This inspection took place on 22 August 2018. The inspection was announced.

Community Support Service is registered to provide personal care support to people. At the time of our inspection the agency supported nine people with personal care and employed 13 care workers, including two team leaders. The service is located in Solihull in the West Midlands.

This service is a domiciliary care agency. It provides personal care to people living in their own homes, including, older people, younger adults, people living with dementia, learning disabilities and people who experience mental health problems.

We last inspected Community Support Service in July 2017 and we rated the service as 'Requires Improvement' overall. This was because people’s medicines and some risks associated with people’s planned care had not been safely and consistently managed. Furthermore, the provider’s quality monitoring systems were not effective and did not support continuous improvement. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17 (Good governance).

We asked the provider to send us a report, to tell us how improvements were going to be made to the service. The provider sent us an action plan which informed us how they planned to make the required improvements to address the issues we had identified. They told us these actions would be completed by August 2017.

At this inspection we checked to see if the improvements had been made and if they were effective. We found improvements had been made and action had been taken in response to the breach in the Regulation. However, further improvement was needed.

The service had a registered manager. A requirement of the provider’s registration is that they have 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.

Improvements had been made to the way people’s medicines and risks associated with their planned care were managed. Known risks had been assessed and risk management plans contained up to date information. Most assessments provided care workers with the information they needed to manage and reduce known risks safely. Care workers had a good knowledge of how to minimise risks to people's safety.

The management team completed regular checks to monitor the quality and safety of service provided, and encouraged people and relatives to share their views about the service to drive forward improvements. However, further improvement was required in both of these areas.

The provider conducted pre-employment checks prior to care workers starting work, to ensure their suitability to support people in their homes. People felt safe with their care workers and there were enough care workers to provide all planned care calls, at the times people expected and for the length of time needed.

Improvements had been made to people’s care records and further improvements were planned.

Care workers had a very good understanding of the people’s needs and preferences and people were involved in developing and reviewing their care. People described their care workers as ‘very caring and kind’.

People who required support had enough to eat and drink to maintain their health. The registered manager and care workers worked in partnership with other professionals to support people to maintain their health and well-being. People and relatives were confident care workers had the knowledge and skills needed to meet their needs.

The management team and care workers knew how to protect people from the risk of abuse and understood their responsibilities to report any concerns. Care workers understood their responsibilities in relation to infection control

Community Support Service is a domiciliary care agency which is registered to provide personal care to people in their own homes. The provider of the service is Family Care Trust. At the time of our visit the agency employed 12 care staff and provided a personal care service to 6 people.

We visited the offices of Community Support Service on 26 July 2017. We told the provider before the visit we were coming so they, and staff, would be available to talk with us about the service.

The service was last inspected June 2016 and required improvement in how the provider responded to people’s needs and how the service was led. Overall the service was rated as ‘Requires Improvement’. During this inspection visit we found the provider had not made all the improvements required and the service continued to have an overall rating of ‘Requires improvement.’

Since our last inspection in June 2016 the provider had experienced significant changes and restructuring within their organisation and this had impacted on the systems and processes carried out to monitor the quality of care provided to people. The provider had lost a tender to provide support to people with the local authority in early 2017. This had resulted in several staff leaving their employment and a reduction in the number of people the provider was providing care and support to.

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 manager had worked hard to stabilise the service, and support people and staff, during the changes.

People told us they felt safe with the staff that supported them. People were supported by staff who knew how to recognise abuse and how to respond to concerns. However, risks in relation to people’s care and support were not always assessed and updated, to protect them from harm. People told us they received their medicines as prescribed, however, medicines records were not always kept up to date.

Checks were carried out prior to care staff starting work to ensure their suitability to work with people who used the service. New care staff completed induction training and shadowed more experienced care staff to help develop their skills and knowledge. Staff completed a programme of training to support them in meeting people’s needs effectively.

The registered manager understood the principles of the Mental Capacity Act (MCA) and how to put these into practice. However capacity assessments were not fully completed and lacked detail. Care staff respected decisions people made and gained people’s consent before providing care.

There were enough care staff to deliver the care and support people required. People were positive about the care they received and told us staff were respectful and caring. People said staff maintained their privacy and dignity and supported their independence.

People received a service based on their personal needs and care staff usually arrived around the time expected to carry out their care and support.

Care plans did not always contain relevant information for staff to help them provide the personalised care people required. Although staff said people had care plans in their home, some plans were not up to date and contained inaccurate information.

Some people told us they did not know how to make a formal complaint. However they felt confident in raising concerns with the staff, knowing they would be listened to and concerns they had would be acted on.

There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. However, we found some of these processes were not regularly carried out. This included reviews o

Community Support Service is a domiciliary care agency which is registered to provide personal care to people in their own homes. The provider of the service is Family Care Trust; some people who use the service refer to the agency as ‘the Trust.’ At the time of our visit the agency employed 25 care staff and provided a personal care service to 22 people.

We visited the offices of Community Support Service on 29 June 2016. We told the provider before the visit we were coming so they could arrange to be available to talk with us about the service.

The service was last inspected in February 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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.

People told us they felt safe with the staff that supported them. Staff understood how to protect people from abuse and knew about risks to people’s safety. There were procedures to manage identified risks with people’s care and people received their medicines as prescribed.

Checks were carried out prior to care staff starting work to ensure their suitability to work with people who used the service. New care staff completed induction training and shadowed more experienced care staff to help develop their skills and knowledge. Staff completed a programme of training to support them in meeting people’s needs effectively.

The registered manager understood the principles of the Mental Capacity Act (MCA) and how to put these into practice. Care staff respected decisions people made and gained people’s consent before providing care.

There were enough care staff to deliver the care and support people required. People were positive about the care they received and told us staff were respectful and caring. People said staff maintained their privacy and dignity and supported their independence.

People received a service based on their personal needs and care staff usually arrived around the time expected to carry out their care and support.

Care plans contained relevant information for staff to help them provide the personalised care people required. Although staff said not all people had care plans in their home and some plans were not up to date.

People knew how to complain and information about making a complaint was available to them. People and staff said they could raise any concerns or issues with the registered manager, knowing they would be listened to and acted on.

There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. However we found some of these processes were not regularly carried out. This included reviews of care plans, observations of staff practice and checking and auditing records completed by care staff.

At the time of our inspection Community Support Service had 150 people who used the service. Some people received 24 hour care and the others had a variety of calls throughout the day. They employed 25 care staff.

During our visit we spoke with the manager and deputy manager. After our visit we spoke by phone with nine people who used the service, relatives of thirteen people who used the service and with five care staff.

People who used Community Support Service and their relatives told us they were satisfied with the care provided. They said care and support needs had been agreed with them before the service started and copies of care plans were available in people's homes. A person who used the service said: “They are always very good.” A relative told us: “I’m very impressed with them.”

The files we looked at contained care plans that were personalised and included people's preferences. People told us care staff were able to do everything they needed within the allocated time. One relative said: "Mum suffers with dementia and they are so friendly and patient with her which is just what she needs.”

We found evidence of quality management processes including complaints, compliments and incident management. People who used the service knew how to raise issues if they needed to. One person said: “I’ve not had any problems with them.”

There were systems in place to monitor calls, review the quality of care and ensure staff training and competency.

We visited the offices of the service without advance notice. We spoke with the nominated individual, who had responsibility for overall control of the service. We also spoke with the registered manager, the deputy manager, and three members of staff who came into the office. Staff were positive about working for the service, and showed a good awareness of how to meet the needs of the people they were supporting. There was a low turnover of staff.

We spoke by phone with four relatives of people who used the service. They told us they were happy with the service. Comments included “absolutely brilliant” and “very good – always on time, know what to do”. They told us the same small group of staff provided the care and support for a person.

We spoke with one person who was supported by the service and who came into the office during our visit. They were very positive about the service. They told us it was “doing a brilliant job” and that “they wouldn’t want anyone else – only Family Care Trust”. They added “I wouldn’t be doing all I’m doing now if it wasn’t for them”.

We also visited a complex of flats where the service supported eleven people with learning disabilities who had tenancies there. There we spoke with three people in a communal lounge. We also visited one person’s flat when they invited us to see it. People there told us they were happy living where they did and with the support they got. One person told us “they help us be independent”.

We visited the offices of Community Support Services on 8 March 2012. We spoke with the registered manager. We looked at the care records for four people receiving a service to see how care workers were organised to carry out the calls. After our visit to the agency we spoke to two people receiving a service and the relatives of another two people.

All the people we spoke to told us that care workers generally arrived at about the time they were expected. They were happy with the care workers that supported them. They said: “We have no problems with the girls.”

All the people we spoke with told us that the care workers were polite and helpful. People said they were:

“Absolutely happy, all needs catered for. “

“Very happy with the service.”

People told us that they felt listened to. One person told us that they had asked for male care workers not to be sent to them and this was respected.

A relative told us that one of a group of six regular care workers usually called on them. The person receiving the service had got to know the different care workers in this group over time. Two other people told us that often different care workers came to help them. They did not always know who to expect. This sometimes worried them. We saw from the care workers rotas that people who used the service were usually visited by the same team of care workers.

A care worker we spoke with told us that sometimes they went to attend calls where people did not know them. On one occasion a person had become very upset by this.

The four people we spoke to told us that they were happy and supported by Community Support Services. They told us that they had never had cause to be concerned. They could raise issues with the manager and care workers. They said

that they had not been formally asked about whether they were happy with the service being provided They told us that on occasions the registered manager visited them and asked if they were happy with the service.