The inspection took place on 19 and 20 February, 2018 and was announced.

Cheshire Homecare Services Ltd is a large domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection the registered provider was providing support to 101 people.

At the last inspection, which took place in August, 2015 the service was ‘Good’.

At this inspection we found the service remained ‘Good’ and continued to meet all of the essential standards.

There was a registered manager at the time of the inspection. 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.

During this inspection we reviewed care plans and risk assessments. Care plans were detailed, consistent and contained up to date information. Risk assessments were regularly reviewed and were updated accordingly.

Medication management systems were in place. Medication was only administered by staff who had received the appropriate training. Regular medication audits were taking place and people received all medication which was prescribed to them.

The registered provider operated within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People who were receiving support from the registered provider provided ‘consent’ to receive care and support and were not being unlawfully restricted.

Recruitment processes were safely and effectively managed. The necessary recruitment checks had been completed, suitable references had been sought and Disclosure and Barring System checks (DBS) were in place for all staff.

Staff training, learning and development opportunities were reviewed during the inspection. Staff expressed that they were supported in their roles and had completed the necessary training in order to effectively carry out their roles.

We reviewed how people’s nutrition and hydration was supported. Staff were familiar with peoples’ preferences and people's likes and dislikes were well known amongst the staff team.

There was a formal complaints policy in place. At the time of the inspection there were no complaints being investigated.

We reviewed ‘Safeguarding’ and ‘whistleblowing’ procedures that the registered provider had in place. Staff explained their understanding of what ‘safeguarding’ and ‘whistleblowing’ meant and the actions they would take if they were presented with any concerns.

People and relatives we spoke with during the inspection all provided us with positive feedback about the quality and standard of care being provided.

Health and safety processes and procedures were reviewed. Audit tools and checks were regularly being completed and the standard and quality of care was being monitored and regularly assessed.

This was an inspection of Cheshire Home Care Services. The provider was given short notice of the visit. The purpose of the visit was to check on action that the provider had taken in respect of non-compliance identified during our previous visit in 2013. We also checked other outcome areas.

We found on this visit that the provider now ensured that people using the service were protected from harm. We also found that the provider had ensured that the service was fully monitored and assessed enabling people to have confidence in them. We found the service compliant with other outcome areas.

For this inspection we involved an expert by experience. The expert spoke with fifteen people. They commented:

“I rate them between good and excellent. I would definitely recommend them”.

“I’ve had no problem with them at all”.

“I would certainly recommend them”

“I really feel it’s working ok”.

“They help me live in my home”.

“They are very good yes, they’re really ok.”

“They are very good. I’ve used them for over a year, and its better now I really know the staff”.

“It’s marvellous”.

“I’ve used them for a few years…and they are really helpful”.

“I rate it as excellent”.

‘”The cover provided by the service is excellent”.”

“My relative’s recovery back home was rapid; we put this down to Cheshire home Care”.

“We they would recommend the service and they were between good and excellent in our opinion”.

We spoke with people who use the service about consent and how they provided it. One person said, “Most carers ask me if its ok to do things, if its not and I don’t want to I will tell them.” Another said that when they joined the service someone came to talk to them about what they wanted and it was agreed then.

We spoke to people using the service and their relatives about if their support needs were met. Everyone we spoke with said they had what they needed. One relative said, “All (family member’s) needs are met, without the service they would not be able to live independently in their own home.”

The service was working with people with differing needs. Some people who used the service had dementia and may have needed support due to a lack of capacity. The service had not developed a capacity policy or any routes for assessment when people lacked capacity. This was also the case where people may lack the capacity in the future. The Manager acknowledged this was a training need and had taken steps to address this by the end of the inspection.

Two of the people we spoke with said that the service could help out at short notice if they required extra support. One person said, “I have used a lot of companies over the years and Cheshire Home Care are the most reliable one I’ve found.”

Management were not doing any monthly audits of the procedures used to protect both the staff and the people using the service.

During this unannounced visit we spoke to a sample of ten people who are provided with support from the service via telephone. We asked their views about the service. They told us they were; ”very happy” and had “no problems” they all felt that the standard of care and support was “very good”.

They told us they were familiar with the staff that supported them and knew most of their names.

People told us; “They have never let us down”: “We have found the care to be excellent”; ”The staff are very supportive and only a phone call away”.

People using the service and their relatives/next of kin told us that staff who support them treat them well and with respect.

However some people told us they would like the stability of the same staff especially at night and the weekend. They felt that if they had the stability of the same staff it would help with the care and support needed. Some people suggested they should have the names of staff being supplied so they always knew in advance who was coming on duty.

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no issues of concern to report.

We carried out an announced inspection of Cheshire Homecare services on the 3rd and 13th of August 2015.

Cheshire Home Care Limited is a large domiciliary care agency providing personal care to people in their own homes. The service has approximately 50 staff supporting about 170 clients in Chester and its rural surrounding area. Staff are available 24 hours day. The office is staffed seven days a week and emergency cover is available after office hours. The service has two registered managers 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.

Our last inspection in August 2013 found that the provider was meeting all the regulations assessed.

People who used the service and their relatives told us they felt safe and comfortable with the staff team. They told us that they were reliable and communicated with them well. All staff had received training about safeguarding and this was updated every year. The required checks had been carried out when new staff were recruited.

The staff we spoke with had good knowledge of the support needs of the people who and had attended relevant training. The staff we spoke with demonstrated a commitment to providing the support people needed as well as a commitment to protecting people from harm.

People we spoke with confirmed that they had choices in all aspects of the support they received and benefitted from a personalised approach to care planning.

People who used the service, their families and staff told us that the management team was open, transparent and knowledgeable. They told us that there had been significant improvements in the standard of support provided since we last visited in 2013. People we met during our visits spoke highly of the management team. The registered provider demonstrated a number of methods used to assess the quality of support provided.