Caring Forever Limited is a family run small domiciliary care agency. It provides personal care to people living in their own houses and flats. Not everyone using the service receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, medicines and eating. Where they do we also take into account any wider social care provided.

We carried out an announced comprehensive inspection of Caring Forever Limited on 7 and 9 March 2018. This was in response to our previous comprehensive inspection on the 31 May and 8 June 2016, where we rated this service as overall Requires Improvement. The key questions Caring and Responsive were rated good. The key questions Safe, Effective and Well Led were rated Requires Improvement. There were two breaches of the Health and Social Care Act Regulated Activities 2014. Shortfalls found were that consent to care and treatment had not been obtained in line with the principles of the Mental Capacity Act 2005 and recruitment procedures were not robust.

At the last inspection we asked the provider to take action to address the shortfalls found. The provider submitted an action plan to us about the measures they were taking to address our concerns. These included training and competency assessments for care workers in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Improvements to their recruitment processes to ensure appropriate references were obtained and documented on staff personnel files.

At this inspection on 7 and 9 March 2018, we found no breaches in Regulations, and the necessary improvements had been fully embedded into practice. Therefore Safe, Effective and Well Led have now been now rated as Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We found evidence to support a change in the overall rating from Requires Improvement to Good.

At the time of this announced inspection of 7 and 9 March 2018, there were 33 people who used the service. The provider was given up to 48 hours’ notice because we wanted to be certain the registered manager and key staff would be available on the day of our inspection. We also wanted to give them sufficient time to make agreements with people and their relatives so we could meet and talk to them to find out their experiences of the service.

A registered manager was 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. Statutory notifications received showed us that the registered manager understood their registration requirements.

Caring Forever Limited provided a safe service to people. This included systems intended to minimise the risks to people, including from abuse, mobility, nutrition and with accessing the community. Care workers understood their roles and responsibilities in keeping people safe.

Recruitment checks were carried out with sufficient numbers of care workers employed who had the knowledge and skills through regular supervision and training to meet people’s needs.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

People and relatives had developed good relationships with the care workers, the registered manager and senior management team who were based in the office. People received care that was personalised and responsive to their needs. People’s care records were accurate and reflected the support provided.

People

The inspection took place on 30 May and 8 June 2016 and was announced.

Caring Forever is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection there were 23 people using the service.

There was 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.

During this inspection we found the registered provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to ensuring they were acting within the principles of the Mental Capacity Act [MCA], and with ensuring that appropriate checks were undertaken when recruiting staff into the service.

Care workers in the service had not received training in MCA. Care workers asked for consent prior to carrying out any care or treatment, however, people's capacity to make decisions was not properly assessed, and there were no MCA assessments or best interest decisions in place.

Improvement was needed in the way the service recruited staff. Appropriate checks were not always undertaken to ensure staff were suitable.

Risks were identified and acted on. Communication between care workers and the management team were effective in ensuring risks to people were understood. Improvements were required with documentation to ensure information to minimise risk was accurate and consistent across the service.

Feedback received from people, relatives and professionals was very positive.

Care workers respected people's privacy and dignity and interacted with people in a caring, respectful and professional manner.

Care workers were trained in subjects relevant to the people they were caring for, and there was an induction plan for new staff which ensured they were confident to perform their role.

Systems were in place which safeguarded people from the potential risk of abuse. Care workers understood their roles and responsibilities in keeping people safe and took action when needed.

People felt involved in their care planning. Care records reflected people’s preferences and other important details relevant to their care needs, however, this needed to be more consistent across the service.

The service was flexible in meeting people’s needs. Staffing levels ensured people received their care at the times they requested.

People received their medicines in a timely manner, but documentation was not always completed correctly.

The registered manager and directors were committed to achieving a service which provided high quality care to people. They were aware of the need to improve documentation, and were already working on this.

Feedback was valued and used to make improvements. People told us they knew how to complain, and that they communicated regularly with the management team.

Quality assurance processes and audits were carried out to identify where improvements could be made. The registered manager had used information from audits to improve documentation and recording of daily notes.