Cephas Care Ltd Domiciliary Care Agency provides personal care and support to people living in their own homes.

This was an announced comprehensive inspection which took place on 25 and 26 April and 4 May 2018. On the first day of our inspection the operational manager told us there were 197 people using the service. The service provided a support to live at home service and a supported living service to approximately 77 people in 19 supported living services ranging from people living alone to larger group living.

The service did not have a registered manager in post for the past two months. A registered manager is a person who has registered with the Care Quality Commission (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. We met the manager who was applying to the CQC to become the registered manager and they had been working in the service for the past month.

At our last inspection of December 2016, we rated the service as requires improvement because of concerns we identified in in the key questions of Safe, Effective, Caring, Responsive and Well-Led. Improvements were needed in the way that people were supported with their medicines and how

this was recorded and monitored. People experienced missed and late visits and the systems in place to monitor were not robust enough to analyse these issues. Improvements were needed in how care workers were provided with supervision to ensure that their work practice were robustly

monitored. People's capacity to make decisions was not always clearly identified in their care records to ensure that the service was acting in accordance with the Mental Capacity Act 2005 at all times. A complaints procedure was in place but improvements were needed in the way that records were maintained regarding complaints and the service’s response. The service had a quality assurance system, however this was not robust enough to ensure all people were provided with good quality care at all times.

At this inspection we found the service had made the necessary improvements in the key questions of Safe, Effective, Caring and Responsive. There were no missed visits and late visits were rare, reasons analysed and action taken to improve the service. People’s medicines were accurately recorded. Additional staff had been employed by the service since our last inspection and all staff were provided with supervision. Complaints received and the action taken to resolve the situation were recorded. Action had been taken to improve the recording of people giving consent but there were examples of where further improvements could be made regarding the recording of people having given their consent. We found that quality assurance still required needed further development and therefore rated the key question of Well-led as requires improvement. In line with our methodology we have therefore rated the service Good overall.

The rota’s informing people of the staff coming to support them were not always accurate. However, staff did attend the scheduled care visit. Most people were supported by regular members of staff who got to know their support needs well through speaking with them and/or their family. Staff knew the risks associated with people’s health and knew what action to take in order to keep people safe.

People were supported by enough members of staff who had the knowledge and skills they required to care for people safely and effectively. The number of late call visits to people had reduced particularly in the past three months leading up to our inspection. This was because additional staff had been appointed to provide support and also manage the staff providing the support.

There remained inconsistencies of quality in care planning between the support to live at home service and the suppor

Cephas Care Ltd Domiciliary Care Agency provides personal care and support to people living in their own homes.

This was an announced inspection. On the first day of our inspection on 13 December 2016 the registered manager told us there were 198 people using the personal care service. The service provided a support to live at home service and a supported living service to approximately 77 people in 19 supported living services ranging from people living alone to larger group living. The service had recently undergone some change, including taking on more commissioned care packages from other support to live at home services.

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.

There were inconsistencies of quality in care planning between the support to live at home service and the supported living services. The registered manager was aware of the shortfalls in the way that people’s needs were assessed and planned for in the support to live at home service and they were in the process of reviewing the care records.

Improvements were needed in the way that people were supported with their medicines and how this was recorded and monitored. The service had identified the shortfalls and were taking action to address them.

People and care workers in the supported living service told us that they felt that there were sufficient numbers of care workers to meet people’s needs. However, feedback received from people using the support to live at home service gave varied comments about missed and late visits. The systems in place to monitor and use incidents of missed and late visits were not robust enough to analyse these issues and use them to improve the service.

Care workers were trained to meet the needs of the people who used the service. Improvements were needed in how care workers were provided with supervision to ensure that their work practice was robustly monitored.

People were involved in making decisions about their care and support and people received care and support which was planned and delivered to meet their specific needs. However, people’s capacity to make decisions was not clearly identified in care records to ensure that the service was acting in accordance with the Mental Capacity Act 2005 at all times. Therefore there were risks that people were not supported to have maximum choice and control of their lives.

A complaints procedure was in place. Improvements were needed in the way that records were maintained regarding complaints and the service’s response.

The service had a quality assurance system, however this was not robust enough to ensure all people are provided with good quality care at all times. Improvements were being made but these were not yet fully implemented and embedded in practice.

There were systems in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Care workers understood their roles and responsibilities in keeping people safe. There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

Care workers had good relationships with people who used the service.

Where people required assistance with their dietary needs, there were systems in place to provide this support safely. Where required, people were provided support to access health care professionals.

We have identified breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the full report for the actions we have asked the provider to take to imp

We spoke with eight people who used the service, and with one person's neighbour. Everyone we spoke with told us that they were happy with the service they received from all or the majority of the staff. One person told us, “At the time I really needed them they were perfectly good.”

Care was planned and delivered in a way that was intended to ensure people's safety and welfare.

There were recruitment and selection processes in place with appropriate checks undertaken before new staff took up their appointments. This helped ensure that people were cared for by suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

There was an effective procedure for dealing with concerns and complaints.

We had the opportunity to talk with 12 of the people who use the service while they were attending a drop-in centre run by the provider in the same building that the service is run from. All of the people we spoke with were happy with the care they received. They told us that they were supported in the way they wanted to be and were able to make their own minds up about the decisions they took regarding their care. They were complimentary about the people who supported them. Some of their care workers were also at the centre and there was a lot of good humoured banter between them and the people they supported.