Cayon Care Service is registered to provide personal care for people who live in their homes. At the time of our inspection one person was receiving personal care in their own home. Not everyone using Cayon Care Service receives regulated activity; 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.

The inspection took place on 14 February 2018 and was unannounced.

The registered provider had registered with the Care Quality Commission. The registered provider was not required to have a registered manager in place and they had chosen to manage the service as a 'registered person'. 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 the last inspection we rated the service requires improvement. At this inspection we found improvements had been made to support an overall rating of good with the key question of safe rated as requires improvement. This was because the provider had failed to display their current inspection ratings on their website and at their registered office. This is a legal requirement to show people had access to the ratings to inform their judgments about services.

Staff took knowledge from their training, [which was an area of improvement since our previous inspection], to reflect their understanding in how to report concerns about potential abuse, and when it was needed, knew how to take action to make sure people were protected from harm.

A person who used the service commented they received the care they needed from staff to feel and be as safe as possible within their home. The person valued the same regular staff who supported them to meet their needs at the agreed times and were flexible if changes were required.

Improvements had been made to the processes in place to reflect the person’s up to date care needs with any potential risks to them and staff identified to guide staff practices in reducing avoidable harm. Environmental risks were also assessed within the person’s home to help avoid any potential accidents to the person who used the service or staff. Staff understood their responsibilities in reducing the spread of infections whilst undertaking their caring roles.

The registered provider showed us they had made sure following our previous inspection their recruitment arrangements were strong so people were not at risk from being supported by unsuitable staff. Staff had received further training following our previous inspection which matched the needs of the person who used the service.

The organisation of staff rotas showed the person who used the service had regular staff who they had formed relationships with and who knew their particular needs. Staff were supported by the registered provider and deputy manager to help them carry out their roles which included direct checks of their care practice.

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. The person who used the service told us they were involved in decisions about their day to day care.

The registered provider had made sure following our previous inspection their processes to support people where required with their medicines had been developed. People would only require support to take their medicines if this was part of their care service.

The person felt staff understood their care needs and wishes and these were followed by the regular staff who provided support. Where the person required support with their meals and drinks this was provided by staff who followed the person’s preferences.

Daily care records reflected when staff support was provided and the improvements in care plan

The inspection took place on 24 August 2016 and was announced. This is the first time we have inspected this service since it was registered in June 2016. However the registered provider was continuing to support the one person who used the service and had supported this person for six years from a previous location.

The service is a domiciliary care service that provides personal care to people in their own homes. At the time of our inspection, one person was using the service. The registered provider had registered with the Care Quality Commission. The registered provider was not required to have a registered manager in place and they had chosen to manage the service as a ‘registered person’. 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.

The one person using the service and their relative told us they felt safe. Staff had not received safeguarding training and clear guidance for reporting concerns were not available to staff or people using the service.

Processes did not ensure that people’s risks would always be managed effectively. Risk assessments were not always updated and completed to reflect the needs of the person using the service. The registered provider had completed some checks to help keep people safe.

The person and their relative were satisfied that they received their calls on time and that they were notified if staff were going to be late.

The registered provider could not demonstrate that safe recruitment practice was always followed.

Although the person using the service did not receive support with taking their medicines, guidance in place for staff was unclear as to whether this support was required. The registered provider told us that they planned to improve their medicines management processes so that where required people would be supported to take their medicines safely.

The person and their relative felt that staff understood the care needs of the person using the service. Staff had not received any updated basic training to ensure they had the skills and knowledge they needed for their roles. The registered provider had failed to arrange the required staff training for a long period of time.

Staff received supervision from the registered provider and the staff member informed us that supervisions were helpful. The staff member told us that the registered provider sometimes conducted spot checks and observed practice for which they received feedback to aid their development.

The person using the service told us that staff supported them to make their own choices and decisions. However the registered provider was unclear of their responsibilities in relation to the Mental Capacity Act (2005) and staff had not received training in this area.

Staff provided some support to help the person to prepare and eat meals, however records did not clearly reflect how they provided this support and whether it met the person’s specific needs.

Staff provided support when needed to help people using the service to access healthcare support.

The person and their relative told us that staff were caring and that staff had established a positive relationship with them. A relative told us that they valued the consistency of staff and that one member of staff had supported a person over a long period of time.

The person using the service and their relative were asked for their feedback and views on the service.

The person received care that was responsive to their needs. Their daily care records were not always maintained and the registered provider did not demonstrate that they had oversight of the records.

The person and their relative were involved in care reviews and said they received the care and support they wanted.

The person and their relative felt comfortable raising concerns about the service and told us that their feedback had been responded to appropriately.

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