Caring for You is a domiciliary care agency which provides personal care to people in their own homes. At the time of our inspection there were 27 people using the service.

At our last inspection we rated the service good. One key question was rated ‘Requires Improvement.’ The service had not always been safe in relation to management of medicines. At this inspection we found the provider had made improvements in this area and was no longer in breach.

There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We saw evidence of a robust medicine management in place and staff were trained and competent in this area to ensure all policy and procedures were followed.

People and their relatives told us they were happy using the agency and felt the staff had the right training to be able to support them with their care needs.

Individual risks to people's safety were known by staff. Accident and incidents were reported and robust in looking at any lessons learnt.

Staff had regular opportunities to update their skills and professional development. Staff demonstrated an understanding of the Mental Capacity Act (MCA) 2005.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were motivated and worked well as a team, with effective support from one another and from the management team. Staff had supervisions and an annual appraisal as well as team meetings.

Care records contained clear information covering all aspects of people’s care and support and staff had a caring approach to working with the people who used the service.

There was a clear management structure so that all staff knew their roles and responsibilities. There was an open and transparent culture in which staff felt valued and able to approach the registered manager.

Further information is in the detailed findings below.

This inspection took place on 20 July 2016 and was announced. The service had been registered with the Care Quality Commission since May 2011 and had previously been inspected during July 2014, when the service was found to be compliant in all areas inspected.

Caring for You provides domiciliary care services to people in their own homes. The people who receive these services have a wide range of needs. At the time of the inspection, the service provided care and support to 22 people.

The service had a registered manager in post, who was also the registered provider, 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 told us they felt safe and staff had received safeguarding training in order to keep people safe. There were enough staff to meet people’s needs with a regular, consistent staff team and there were robust recruitment practices in place, which meant staff had been recruited safely. Risks to people and staff had been assessed.

The recording of the administration of people’s medicines was not safe. Records did not provide a clear and accurate record of the medicines people were prescribed and the medicines which staff had administered. This demonstrated a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People felt staff had the necessary skills and training to provide effective care. Staff told us they felt supported and we saw staff had received induction and training. Staff received ongoing supervision, although the frequency was not in line with the registered provider’s own policy.

We saw from the care files we reviewed the registered manager sought and obtained consent from people, prior to their care and support being provided.

People and their relatives we spoke with told us staff were caring. The staff we spoke with were enthusiastic and were driven to provide good quality care. Staff told us how they respected people’s privacy and dignity and the people we spoke with confirmed this.

Some care plans were personalised and others required further development in order to be personalised and person centred. Care plans were reviewed regularly. People were offered choices in relation to their care and support. Appropriate referrals to other health care professionals and services for additional care and support for people were made when necessary.

Regular quality assurance audits took place. People told us they felt listened to and that the service was well led. The registered manager encouraged a culture of openness.

You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We looked at a sample of two care records and saw each person had a care plan and risk assessment which covered their needs. We saw regular reviews of the care plans had taken place.

We spoke with four people who told us they felt “safe” with the care staff. All four people and the two relatives we spoke with provided positive feedback about the staff and service.

We saw the provider had safeguarding and whistleblowing policies in place to provide staff with guidance about protecting people from abuse. The two members of staff we spoke with were aware of the different types of abuse and described how they would respond if abuse was suspected or happening.

However, we found that one incident regarding a service user being given an incorrect dose of medicines had not been reported to the Care Quality Commission (CQC) as required by regulation 18 of the CQC (Registration) Regulations 2009. The manager told us they had reported this matter to the local authority safeguarding team and believed it was an oversight that the CQC had not been notified. The manager sent the notification immediately following the inspection.

Is the service effective?

We spoke with four people who used the service. All the people we spoke to were happy with the service provided and told us the staff understood their care and support needs. Comments included:

“They never let me down.”

“They are friendly. I’m quite satisfied.”

“I tell them what I want and they do it.”

“They’re wonderful.”

We spoke with two relatives who were complimentary about the service. One relative said: “It’s a very flexible service. My [relative] loves the carers.” Another relative told us: “The service is totally flexible. The carers are lovely.”

Is the service caring?

All the staff we spoke with told us there were enough staff to meet people's needs and that they had enough time to support people in the way they wished. People told us they were able to do things at their own pace and were not rushed.

Is the service responsive?

Staff said they were aware of the complaints policy and explained to us what they would do if a complaint was made. The four people and two relatives we spoke with told us they knew how to make a complaint but they had never had any cause to complain. We found people were made aware of the complaints system.

Is the service well-led?

We spoke with the manager regarding the audits used to assess and monitor the quality of service people received. Audits were carried out on areas such as: staff training, staff supervisions, spot checks and care records. We saw documentary evidence which confirmed this. This information was fed into action plans where areas for improvement were identified.

Staff meetings were held at least three times a year in order to ensure staff views and opinions were taken into account in relation to the running of the service. We saw meeting minutes which confirmed this.

We looked at a sample of feedback questionnaires which had been completed by people who used the service. The sample we looked at was positive.