The inspection visit to the provider’s office took place on 15 December 2017 and was unannounced. Phone calls to people who used the service and their relatives were carried out on 15 December 2017 and a visit to one person’s home was undertaken on 21 December 2017.

Connie’s Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection 13 people were using the service which provides care to people in both Norfolk and Cambridgeshire.

The service had a registered manager in post. They were also the owner of the business. 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.

Staff were recruited safely but staffing levels meant that some people had missed calls and scheduling of calls sometimes meant that people could not receive all their agreed care hours. A small staff team of allocated carers provided consistent care to people and feedback on individual carers was positive.

There were systems in place designed to help protect people from abuse. Staff understood their responsibilities to report concerns if they suspected someone was being abused. The registered manager had not notified CQC of a significant safeguarding matter.

Risks to people’s health and safety were assessed and managed well in most cases. Staff required better understanding of the risks associated with pressure care. Staff understood their role in reducing the risk of infection and worked in accordance with best practice.

The provider carried out a detailed assessment of people’s needs and enabled them to be involved in decisions about their care and support.

Staff received the training and the formal and informal support they needed to carry out their roles. The provider needed better procedures for sharing important information about people’s needs between staff. We understand that new systems have been put in place since our inspection visit.

Staff worked in accordance with the Mental Capacity Act 2005 (MCA). The MCA ensures that people’s capacity to consent to their care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. People consented to their care, although some records needed review or clarification. Some staff did not have a record of further training in MCA and had only covered this in their induction.

Staff supported people to manage their eating and drinking and other healthcare needs and worked in partnership with other healthcare professionals. However, staff were not working in line with one person’s care plan which had been put in place by a healthcare professional.

Staff treated people with patience, warmth and kindness and relationships were good. Staff respected people’s privacy and maintained their dignity. People were encouraged to be as independent as possible and staff saw this as a priority.

People received person centred care which met their individual needs and preferences. Staff treated people as individuals and were committed to ensuring that people received their care in the way they chose.

A complaints procedure was in place but no formal complaints had been logged. There was not always robust recording to show what action had been taken in response to informal complaints.

There was no structured system of audits in place, although the registered manager regularly spoke with people directly about their care when carrying out spot checks of staff.

The provider demonstrated that they needed a clearer understanding of some aspects of the role

The inspection took place on 19, 26 and 28 April 2016 and was an announced inspection.

The service was registered to provide personal care to people living in their own homes and there were 17 people accessing the service which meant a delivery at that time of 268 hours per week.

There was a registered manager for this service, who was available every day. 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 felt safe using the service. Staff were trained in adult safeguarding procedures and could identify what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. Risk assessments recorded what action staff should take if someone was at risk and referrals were made to appropriate health care professionals to minimise risk going forward.

There were sufficient staff to keep people safe and meet people’s needs, the registered manager had followed safe recruitment procedures. Staff were competent with medicines management and could explain the processes that were followed.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. The registered manager understood that there should be processes in place for ensuring decisions were made in people’s best interests. However the registered manager did acknowledge that they required further training in this area and would be undertaking it soon.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff acknowledged people’s privacy. People felt that staff were understanding of their needs and had positive working relationships with people.

Care provided was individualised according to each person’s needs and preferences. People and their relatives were involved in assessment and reviews of their needs. Staff had knowledge of changing needs and supported people to make positive changes to their care plans.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people, relatives, health and social care professionals were sought as part of the quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

People’s rights to give consent to their support and care was obtained and respected. This included asking people for their consent regarding their personal care.

All of the people who we spoke with were satisfied with the standard and quality of the support and care provided. Comments included, “They are here for mum and are a great support for me”. We found that people’s support and care met people’s needs, including their main carer’s needs, and respected their dignity.

Systems were in place to ensure that people were protected from the use of unsafe equipment. This included relevant training of staff. There was enough equipment available to promote people’s health, safety and comfort needs.

All of the people that we spoke with had positive comments to say about the team of staff. People told us that members of staff were kind, attentive and trained and competent to safely do their job.

There were quality assurance systems in place that asked people, including members of staff, for their views and comments about the service. Other systems were in place monitor the standard of service provision, including monitoring of members of staffs’ work performance. Our findings noted that people were satisfied with the standard and quality of the service provided. One person said that, in their view, the standard and the quality of the service provided was, “Perfect”.

Although we did not speak with any person who used the service, on this occasion, during our last inspection of 04 October 2012, people were satisfied with the quality and standard of their support and care. During this inspection of 27 November 2012, our review of records and people's returned survey questionnaires indicated that people were satisfied with the service provided to them.

Improved standards of records indicated that a person’s choice in how they wished to be dressed was respected. Their dignity and privacy was maintained to the standard that met the person’s choice and expectations.

People received safer support and care due to the improveds standard of the environment and health risk assessments. Improvements were also made regarding the assessment, monitoring and reviewing of people’s skin conditions.

There were improvements made to ensure that prospective staff underwent appropriate recruitment checks before they were allowed to work with vulnerable people who used the service.

Quality assurance systems had improved. Opportunities were provided for people to tell the provider about how they viewed the quality and standard of their support and care. Recording of concerns/complaints had also improved. People were now better supported due to an improved standard of care records.

We spoke with people who used the service and their relatives. People told us that they were generally satisfied with the standard and quality of care provided. They said that their privacy and dignity was maintained.

People had no reservations in making a concern or complaint known when the standard and quality of care fell below their expectations. They had access to information about what to expect from the service and how to make a formal complaint if they chose to do so.

We also spoke with two external agencies, including the district nursing service. Neither of these agencies had major concerns about how the agency provided people with their support and care.

Although we had noted what people told us, we found evidence that people’s health and safety were placed at risk. This was due to ineffective systems in place to assess, plan and review people’s care. People were sometimes, but not always, supported in accessing the district nursing service.

Systems were in place to safeguard vulnerable people who used the service from abuse.

Staff were provided with training opportunities to ensure that people received safe and appropriate care. However, people were placed at risk from unsuitable staff due to inadequate recruitment and selection procedures.

There were ineffective quality assurance systems in place to ensure that people received safe and appropriate care and that their views were actively taken into account.