We carried out this announced inspection on 08 and 09 August 2017.

Charisma Services provides care for people in their own homes. The service can provide care for adults of all ages. It can assist people who live with dementia or who have mental health needs. It can also support people who have a learning disability, special sensory needs or a physical disability. At the time of our inspection the service was providing care for 22 people under the regulated activity ‘personal care’ most of whom were older people. The service covered Caythorpe, Grantham, the Vale of Belvoir, Colsterworth and surrounding villages.

The provider of the service was a sole trader. This meant that the person who was the sole trader acted both as the provider of the service and the registered manager. In this report we refer to this individual as being, ‘The registered person’. The registered person has a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out our last announced comprehensive inspection of this service on 30 December 2015 and found that there were two breaches of legal requirements. We found that the registered person had not always ensured that sufficient staff were deployed to reliably meet people’s needs for care. We also found that the registered person had not consistently protected people against the risk of inappropriate or unsafe care by regularly assessing and monitoring the quality of the service provided. This was because shortfalls in the completion of quality checks had led to problems not being quickly resolved. These included people not receiving visits at the right time and full background checks on new staff not always being undertaken. In addition, some staff had not received all of the support and guidance they needed.

After our inspection of 30 December 2015 the registered person prepared an action plan. They told us what improvements they intended to make in order to meet the legal requirements in relation to the breaches. They said that all of the problems we noted would be addressed so that people consistently received safe care. The registered person said that all of the necessary improvements would be completed by 31 March 2016.

On 19 October 2016 we carried out a focused follow up inspection visit to inspect the areas related to ‘safe’ and ‘well-led’ which the registered persons had told us they had made improvements with. At this inspection, we found that the registered person had introduced most of the improvements that were necessary to ensure that people safely and reliably benefited from receiving safe care. This meant that the relevant legal requirements had been met. The registered person told us they would continue to work toward improving the services provided.

At the present inspection we found staff knew how to keep people safe from situations in which they might experience abuse and people had been supported to avoid preventable accidents. Staff were recruited using safe systems and there were enough care staff available to provide the care people needed.

People were supported to take their prescribed medicines and staff had received most of the training and guidance the registered person had identified as required of them. People had been assisted to eat and drink enough and the registered person worked together with community health professionals to ensure people were supported to receive the healthcare assistance they needed.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff understood the principles of the MCA and how to support people who lacked the capacity to make some decisions for themselves.

People were treated with kindness and compassion. Staff recognised people’s right to privacy and promoted their dignity. Confidential information was kept private.

People had been consulted about the car

This was an announced inspection carried out on 19 October 2016.

Charisma Services provides care for people in their own homes. The service can provide care for adults of all ages. It can assist people who live with dementia or who have mental health needs. It can also support people who have a learning disability, special sensory needs or a physical disability. At the time of our inspection the service was providing care for 14 people most of whom were older people. The service covered Caythorpe, Grantham, the Vale of Belvoir, Colsterworth and surrounding villages.

The provider of the service was a sole trader. This meant that the person who was the sole trader acted both as the provider of the service and the registered manager. In this report we refer to this individual as being, ‘the registered person’. The registered person has a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out an announced comprehensive inspection of this service on 30 December 2015 and found that there were two breaches of legal requirements. We found that the registered person had not always ensured that sufficient staff were deployed to reliably meet people’s needs for care. We also found that the registered person had not consistently protected people against the risk of inappropriate or unsafe care by regularly assessing and monitoring the quality of the service provided. This was because shortfalls in the completion of quality checks had led to problems not being quickly resolved. These included people not receiving visits at the right time and full background checks on new staff not always being undertaken. In addition, some staff had not received all of the support and guidance they needed.

After our inspection of 30 December 2015 the registered person prepared an action plan. It said what improvements they intended to make in order to meet the legal requirements in relation to the breaches. They said that all of the problems we noted would be addressed so that people consistently received safe care. The registered person said that all of the necessary improvements would be completed by 31 March 2016.

This report only covers our findings in relation to the action taken by the registered person to meet the breaches of legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Miss Teresa Killick on our website at www.cqc.org.uk

At this inspection, we found that the registered person had introduced most of the improvements that were necessary to ensure that people safely and reliably benefited from receiving safe care. This meant that the relevant legal requirements had been met. However, a small number of further improvements still needed to be made to ensure that the service continued to reliably care for people in the right way.

Charisma Services provides care for people in their own homes. The service can provide care for adults of all ages. It can assist people who live with dementia or who have mental health needs. It can also support people who have a learning disability, special sensory needs or a physical disability. At the time of our inspection the service was providing care for 30 people most of whom were older people. The service covered Caythorpe, Grantham, the Vale of Belvoir, Colsterworth and surrounding villages. The service was provided by a sole trader and who also acted as being the registered manager. We refer to this person as being, ‘the registered person’.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered person had not always provided staff at the right time to care for people including people who needed to use medicines. We also found that quality checks had not been robust. You can see what action we told the registered person to take at the end of the full version of this report.

Background checks had not always been completed before new staff had been appointed. Staff knew how to recognise and report any concerns so that people were kept safe from abuse and people were helped to avoid having accidents.

Although staff knew how to care for people in the right way, they had not received all of the training and support that the registered person said they needed. People had been supported to eat and drink enough and staff had helped to ensure that they had access to any healthcare services they needed.

The registered person and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, promoted people’s dignity and respected confidential information.

People had received all of the care they needed including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive. Staff had offered people the opportunity to maintain their independence and to pursue their interests. There were arrangements to quickly and fairly resolve complaints.

People not been fully consulted about the development of the service and had not benefited from staff acting upon good practice guidance. However, the service was run in an open and relaxed way, there was good team work and staff were enabled to speak out if they had any concerns about poor practice.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

People thought that staff were respectful, kind and attentive. People said that they looked forward to staff calling to see them because the visits provided them with assistance, company and reassurance.

Is the service responsive?

We saw that people's individual needs for care were assessed and met. Staff knew about each person’s individual care needs, choices and preferred routines. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person’s changing needs and wishes. Relatives said that staff consulted with them. This helped to ensure that staff organised their work to complement the care already provided by relatives. These measures meant that people received an efficient, flexible and coordinated response to their care needs at home.

Is the service safe?

Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse. There were reliable systems for staff to follow when handling money on people’s behalf. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. These measures helped to keep people safe from abuse and to promote their welfare.

Is the service effective?

People were helped to stay safe by avoiding risks to their health and safety. Staff had assessed and managed potential risks. This included following safe working practices when helping people with reduced mobility so that there was a reduced likelihood of people experiencing falls and accidents. Robust arrangements had been made for staff to access and leave people’s homes so that the accommodation was kept secure. Visits to people’s homes had been undertaken on time, staff had completed the required tasks and they had stayed for the correct time. These measures contributed to people receiving a service that provided them with effective care at home.

Is the service well led?

The quality assurance system was robust. People had been consulted about their experience of using the service. There was a clear line of management. This meant that important decisions about organising someone’s care were made by senior staff while carers could use their own judgement to provide a flexible service. Quality checks had been completed to ensure that people’s care needs were met in a safe and reliable way. These included checks to make sure that visits were being completed as planned and that record keeping accurately described the assistance being provided. These measures helped to ensure that people consistently and reliably received the care they needed at home.

Prior to our visit we reviewed all the information we had received from the provider. We spoke with three people who used the service and two relatives and asked them for their views. We also spoke with three care workers and the registered manager. We looked at some of the records held in the service including the care files for four people.

We found people gave consent to their care and treatment and received care and support that met their needs. A person who used the service told us, “The (care workers) always get my agreement.” Another person told us, “They have improved (timekeeping) but every now and then they slip back. It happened last week.”

We found people were supported to take their medication safely. A person told us, “They remind me to take my medication. They are good at reminding me.”

We found the staff team were supported through training and the provider assessed and monitored the quality of the service. A person told us, “One or two new recruits are learning fast.” Another person told us, “I get sent questionnaires. The service is well led. I have some carers who are particular stars.”

Prior to our visit we reviewed all the information we had received from the provider. We visited the office and spoke with the registered manager and looked at some of the records including the files for three people who used the service. Following the visit we spoke with three support workers, two relatives and one person who used the service.

We found people’s ability to consent was not always known. Another person told us, “I have seen my care plan. We sat down and discussed it between us.”

We found there were inadequate arrangements to plan and deliver people’s care and support. A relative told us, “I can only say good things about them. They go above and beyond to help.” A person who used the service told us, “They provide me with an excellent service, but they are terrible time keepers.”

We found there were inadequate arrangements for the management of people’s medication. There was not an up to date medication policy. A person who used the service told us, “They make sure I take my medication every morning."

We found there were inadequate arrangements in place to train and supervise support workers. A person who used the service told us, “They are the best I’ve had they really know what they are doing.” Another person said, “They seemed trained to me. I think they are brilliant.”

We found there were inadequate arrangements how the provider assessed and monitored the quality of the service. People made positive comments in surveys forms they completed.

People were complimentary about the care provided by the service. They told us the staff were very good to them and they were given the opportunity to express their views regarding the care and support they received.

People said they felt supported to keep their independence. They said that staff spoke to them with dignity and respect at all times.

The people we spoke with all said that they were involved in preparing their care plans.

People also told us they felt safe and trusted the staff that support them.