19b is a small domiciliary care service which provides personal care and live –in care to people in their own homes. It provides a service to older adults, people living with dementia, mental health impairments, physical disabilities, sensory impairment and younger adults. The domiciliary care agency office is situated within Ipswich town.

When we inspected on 16 April 2018 there were five people using the service. This was an announced inspection. The provider was given up to 48 hours’ notice because the location provides a domiciliary care service and we wanted to be certain the registered manager and key staff would be available on the day of our inspection. This service was registered in 4 May 2015.This was their first inspection.

Not everyone using the service from 19b receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, medicines and eating. Where they do we also take into account any wider social care provided.

A registered manager was 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.

Overall the feedback was positive about the approach of the care workers and the service provided. Relatives told us that the care workers were kind and compassionate, promoted people’s independence and respected their privacy and dignity.

Care staff knew what actions to take to protect people from abuse. The provider had processes in place to identify and manage risk. People’s risk assessments were regularly reviewed and amended to meet changing needs.

Improvements had been made and were ongoing to ensure people’s care records reflected individualised personalised care.

Care workers knew the people they provided care to well and were able to describe how to meet people's needs effectively. Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment. Where required people were safely supported with their dietary needs.

Recruitment checks were carried out with sufficient numbers of care workers employed, to maintain the schedule of visits and provide continuity of care for people. Where we identified gaps in the recruitment processes the management took swift action to address this. Care workers received supervision and training to support them to perform their role.

Where people required assistance with their medications, safe systems were followed. Care workers were provided with training in infection control and food hygiene and understood their responsibilities relating to these areas. Systems were in place to reduce the risks of cross infection.

People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and, when appropriate, their relatives were involved in discussions about their care planning and given the opportunity to provide feedback on the service. They were also supported to raise complaints should they wish to.

At the time of the inspection no one using the service was receiving palliative care. However the registered manager assured us that people would be supported to receive a comfortable, dignified and pain- free death.

Feedback from relatives and care workers was positive about the management arrangements at the service. However they described inconsistencies with communication due to personnel changes at the office. Improvements had been made and were ongoing to address this, these need to be fully embedded into