We inspected Choices Home Care Limited on 21 October and 2 November 2016. This was an announced inspection. We gave the registered provider 48 hours’ notice that we would be visiting to inspect. We did this because we wanted the registered manager to be present at the service on the day of the inspection to provide us with the information we needed. We last visited this service on 18 July 2013 and the registered provider was meeting all the regulations inspected at that time.

The service is registered to provide personal care to people living in their own homes. At the time of our inspection 27 people were receiving support. The service supported older and younger people, people with a learning disability, mental health concerns and people with physical disabilities. Some people were living with dementia and some with sensory impairments.

The service had a registered manager who was also the registered provider. 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.

Systems were in place for the management of medicines so people received their medicines safely. Some improvements were needed to ensure all good practice guidelines were used. We made a recommendation the registered provider did this and work had already started on day two of our inspection.

The registered provider ensured risk assessments were in place for staff to follow when they supported people and also around the equipment they used in people’s homes they visited.

This meant the registered provider took steps to ensure the safety of people and staff. Formal assessment tools were not used for areas such as pressure care and nutrition. The registered manager told us they will start to use these where appropriate to ensure staff have all of the written guidance they need to help people to remain safe.

Care plans we saw contained information about the person's likes, dislikes and personal choices. Care plans were reviewed regularly and any actions from those reviews were carried out to improve the service people received.

People were supported to access their choice of food and drinks which helped to ensure their nutritional needs were met. Staff worked with other healthcare professionals to support people to have their health needs met.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice. People and their relatives told us staff treated them with dignity and respect. Staff showed compassion, were patient and gave encouragement to people. People were supported to have choices and be independent.

The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. People were supported to make their own decisions and were involved in decisions about their care and support.

There was enough staff employed to provide support and ensure people’s needs were met. Effective recruitment and selection procedures were in place and we saw appropriate checks had been undertaken before staff began work.

Staff told us the registered manager and senior members of staff were supportive. Staff had received regular supervision and appraisal. The registered provider had a system in place to ensure staff received all of their training and this confirmed training was up to date. Staff told us they felt they had received enough training to enable them to fulfil their role.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident staff would respond and take action to support the

We spoke with five people or their relatives who used this agency. They all spoke highly of the care they or their relative received and told us they would recommend it. We also reviewed comments from the service user survey undertaken in June 2013.

Comments included,

"They are outstanding, very good indeed.”

“They do an exceptionally good job."

“They look after all my needs.”

“Exceptional carer the service is responsive to changing needs.”

“Always there to help if you need it.”

The care records we reviewed showed that the care plans were up to date and people had their health and welfare needs met.

Care staff were very complimentary about the agency and the support they received. One care worker told us "I love my job”.

We spoke with six people or their relative who used this agency. They all spoke highly of the care they or their relative received and told us they would recommend it. Comments included, "Absolutely 100%," and "Smashing; they do a good job." The care records we reviewed showed that people were involved in making care decisions and consented to their care. They also showed that care plans were up to date and people had their health and welfare needs met. Care staff were very complimentary about the agency and the support they received. One care worker told us, "This company has everything in place and I love working with my clients."

As part of this planned review, we spoke with four people who are receiving a service. In general the feedback was positive.

All the people we spoke with said the staff were kind, treated them with respect and ensured their privacy and dignity was respected.

People told us they were offered choices about how their care was delivered and staff listened to their views and opinions. People knew how to contact the office if they needed to speak with a manager or make any changes to their service, and they all felt comfortable approaching the management team.

People knew how to make a complaint, although only one person had ever needed to do this. We were told their complaint had been dealt with quickly and to their satisfaction.

Most people said staff kept a record of what services had been delivered and the times of each call; they all confirmed the records were an accurate reflection of what had happened.

Most people were happy with the times the service was delivered, although one person said they would prefer staff to come later to support them in getting to bed.

One person told us their carer had left and nobody had let them know. They said they would like to be told if one of their carers leaves.

People said that generally they receive a service from a consistent, small team of staff, although occasionally they get new staff if someone is off sick or on holiday. One person told us they had been receiving a service from the same member of staff for around six years; they viewed this very positively.

Some people said managers came to their home to check they were receiving a good quality service.