We carried out this inspection on 10 and 11 October 2018. This inspection was announced, which meant the provider was given 48 hours’ notice of our inspection visit. This was because the location provides a small domiciliary care service and we needed to be sure that someone would be available to meet with us.

We checked progress the registered provider had made following our inspection on 13, 14 and 15 September 2017 when we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to fit and proper persons employed. We asked the registered provider to complete an action plan to show what they would do and by when to improve the key question of safe to at least good. We found improvements had been made in this area and the service was no longer in breach of this regulation.

This service is a domiciliary care agency. It provides support to people living in their own houses and flats in the community. It provides a service to older people and younger disabled adults. Care staff are employed as personal assistants to provide a combination of practical and personal care, as well as general day to day assistance both within the person’s own home and during any outings and activities. Not everyone using Caring Personal Assistants Ltd receives support with the regulated activity of ‘personal care’; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection five people were being supported with personal care tasks.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

There were systems in place to monitor and improve the quality of the service provided. However, these were not always formally recorded to provide a clear audit trail.

There were no team meetings for staff. These meetings are an opportunity for shared learning and peer support. We recommend the registered provider consider ways of providing this type of support to staff.

The registered provider now had safe recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the registered manager and the nominated individual.

Safe procedures were in place to make sure people received their medicines as prescribed.

Staff told us they received an induction, training, regular supervisions and yearly appraisals to support them to carry out their jobs effectively. However, staff personnel files we looked at did not contain evidence of supervision meetings taking place in line with the registered provider’s policy of four a year. The nominated individual told us they would review this.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

Where required, people were supported to eat and drink to maintain a balanced diet.

People were supported to access relevant health and social care professionals to ensure they were getting the care and support they needed to meet their needs.

Staff knew people’s care and support needs. They were able to tell us about people’s life histories and their likes and dislikes.

People told us they were treated with dignity and respect.

We carried out this inspection on 13, 14 and 15 September 2017. This inspection was announced, which meant the registered provider was given 48 hours’ notice of our inspection visit. This was because the location provides a small domiciliary care service and we needed to be sure that someone would be available to meet with us. This was our first inspection of the service.

Caring Personal Assistants Ltd is a domiciliary care agency providing the regulated activity of personal care to people in their own homes. Care staff are employed as personal assistants to provide a combination of practical and personal care, as well as general day to day assistance both within the person’s own home and during any outings and activities. At the time of this inspection Caring Personal Assistants Ltd was supporting six people.

There was a registered manager employed at the service. 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 and their relatives were overwhelmingly positive about the service they received. One person told us, “They have taken all the stress away allowing me to do what I want to do.”

Safe recruitment procedures were not always being followed.

Staff told us they received regular supervisions and yearly appraisals to support them to carry out their jobs effectively. However, there was very little, if any evidence of these taking place on the staff personnel records we looked at. We have made a recommendation to the nominated individual and registered manager about this.

Not all staff were aware of the principles of the Mental Capacity Act 2005. However, they were clear on the importance of involving people in decision making. Staff were in the process of undertaking eLearning in this subject area.

The service had a number of quality assurance tools they used. Not all sections were relevant to the service they provided and the nominated individual and registered manager told us they were adapting and editing these tools as they had recently started using them.

The service had up to date policies and procedures which reflected current legislation and good practice guidance.

All staff we spoke with understood what it meant to protect people from abuse and what actions to take if they suspected someone was being abused.

The care records we looked at included risk assessments, which identified any risks to the person. They had been devised to help minimise and monitor the risks, while promoting the person’s independence as far as possible.

The service employed enough staff to ensure people’s needs were met. The service did not use agency staff.

Procedures were in place to make sure people received their medicines as prescribed.

People were supported to access a wide range of health and social care professionals to help maintain their health and wellbeing.

Positive and supportive relationships had been developed between people, their relatives, and staff. People told us they were treated with dignity and respect.

People received personalised care. Care records reflected people’s current needs and preferences. We saw these were regularly reviewed with the person and their relatives.

The service had a complaints and compliments policy and procedure in place and people were aware of how to make a complaint if they needed to. There had been no formal complaints recorded at the service at the time of the inspection. People and their relatives confirmed they had no reason to complain.

Staff told us they felt supported by the nominated individual (a member of staff acting on behalf of the registered provider) and registered manager and were comfortable raising any concerns or queries.

During our inspection we found one brea