This inspection started on 29 November 2018 and was completed on 3 December 2018 and was announced. We gave the provider 48 hours’ notice of our intended inspection to make sure someone would be available to assist us with locating documents. The inspection began on 29 November and was completed on 3 December. We asked the provider to request authority from people to visit them in their homes. People agreed to our request and was happy for us to visit them in their homes.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and disabled adults. At the time of our inspection the service was supporting six people.

The service is required to have a registered manager to manage the service. At the time of our inspection a registered manager was managing the service. 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.

People we spoke with told us the service was good and they thought the staff were good and knew how to take care of them. People we visited said, “Very good, they are marvellous they know what’s what” and “Oh yes, they know what to do alright.”

Staff received training in safeguarding and were aware of their responsibilities of reporting any concerns to the relevant authority. There were sufficient numbers of staff to support people. The service had robust recruitment procedures in place. The provider did not use any agency staff to support people.

Staff received regular supervisions and appraisals. Staff told us the registered manager was always at the end of the phone if they required advice or support. The provider told us they spoke with staff on a daily basis.

Medicines were not managed safely at the time of our inspection. The provider had not followed best practice guidelines in the administration of medicines.

People had 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.

A complaints procedure was given to people when they first joined the service. There had been no complaints since the service was first registered.

Staff were appropriately inducted and completed mandatory training before they supported people. However, some tasks were carried out without the relevant training. The registered manager told us they carried out spot checks to monitor staff.

The service supported people with their meals. People were monitored who were at risk of malnutrition. However, the provider had not used an assessment tool such as the Malnutrition Screening Tool (MUST).

We have made a recommendation in relation to this.

Risk assessments were mostly in place for people when they first joined the service. However, specific risks for people with additional support needs were not assessed or in place at the time of our inspection.

Staff had access to personal protective equipment to protect people and understood their roles and responsibilities in relation to infection control and hygiene.

The provider had had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

People were able to access health care professionals to maintain their health and well-being. We saw community nurses and occupational therapists were involved in the support of people who used the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

The inspection took place on 4th March 2016 and was announced and was the first inspection following registration on 21 May 2013.

Chiltern Homecare Limited is registered to provide domiciliary care to people who require support in their own homes. On the day of our visit there were six people using the service.

The registered manager has been in post since May 2013 when the service was first registered.

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.

People said the service was caring and promoted their independence and supported them to exercise choice. One person commented “Staff attend to my needs in a thoughtful sensitive way.”

Staff had established good working relationships with the people they supported and were aware of their care needs.

People said their care was centred on their wishes and any changes in care that were required they were consulted and were able to express their views. Comments included “They know what they are doing and they do what is needed”.

People said they felt safe and would know who to speak to if they had concerns or felt unsafe.

Staff knew how to protect people from abuse and how to respond if they had concerns. For example, staff told us, “If we see signs of abuse or neglect we would report this to our manager”.

This was in line with the service’s safeguarding policy and procedure.

Staff received appropriate induction, training and were supervised on a daily basis by the registered manager. However, this was not always documented; we recommend that this takes place to ensure evidence of meetings with staff is available.

Safe recruitment procedures were in place. Care records showed where risks had been identified appropriate risk assessments were in place to ensure people’s safety.

Staff were aware of the Mental Capacity Act 2005 and the implications in relation to their care practice. People who use the service had capacity to make decisions therefore the service did not carry out capacity assessments.

People said they knew how to make a complaint and were given the information on how to do this within their pre contract information guide.

The provider had systems in place to ensure the running of the service. This included the use of continuous quality checks. People and staff told us the service was extremely well led by the registered manager. Staff’s hard work was recognised by the provider and the service promoted the provider’s values.

The provider informed us that they focused on the quality of care, not the quantity. New care packages were thoroughly assessed by the registered manager to ensure the service could provide care people needed before committing to offering the service.

The service was well-led and people’s care was regularly reviewed. The registered manager had an excellent oversight of the service. Staff told us they felt supported and happy working for Chiltern Homecare.

People were supported to have access to healthcare services to maintain good health.