff confirmed that these were carried out on a regular basis. We made a recommendation in relation to this.

People told us they felt they received care in a safe way. Individual risks to people and the environment had been identified and assessed and measures put in place to manage them and minimise the risk of avoidable harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely by trained staff who ensured that people received medicines at the right time.

Sufficient numbers of suitably qualified and skilled staff were deployed to meet people’s individual needs. Staff had received a range of training and support to enable them to carry out their role safely. People told us they received the right care and support from staff who were well trained and competent at what they did.

Staff showed a genuine motivation to deliver care in a person-centred way based on people’s preferences and likes. Staff treated people with kindness, compassion and respect and ensured that people’s dignity was maintained at all times. People spoke positively about the care and support they received. People told us they received support from regular staff who knew them well. They told us staff always arrived on time and stayed the right amount of time.

People’s needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

Records relating to consent for care were accurately completed and people told us they were always offered choice and control over the care they received.

Care was delivered in a personalised way which was in line with information recorded in people's care plans. People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted person centred care and a positive culture within the staff team. People, family members and staff all described the registered manager as supportive and approachable. The registered manager showed a continued desire to improve on the service and displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

Rating at last inspection: Requires improvement (Report published 13 February 2018)

Why we inspected: This was a planned comprehensive inspection based on the rating from the previous inspection.

The inspection took place on 13 December 2017 and was announced. We gave 24-hour's notice of the inspection because we needed to be sure that someone would be available in the office to assist with the inspection.

At the last inspection on 9 & 10 April 2015 the service was rated Good. At this inspection the service was rated Requires Improvement.

Caring Companions is a small domiciliary care service supporting people within the St. Helens area. At the time of our inspection they were supporting five older people with activities of daily living that included personal care. Three permanent staff were employed by the service and they also had one bank staff member to support with staff sickness and annual leave cover.

The registered provider at the service is also the 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 2008 and associated Regulations about how the service is run.

At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered providers audit systems had failed to identify that policies and procedures held out of date information and required review and update. The registered provider did not have formal systems for the recording of staff supervisions and appraisals. The registered provider did not have a formal process for the arranging and recording of people's care plan reviews. You can see what action we told the registered provider to take at the back of the full version of the report.

Staff training was not fully up to date and clearly documented. We have included a recommendation within the report for the registered provider to follow best practice to ensure they keep up to date with legislation.

Staff recruitment systems were safe and this ensured that only staff suitable to work with vulnerable people were employed. All staff had completed an induction that included shadow shifts prior to lone working with people. There were sufficient staff employed to meet the needs of the people supported.

Staff demonstrated a good understanding of safeguarding as well as the processes to be followed to protect people from abuse.

People had their needs assessed prior to them using the service. Care plans and risk assessments were in place to inform staff of how people would like to be supported. People and their chosen relatives participated in the preparation of their care plans.

People and their relatives spoke positively about the registered manager and staff. People told us they had developed positive relationships with staff and were treated with kindness. People told us that staff treated them with dignity and respected their privacy at all times.

People and their relatives knew how to raise a concern or complaint and felt confident that should they have any concerns they would be listened to and acted upon by the registered manager.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we found. We saw that the registered provider had policies and guidance available to staff in relation to the MCA. Staff demonstrated a basic understanding of this and had completed training. The registered provider had not been required to make any applications through the Court of Protection as people in receipt of the service were not deprived of their liberty.

We spoke with two people on the day of the inspection who were both happy with the care and support they received from the service. One person told us, “I like all the staff that come to see me. I agreed with the service for the time of my visit to be changed and it wasn’t a problem.”

Everybody we spoke with were happy with the support they received and said it met their needs. One person said, "I’m very happy with the manager and all the staff, they have been very good to me.”

Everyone we spoke with about the staff said they were suitably trained to meet their needs. One person said, "I wouldn’t want anyone else to look after me, all the staff are great and treat me kindly.”

Everyone we spoke with said they had opportunities to feedback to the manager regularly. One person said, “I am asked by the manager when they see me if I’m ok.” No one we spoke with said they had completed a formal questionnaire or survey on the service they received.

People we spoke with all said they had never had a reason to complain. One person said, “Communication with the manager is really good and they are on the ball.”

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld, and how they can make choices about their care.

We carried out telephone interviews with four of the relatives of people receiving a service and made home visits to two people who use the service to gain their views about the quality of the service being provided. We visited the office to look at records and talk to the registered manager. We also talked to one of the carers providing support to service users.

The people we spoke with said, support workers had always treated them with dignity and respect. One person said, "They (support workers) are always on time and very respectful towards me," "I have confidence that they (agency) wouldn't send anybody that wasn't properly trained" and "this company cares. There’s nothing wrong with this agency". Another person said, "I am very pleased, they are all very good. I am satisfied with everything" and “I am so glad I decided to go with Caring Companions”.

The comments received from the telephone interviews were all positive including, "I can't fault any of the staff," "My mum knows everyone (support workers) by name and she is very fond of them. She looks forward to seeing them,” "They go the extra mile," "I am pretty happy with the service, its consistent and the same familiar faces. This is what she needs," "They (carers ) keep her stimulated and take her out a couple of times a week," "They have kept a continuity of care and a good consistency of staff," "They are excellent, never late," " at the beginning my mum was involved in choosing Caring Companions," “the carers are absolutely excellent with mum," "I am always kept informed and let me know if there are any issues," " the manager has always brought any new staff to be introduced to my mum and to me," "If I was not happy with the service, I wouldn't hesitate to complain," "once my mum objected to a carer coming in. We spoke to the manager and it was sorted out immediately” and "the agency overall has a strong sense of a caring duty".

We inspected the service on the 9 & 10 April 2015. We gave the provider a short amount of notice that an inspection of the service would take place. The Domiciliary Care Agency provided care and support to people living in their own homes.

At the time of our inspection there were five people using the service with a variety of needs, mainly older people.

The registered provider of the service is also the manager of the service.

At our previous inspection we found that the registered provider was not meeting two regulations. These related to people not being asked for their consent, before they received any care and there was no effective system to regularly assess and monitor the quality of service that people received in place. The registered provider sent us an action plan outlining how they would make improvements.

We checked for improvements during this inspection and found that the registered provider had made the improvements needed. We found that people had been asked for their consent before receiving a service. We saw consent forms which had been signed and dated by the person who used the service or their representative.

There were effective systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service and monitoring the quality of service provided. We visited people in their own homes and they told us they were satisfied with the care and support provided. They had developed good relationships with their support workers and told us they were treated with kindness and respect and felt safe using the service. People told us that if they had any issues or concerns they were confident that they would be appropriately dealt with by the service.

Staff we spoke with had a good understanding of the needs of people they supported and were positive about their role and the support they received from the service. Staff received on-going training to ensure they had up to date knowledge and skills to provide the right support for the people they were supporting. They also received regular supervision, appraisal and observations of their work practice.

Staff recruitment procedures were satisfactory, with evidence of appropriate disclosure and barring checks and references being obtained before commencing employment.

Staff were complimentary about the manager and had no concerns about raising any issues or concerns.

People’s care needs were assessed and care plans were put into place to meet those needs. People’s wishes and preferences were recorded in their care plans. Risks to people’s health and well-being were identified and risk assessments were in place to manage those risks.

People had been supported to access healthcare professionals, when needed and people’s medicines were appropriately managed and administered safely. People had signed and dated consent forms, regarding medication.

The manager understood the principles of the Mental Capacity Act and how they might apply to the people who used the service.