The inspection took place on 16, 25 and 27 January 2017 and was announced. We last inspected the service on 13, 14, 16 and 22 October 2015 and found the provider had breached the regulation relating to safe care and treatment and in particular the management of medicines.

Choice Care is a domiciliary agency which is registered with the Care Quality Commission to provide personal care for people in their own homes. The agency operates in the Washington and Gateshead areas. At the time of our inspection 41 people were using the service.

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.

The provider had made significant improvements to the management of medicines within the service. Medicines administration records provided an accurate account of the medicines care workers had given to people. Care workers also had access to clear and detailed guidance about the help each person needed with medicines.

Medicines audits were being completed consistently every month. They were effective in identifying areas for improvement and ensuring appropriate action was taken.

Since our last inspection the quality assurance processes were now fully operational and identifying areas for improvement.

People told us they received good care from kind and considerate care workers. They said they had a consistent group of care workers providing their care and they were reliable.

People and relatives told us they felt the service provided safe care.

Care workers had a good understanding of safeguarding adults and the provider’s whistle blowing procedure. They knew how to report any concerns and confirmed they would not hesitate to do so if required. A previous safeguarding concern had been referred to the local authority safeguarding team and fully investigated.

Recruitment checks were carried out prior to new care workers starting their employment. This included disclosure and barring service (DBS) checks.

Incidents had been fully investigated and action taken to help prevent the situation happening again. Action taken included contact with GPs, additional training, specific supervision and disciplinary procedures.

Care workers were well supported and received training essential to their role. Records confirmed supervisions, appraisals and training were up to date.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA). Where people lacked capacity, guidance on supporting people to make decisions was in place for care workers to follow. People told us they were supported to be in control and make their own choices and decisions.

People were supported to have enough to eat and drink. Care plans described the support people required and gave details of their preferences.

Care records showed people had regular access to health professionals when required.

People’s needs had been assessed and personalised care plans developed. People were involved in deciding what information went into their care plans which included details about people’s preferences.

People had opportunities to give their views and feedback about their care. Regular reviews took place and people were sent questionnaires to complete from time to time. Positive feedback had been received during the last consultation in December 2016 with people describing the service as ‘the very best’ and ‘5 star’.

People did not have any concerns about their care but knew how to complain if needed. Previous complaints had been dealt with appropriately.

Regular staff meetings were held which gave care workers the opportunity to feedback their views and suggestions about the service.

We spoke with one person who received care in their own home and we spoke to one person’s relative. Both people were very positive about the care provided. The person using the service said carers were “very good.” This person told us they were involved with their care plan and the staff knew them well. They said they felt staff were “well trained” and the person and their family trusted the carers.

Another person using the service had complex needs which meant they were unable to tell us their views. With advance agreement we contacted the persons’ representative. They told us they were “very pleased with every aspect of care.” They said they were “very involved” with their relatives care plan and staff always took their views into account.

We found people’s privacy, dignity and independence were respected and people experienced care and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse and people were cared for by staff who were supported to deliver care and treatment safely.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us the care staff treated them with dignity and respect. One relative told us, “She is always covered with a bath sheet to make sure her dignity is preserved”. One person who used the service told us, “They treat my house with respect, and consider themselves as guests to my home.”

We found that before the agency started to provide care for people, their needs were assessed by a senior member of staff. This was to make sure the agency had the skilled workforce and necessary equipment to look after the person.

We found there were care plans in place and each care plan was individualised and written to meet the needs of the person. One staff member told us, “The care plans are very good and tell you how to carry out your duties.”

Staff told us the manager and senior staff regularly carried out spot checks on them. One staff member told us, “The spot checks keep us on our toes, especially when they also ask the clients about our practice.”

Customer satisfaction surveys were periodically undertaken. We found there was high satisfaction rate amongst the people who responded to the questionnaire. We also found the survey report highlighted both positive comments and negative comments. Some of the included: “I think I am always confident with Choice Care. They are very flexible and courteous and friendly”; and

“Would like more flexibility with hours in the summer months”.

The inspection took place on 13, 14, 16 and 22 October 2015 and was unannounced. The service was last inspected on 5 August 2014 and was found to be meeting the legal requirements we inspected against.

Choice Care is a domiciliary agency which is registered with the Care Quality Commission to provide personal care for people in their own home. The agency operates in the Washington and Gateshead areas. At the time of our inspection 41 people were using the service.

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.

The registered provider had breached regulation 12 of the Health and Social Care Act 2008. This was because medicines records did not accurately account for individual medicines given to people. Where people had medicines to help with specific medical conditions, care plans and risk assessments did not contain personalised information to ensure people received these medicines safely.

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

We received positive feedback from people using the service and their family members about the care people received. One person said, “I am perfectly happy with them.” One family member described their relative’s care as “very good” and “very caring.” People were treated with dignity and respect. One person said, “They always take me into consideration, always involving me. They allow me the dignity of hanging onto one or two things. I am involved in choices. It is what keeps me going.”

People told us they had no concerns about safety. One person said, “I feel extremely safe.” People received their care from a skilled, reliable and consistent staff team who knew their needs well. One person said, “We have the same girls so we have a routine worked out.” They added, “Staff stay the full time, we never feel rushed. They have stayed over their time if something needs doing.” Another person said staff were, “Pretty much reliable. If I needed them they would come out and help me. They wouldn’t just leave me to wait for the next call.” They went on to say, “They turn up on time, they have never really been late. If they are late they ring me first to let me know.”

Staff had a good understanding of safeguarding adults and whistle blowing including how to report concerns. Staff were confident concerns would be dealt with appropriately. One staff member said, “They would look into it, they deal with whistle blowing.”

Potential risks had been assessed when the person started using the service. Assessments identified the measures needed to manage the risks.

Recruitment and selection procedures were followed to check new staff were suitable to care for vulnerable adults. Care records contained details of regular checks to make sure any specialist equipment people used was safe.

Staff told us they were well supported to carry out their caring role and received the training they needed. One staff member commented, “Very much so, I am very supported in all areas.” They went to say they had, “Appraisal, one to one with [manager’s name]. I enjoy coming in for one to one. There is an open door policy.” Another staff member said, “[The registered provider is] supportive of training, my training is up to date.” Records confirmed training, supervision and appraisal were up to date.

People were asked for their consent before they received care. They confirmed they were in control of their care. One person said, “I am in control so I can choose to go anywhere.” Another person said, “It’s about what we want and need.” Another person said, “[Staff] always ask me first.” Another person commented, “One thing I will say about Choice Care is they always ask me are you sure there is nothing else you need.” Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and their role in supporting people to make decisions. Communication care plans provided prompts for staff to use when communicating with people so that they received consistent support.

Staff supported people to have enough to eat and drink. Care plans identified the support people needed with eating and drinking including their food and drink preferences. People were supported to access healthcare, such as from GPs and community nurses.

People and family members were involved in developing and reviewing care plans. One person said, “We are involved in the care plan and deciding what went in.” People had their needs assessed before and after they started using the service. Care records contained a ‘brief life history’ about the person.

People told us staff listened to them and responded to their wishes. One person said, “If there are any problems we ring the office and it is sorted. There were times when we needed earlier appointments for hospital and it was no problem. Sometimes we need very early care, this is dealt with without any problems.”

People knew how to complain and told us they would feel comfortable raising concerns. The service user guide provided people with information about how to complain. One person said, “If we have problems we ring the office and we find them absolutely fantastic. We are aware of the complaints [procedure] but not needed to.”

People, family members and staff told us the registered manager was approachable. One person told us about a time when they had a problem. They said, “[The registered manager is] absolutely fine. We had a lot of problems. We met her every week until they were sorted.”

There were some systems in place to check people received good care. One person said, “The senior comes in to ask whether we are happy.” These included spot checks and other ad hoc checks. Medicines audits were not done consistently or in a timely manner so that issues relating to medicines management were identified and dealt with quickly. A more structured approach to quality assurance was being implemented.

People were consulted regularly about their experience of the service they received. One person said, “They send questionnaires out, I occasionally fill them in.” People and family members consistently told us they did not receive feedback from the registered provider following the consultation.