We inspected this service on 4 October 2016. The inspection visit was announced.

The service delivers personal care to people in their own homes. At the time of our inspection, 12 people were receiving the service. The service predominantly supports people with a learning disability or with mental health support needs.

There was 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. On the day of the inspection visit, the provider's head of care supported the registered manager to explain how the service operated and was managed.

People told us they felt safe with the staff that came to their home. Staff were trained in safeguarding and understood the signs of abuse and their responsibilities to keep people safe. The provider had introduced a safeguarding spot check of the service so staff were kept abreast of the safeguarding policy and procedure. Staff were recruited safely.

Risks of harm to people were identified at the initial assessment of care and their care plans included the actions staff would take to minimise the risks. Staff understood people's needs and abilities because they had the opportunity to get to know people well through shadowing experienced staff during induction before working with them independently.

The manager identified potential risks in each person's home, so staff knew the actions they should take to minimise the risks. Staff were trained in medicines management, to ensure they knew how to support people to take their medicines safely to keep accurate records.

Staff received the training and support they needed to meet people's needs effectively. Staff had regular opportunities to reflect on their practice, to attend training in subjects that interested them and to consider their personal development.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People made their own decisions about their care and support.

People were supported to eat meals of their choice and staff understood the importance of people having sufficient nutrition and hydration. Staff referred people to healthcare professionals for advice and support when their health needs changed.

People told us staff were kind and respected their privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's cultural values and preferences.

People and relatives said that the service was responsive to their needs however concerns were raised to us about the use of agency staff, the consistency of care and the lack of proactive support for people when keyworkers were not on duty. A keyworker is a carer who is the main contact and organiser of a person’s care

People were confident any complaints would be listened to and action taken to resolve them. When people raised issues, they would be investigated and resolved.

The service was well led however there was some confusion for care professionals about who was managing the service. A social worker also said the service needed to improve their communication with them.

The provider's quality monitoring system included asking people for their views about the quality of the service through telephone conversations, visits by a supervisor and regular questionnaires.

The manager checked people received the care they needed by monitoring the time staff arrived for scheduled calls, reviewing care plans and daily records, and through feedback from care coordinators.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The service had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards .

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their support plans. People said that they had been involved in this process and that they reflected their current needs. It was clear from speaking with staff that they had a good understanding of people's care needs and were adequately trained and supported to carry out their duties safely and effectively.

Is the service caring?

People were supported by kind and attentive staff. We were told that care workers showed patience and gave encouragement when supporting people. One person said, "They are so kind and caring".

People using the service and their families completed and returned an annual satisfaction survey. These were used to help improve the service in the future.

Is the service responsive?

People knew how to make a complaint if they were unhappy though nobody had done so recently.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service also operated a quality assurance system which identified and addressed shortcomings. As a result, the good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were looking after and were properly trained to carry out their duties.

People we spoke with told us that the staff were polite, caring and respectful. They said that their privacy and dignity was respected. One person who used the service told us that “The service suits my needs and my rights are respected”.

We looked at the support plans for six people who used the service. We saw that a comprehensive assessment of needs had been completed before they had started to use the service and this was used to develop the individual's support plan.

We spoke with five members of staff who told us that they had received safeguarding training as part of their induction and that the training was repeated on a yearly basis. They all demonstrated a clear understanding of the signs and behaviours associated with potential abuse.