About the service: Chilworth House Home Care Services Limited is a domiciliary care service. It provides personal care to people living in their own homes. It provides a service to younger adults, people with disabilities, older people and people with dementia. It was providing care to 43 people at the time of our inspection.

People’s experience of using this service:

• People’s overall impressions of the service were positive. “Excellent service” and “Very happy” were typical responses from people we spoke with. One relative said they were “Happier and more content knowing that someone is coming in.”

• The service had made improvements since the previous inspection. Regulatory requirements were now being met.

• People’s needs were recorded in care plans. Risk assessments had been completed to reduce the risk of avoidable harm.

• People were supported by care workers who had been robustly recruited. Staff received a structured induction and training to be able to meet the needs of people they supported.

• The quality of care was monitored through provider questionnaires, reviews and ‘spot checks.’

• People were supported by kind and caring staff.

• The service liaised with other agencies to promote people’s welfare.

• People received help with their medicines, where this was part of their care package. Improvement had been made to medicines administration records.

• We have made a recommendation where Lasting Power of Attorney has been granted. This is to make sure the service checks others have legal authority to make decisions on people’s behalf.

Rating at last inspection: The service was rated ‘Requires Improvement’ at the last inspection on 22 March and 6 April 2018. We published our report on 10 May 2018.

Why we inspected: The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Where services are rated ‘Requires Improvement,’ we re-inspect within a year of when we published our last report. We asked the provider to send us an improvement plan following the last inspection. This was received and showed the changes they would make at the service.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 22 March 2018 and 6 April 2018. It was an announced visit to the service.

We previously carried out a comprehensive inspection of the service in April 2016. The service was not meeting all the requirements of the regulations at that time. A focussed inspection took place in February 2017 to check that improvements had been made; we found the provider had taken the necessary action.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults and younger adults with disabilities. Forty four people were receiving care from the agency at the time of the inspection

The service had 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.

We received positive feedback about the service. People felt the service met their needs and that staff were caring and kind. They told us they were treated with dignity and respect.

Staff understood about protecting people from abuse. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns.

There were sufficient staff to meet people’s needs. Two staff were assigned to support people where lifting equipment was required, to ensure this was carried out safely.

Thorough recruitment processes were used to ensure all required checks and clearances were received before care workers supported people. Staff received a structured induction, supervision and training to make sure they had the skills and knowledge to support people safely.

Care plans had been written to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs. The service ensured risks associated with people’s care and support had been assessed. For example, helping people to re-position.

People were supported to have 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. We have made a recommendation to promote good practice with the Mental Capacity Act 2005, where relatives or others say they have legal authority to act on behalf of people.

Where people were supported with their medicines, we found the service did not always maintain accurate or well-maintained records. This meant clear audit trails were not evident and errors could occur.

The provider regularly checked the quality of care at the service through surveys and spot checks.

We have advised the service to develop a policy around duty of candour, to ensure they understand what is required of them in the event of things going wrong.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safe management of people’s medicines.

You can see what action we told the provider to take at the back of the full version of this report.

This focussed inspection took place on 10 February 2017. It was an announced visit to the service.

We previously inspected the service on 27 April 2016. The service was rated ‘good’ overall at that time. However, there was one area where a regulation was not fully met. This was in relation to management of people’s medicines. We made a requirement for the provider to improve practice. They sent us an action plan which outlined the measures they would take to make improvements. This visit was to check the improvements had been made and only covered the ‘safe’ domain.

Chilworth House Homecare Services Ltd was providing care to approximately 33 people in their own homes at the time of this visit, in High Wycombe and surrounding areas.

The service had 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.

We found improvements had been made to the recording of medicines administered to people. Staff now signed consistently to show when they had given or offered people their medicines.

Staff completed training on medicines administration as part of their induction. The registered manager told us they now had a senior member of staff who shadowed new workers, to make sure they followed safe procedures before they administered medicines alone.

People were protected from the risk of harm. The service had a policy on how it aimed to protect people from the risk of abuse and staff completed safeguarding training. Risks to people’s safety and well-being had been assessed and documented. Appropriate measures had been put in place where high risks were identified. For example, two staff supported people whose moving and handling assessments required this.

People were protected from the risk of being supported by unsafe workers. Robust recruitment practices were used at the service. Staff completed a range of training to help ensure they supported people safely and appropriately. This included moving and handling theory and practice, basic life support and health and safety.

People who completed a recent provider questionnaire were very satisfied with the overall care they received. They said staff had enough time to meet their agreed care needs and rated the friendliness of staff as ‘excellent’ in five out of six cases; the sixth person rated friendliness as ‘good.’ Comments included “I have appreciated it when you have phoned to let me know if the carer is running late,” “The staff are friendly and cheerful which helps lift her mood” and “Mum and I are very pleased with the standard of care and friendliness of staff. Would recommend your company.” A relative who completed a questionnaire commented they could now go away on holiday “Knowing she is well looked after.”

People we contacted said the service was reliable. One relative told us “They’re very good, very compassionate, the carers are doing a good job.” Another relative said “They’re really nice, friendly, I can’t fault them.” The person added care workers were “Very patient” with their relative and said “They really help me.”

This inspection took place on 27 April 2016. It was an announced visit to the service.

We previously inspected the service on 5 December 2013. The service was meeting the requirements of the regulations at that time.

Chilworth House Home Care Services Ltd provides support to people in their own homes in the High Wycombe and surrounding areas. It was supporting 31 people at the time of our inspection. This included older people, people with dementia and people with physical and learning disabilities.

The service had 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.

We received positive feedback about the service. Comments from people included “Carers do a great job,” “The service has been very good,” “Anything you need done, they do it,” “They’re very good” and “You couldn’t fault them.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Risk was managed well at the service to enable people to be as independent as possible. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care.

We found people’s medicines were not consistently managed safely, as records of medicines administration were not always accurate.

There were sufficient staff to meet people’s needs. Staff were recruited using robust procedures to make sure people were supported by care workers with the right skills and attributes. Staff received appropriate support through a structured induction, regular supervision and an annual appraisal of their performance. There was an on-going training programme to provide and update staff on safe ways of working. Staff were encouraged to undertake further learning to help them develop as workers.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs.

People knew how to raise any concerns about their care and said they felt able to approach the registered manager if they needed to.

The service was managed well. Feedback from a recent survey carried out by the provider showed people were either ‘satisfied’ or ‘very satisfied’ with the standard of care they received.

Records were generally maintained to a good standard and staff had access to policies and procedures to guide their practice.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safe management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with three people who used the service or a relative (primary carer) if they were unable to speak with us themselves. Each person spoke positively about their experiences of using the service. A relative told us “I think they’re a good service.” They said the service was reliable and they had no concerns about quality of care. One person said “I’m happy with the service I get. The last service I used didn’t do their job properly – this one does.” They added “They’ve been very good to me.”

We read four people's care plans. These provided up to date and comprehensive accounts of people’s care requirements. Risk assessments had been written for each person. These included moving and handling and health and safety assessments. The assessments identified where, for example, people needed two staff to assist them. Two staff were then allocated to carry out visits to these people. This showed care was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found there were enough staff to meet people’s needs. Rotas were planned in accordance with people’s care requirements. We contacted two members of staff. They told us they had enough time to provide support to people during their visits. They said the manager and senior staff were easy to contact and were approachable if they needed any advice or guidance. Staff described good training opportunities. One member of staff said they had a “Very good induction” and “Quite a lot of training.” The other member of staff said “There’s always some course going on.”

Records were kept securely and could be located promptly when needed. We saw all the records we requested were kept in the office. Staff records and other records relevant to the management of the service were accurate and fit for purpose.

When we visited the service on 19 November 2012, we had concerns about how people's care and welfare were being managed. This was because risk assessments had not been consistently signed, dated and updated as necessary. This meant risks to the person and ways of reducing the risks had not been managed effectively. We set a compliance action for the provider to improve practice.

During this visit, we saw improvements had been made at the service. We looked at five people's records. Risk assessments had been kept up to date to reflect changes in people's circumstances. Dates and signatures were in place which showed who completed the assessments and when. We were satisfied the provider was now meeting this standard.

We found there was good regard for people's dignity and independence. People and their relatives had been involved in pre-service assessments and care plans. Care plans were in place for each person. However, care was not delivered and planned in a way which ensured the welfare and safety of people using the service. This was because risk assessments had not been consistently signed, dated and updated as necessary. This meant risks to people and ways of reducing the risks had not been managed effectively.

There were systems in place to safeguard people from abuse, such as policies and staff training. Thorough recruitment checks were carried out to make sure prospective staff were suitable to work with vulnerable people.

We found people were aware of the complaints system and who they could speak with if they had any complaints.