About the service: City Care Welwyn Ltd 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. At the time of the inspection, the service was providing personal care to 52 people.

People’s experience of using this service:

¿ At the last inspection on 30 June 2016 we identified people had not signed to give consent to care and treatment, risks associated with the support people received were identified by staff and effectively mitigated, however these were not evidenced in people`s plan of care; and audits had not been always as effective. At this inspection on 7 and 8 March 2019 we identified the registered manager had made improvements to all areas and we were satisfied with their response.

¿ People continued to be safe as risk management plans identified known risks and gave staff clear guidance on how to mitigate those risks. Staff had sufficient understanding of how to identify, respond to and escalate suspected abuse. Staff received on-going safeguarding training.

¿ People’s medicines were managed safely and administered as intended by the prescribing Pharmacist. Medicines were regularly audited to ensure any errors were identified quickly and action taken to minimise the negative impact on people.

¿ The registered manager deployed sufficient numbers of suitable staff to keep people safe. Staffing levels were adequate and people confirmed staff had sufficient time to sit and talk with them.

¿ People continued to be supported by staff that received regular training to enhance their skills and experience. Through regular supervisions and spot checks, staff reflected on their working practices.

¿ Staff were knowledgeable about and adhered to the principles of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. People’s consent to care and treatment was sought, documented and respected.

¿ People were supported to access food and drink that met their dietary needs and preferences where agreed in their care package. Where there were concerns about people’s health and well-being referrals were made to healthcare professionals and advice given implemented into the delivery of care.

¿ People continued to be supported by staff that encouraged their independence, treated them equally and with kindness and compassion. People’s dependency levels were regularly reviewed and support provided to reflect people’s current needs.

¿ Care plans were person centred and gave staff clear guidance on the support people required in line with their wishes and preferences. Care plans were reviewed regularly and where possible people and their relatives were encouraged to develop these.

¿ People were able to raise concerns and complaints and there were systems and processes in place to ensure complaints were managed responsively and in a timely manner.

¿ People, their relatives and staff spoke positively about the registered manager. People and staff confirmed the management structure at the service was effective. People’s views were regularly sought to drive improvements. An external organisation carried out a comprehensive quality monitoring process, to gather people’s views. Issues identified were acted on in a timely manner.

¿ The registered manager carried out regular audits of the service to monitor the service provision. Issues identified during the audits were acted on swiftly and lessons learnt to minimise the risk of repeat incidents.

¿ The registered manager continued to encourage partnership working with other stakeholders and healthcare professionals.

Rating at last inspection: The service was previously inspected on 30 June 2016 and was given an overall rating of Good. We gave the service a rating of Requires Improvement in the key question, is the service well-led?

Why we inspected: This was a planned inspection in line with our inspection programme.

Follow up: We will continue to monitor intel

The inspection took place on 30 June 2016. We gave the provider 48 hour notice of our intended inspection to make sure that appropriate staff were available to assist us with the inspection. The service provided personal care and support to 50 people living in their own homes.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Potential risks to people’s health and well-being were identified by staff and they knew how to manage these effectively and protect people from harm. However risk assessments were not developed in people`s care plans for auditing purposes. We couldn`t see how people`s needs changed and how risk assessments were reviewed or adapted to keep people safe.

People told us staff asked for their consent before providing care and support, however not all the care plans we looked at had consent to care forms signed by the people or their rightful representatives who received care and support.

People told us and their relatives and their relatives agreed that people were kept safe and well cared for when they were being supported by the service. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse.

Recruitment processes were robust and ensured staff employed to deliver care and support for people were of a good character and suitable to meet people`s needs safely. There were sufficient numbers of staff available to meet people’s individual needs, and the service provided was flexible.

People told us staff supported them to take their medicines in in time. Staff were trained in safe administration of medicine practices and had their competency regularly observed by the management.

People and their relatives were very complimentary about the abilities and experience of the staff who provided care and support. Staff received training when they were employed and regular updates to ensure they were up to date with their knowledge and best practice guidance.

Staff supported people to stay safe in their homes, and people were supported to maintain their health and well- being. Staff developed appropriate positive and caring relationships with the people they supported and their families, and feedback from people was consistently positive about the service they received.

People and their relatives where appropriate were involved in the initial planning of the care and support people received. People's personal information was stored securely and confidentiality was maintained.

People told us they felt the staff provided care and support that was delivered in a way that promoted their dignity and respected their privacy. Staff were knowledgeable about people`s preferred routines and delivered care that was individualised to the person they were supporting.

People told us they felt that staff listened to them and responded to them in a positive way. People and their relatives knew how to raise concerns and they were confident that the manager would take appropriate action to address any concerns in a timely way.

People were asked to provide feedback about the service they received regularly and we saw these were very positive. The registered manager contacted an independent company to carry out a survey which included people who used the service, their relatives, staff and health and social care professional to gather feedback about the service they offered.

People and their relatives were positive about the staff and the management of the service. The registered manager regularly audited the service any improvements needed were promptly actioned.