This comprehensive inspection took place on 3, 4 and 5 December 2018 and was announced on the first day.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults. Not everyone using Cherish U Limited 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. At the time of the inspection the service provided support to 48 people, with all but one receiving regulated activity

During the last inspection we found that the registered person was in breach of regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to consent, safe care and treatment, good governance and staffing. During this inspection we found that the registered person was no longer in breach of regulations 11, 12 and 18 but remained in breach of regulation 17 in relation to good governance.

The service had a registered manager. 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.

We found shortfalls relating to risk assessment and management documentation as there was not always information about the level of risk, measures implemented to mitigate the risk or information was not reflective of people’s current needs. We found that audits had not been sufficiently robust to have identified the issues we highlighted during the inspection.

Following the inspection, the registered manager provided us with copies of new monthly audit tools but these were not fit for purpose. This meant that the registered provide had failed to establish and operate effective systems to assess, monitor and improve the quality and safety of the service.

People’s needs were assessed before they received support from Cherish U. People told us they felt safe and confident with the care they received and that they were treated kindly and with respect. People told us that staff were on time however, should there be a delay with their call staff would let them know.

Management operated an open-door policy and people could express their views in a variety of ways including by telephone, meetings and survey questionnaires. There was a policy and procedure in place to manage and respond to complaints and people were aware of how to complain should they need to.

Staff received the training they needed to carry out their roles effectively and those we spoke with felt supported by the management team. Training and guidance was available to support safe administration and management of medicines. Measures were in place to protect people from abuse. Recruitment procedures were safe.

Although the registered manager could explain how the business would continue in the event of an emergency, for example, fire, flood or severe weather, there was no formal plan in place. Although they submitted a plan following the inspection we found that this needed further development.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Management and staff had received training and those spoken with demonstrated a good understanding of the requirements of the MCA.

Staff arranged appointments and sought guidance from external professionals to support people’s health and well-being. People were treated fairly and without discrimination and their communication needs were considered.

We inspected Cherish U Limited on 27 November 2017. As this was a domiciliary agency we contacted the registered manager 48 hours before the inspection. This was so that we could ensure that staff were available at the office.

Cherish U Limited is a domiciliary care agency which is registered to provide personal care to adults who live in their own homes. The office for the service is located in Congleton and is within walking distance of the town centre. At the time of the inspection there were 49 adults in receipt of personal care.

There was a registered manager in place. 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.

At the last inspection in June 2016 we found two breaches of relevant legislation and the service was rated as 'Requires improvement'. This was because the people employed by the service provider had not received supervision or appraisal and that systems were not in place to enable the provider to assess, monitor and improve the quality of the service. The provider sent us an action plan setting out the improvements they intended to make.

During this inspection we found three breaches of the relevant legislation, relating to safe care and treatment, governance and not acting in accordance with the requirements of the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe with the care they received and that staff supported them treated them with dignity and respect. The risks to people had been assessed however, we found that there was not always sufficient information as to how the risks would be managed and that risks were not regularly reviewed. Staffing levels at the service ensured people received a consistent and reliable service.

People received support and assistance with their medicines from trained staff however we found that records were not always completed accurately, although we made checks and were confident that the correct medicines had been taken.

People had confidence in the knowledge and skills of staff employed at Cherish U Limited. Staff received training by e-learning. During the last inspection we recommended that the service sourced training for the registered manager in relation to the Mental Capacity Act 2005 and that they adjusted practice accordingly. During this inspection we found that there remained a lack of clear understanding particularly around mental capacity assessment and best interest decision making; documentation in place in this regard was not fit for purpose.

Policies and procedures were in place to protect people from avoidable harm and abuse which staff were aware of and understood. Accidents and incidents were recorded and followed up appropriately. Staff approached their work with a kind and caring attitude, demonstrating pride in the care they provided.

We saw that safe recruitment practices were taking place. Although we found that induction records had not been completed as required staff told us that they received induction which enabled them to carry out their job role. Staff received regular supervision but there was still no programme for annual appraisal.

Staff supported people with their health care needs by making appointments with health care professionals such as GP, Occupational Therapy and District Nurses.

People told us that staff were caring and that they were happy with the service they received. Staff spoke passionately about treating people with respect and demonstrated a good understanding of people’s needs. Staff and people using the service were positive about the management team, feeling that they were professional, approach

We inspected Cherish U Ltd on 17 and 16 June 2016. As this was a domiciliary care agency service, we contacted the registered manager 48 hours’ before the inspection. This was so that we could ensure that staff were available at the office. At the last inspection in May 2014 we found the service met all the regulations we looked at.

Cherish U is a domiciliary care agency which is registered to provide personal care to adults who live in their own homes. The office for the service is located in Congleton and is within walking distance of the town centre. At the time of the inspection, there were 40 adults in receipt of personal care.

There was a registered manager in place. 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.

We found two breaches of the relevant legislation, relating to staffing and governance. You can see what action we told the provider to take at the back of the full version of the report.

We found that people were very positive and complimentary about the service they received. People using the service told us they felt safe and the relatives we spoke with also agreed people were safe. We found that people were protected from the risk of harm and abuse. All staff spoken with had a good understanding of safeguarding, the signs of abuse, and how to report it. We found that the service had a safeguarding policy in place, but was out of date and did not incorporate the latest legislation. During the inspection the registered manager obtained the current safeguarding policy. However we saw that the registered manager had recently reported a safeguarding concern appropriately as per local procedures.

People, their relatives and carers told us they thought there were enough staff to meet people's needs. The rotas demonstrated that staffing levels were planned and organised, so that people received consistent care staff. People told us that care calls were never missed and were usually at the expected time. Safe recruitment practices were demonstrated.

People’s medicines were administered safely. However we found that protocols were not in place for “as and when required” or PRN medicines. The registered manager assured us that these would be implemented.

Staff were skilled and knowledgeable. We found that staff completed an induction prior to starting work in the service. Staff received regular and ongoing training. However staff had not received regular supervisions as frequently as required by the service’s policy.

Risk assessments were carried out and included action taken to reduce and mitigate risks around moving and handling and the environment. However we found that more robust recording was required for other potential risks not included on the basic risk assessment documentation.

We found that staff had some awareness and had received training in the Mental Capacity Act 2005 (MCA). However we found that records did not demonstrate that the service had taken account of people’s mental capacity during assessments. It was unclear whether best interest decisions had been made and recorded for people who lacked capacity to consent to aspects of their care and support. The registered provider had not ensured that the policy around MCA had been fully implemented.

People told us that staff were caring and treated them with kindness. We found that people and their relatives were very happy with the support that they received and told us that staff treated them with dignity and respect. Staff demonstrated a good understanding of the importance of treating people with compassion and dignity. They told us that the service had very “high standards.”

Staff had a good understanding of people’s care needs and knew how to suppor

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had developed policies and procedures on recruitment and selection to provide information on the procedures for recruiting new employees.

We looked at three staff files to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We looked at the training records for staff working for the agency which revealed that staff had access to a range of mandatory, national vocational qualifications and other more specialised training relevant to the needs of the people they supported.

Staff told us that they had regular training on the computer system and felt this was very good.

Staff said they felt supported in their roles and that the manager and senior staff were always on hand.

Staff files held details to confirm that training and supervision sessions were carried out as an ongoing process. (Supervision is regular meetings between an employee and their line manager to discuss any issues that may affect the staff member. This would include a discussion of training needs).

Is the service effective?

We spoke with people who used the service and they told us their needs were being met and they were confident in the care they received from staff. People also said that they had been visited by the manager or a senior staff member of the agency to discuss their needs prior to using the service and confirmed staffing was reliable and consistent.

People told us that they were very happy with the care and support they received and said their individual needs were catered for.

Is the service caring?

Comments such as “I am very happy with the carers they are all great,” and “ Staff are brilliant with my family member, all the staff are polite and I think the service is fantastic.” were made. One person said “ the staff are very good it is a pleasure to have them in the house.”

Another person said " The girls are that good I treat them like my own daughters."

Is the service responsive?

The manager told us the agency used various quality assurance systems to assess the quality of the service it was providing to people using a variety of methods. These included: telephone calls, face to face visits, service reviews, client survey forms and random spot checks.

Staff spoken with said that during reviews of care, people who used the service were asked what they thought about the way the care was delivered. They were also asked if they wanted anything to be changed.

People we spoke with said that the manager or a senior staff member rang them or visited to make sure everything was going well.

Is the service well led?

The provider has worked well with the Care Quality Commission and was aware of the need to keep us updated on any significant events via statutory notifications.

The service continued to utilise a comprehensive internal quality assurance system and had developed systems to involve and obtain feedback from people using the service and / or their representatives