We carried out an announced comprehensive inspection at Country Carers Limited (Ltd) on 15 December 2015 where a breach of Regulation was found. We issued a requirement notice for this breach. As a result we undertook an inspection to follow up on whether the required actions had been taken. At this inspection we found significant improvements had taken place and the breach in Regulation had been met.

This inspection took place between the 27 April 2017 and 4 May 2017. We visited the office of Country Carers Ltd on 27 April 2017. This was an announced inspection. This means the provider was given notice due to it being a domiciliary care agency and we needed to ensure someone was available. The inspection involved a visit to the agency’s office and telephone conversations with people, their relatives and staff, between the beginning and end dates.

Country Carers Ltd is a domiciliary care company based in Rye. They provide support and care for predominately older people living in their own homes. The age range of people receiving support was to 51-91 years of age. People had been assessed at risk of falls and some had long term healthcare needs such as Parkinson’s and diabetes and people were living with dementia type illnesses.

Country Carers Ltd provide their services within an approximate 15-20 mile radius from their office in Rye. The catchment area is predominately rural. At the time of our inspection 58 people were using the service. There was a registered manager in post, a registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At Country Carers Ltd, the registered manager was also the provider.

We found the provider did not have a consistent approach to assessing people’s mental capacity in line with good practice. This meant staff could not be assured people who lived with dementia type illnesses had the capacity to consent to all decisions and aspects of their daily living care routines.

People spoke positively about the services they received from Country Carers Ltd and told us they felt safe using their services. Comments from a person included, “I have been delighted with the service.” Staff had an understanding of safeguarding and different types of abuse and how to raise and escalate any concerns they had for people’s wellbeing and safety.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines records were audited and reviewed to check for errors or omissions.

There were enough staff to meet people's care needs and staff had regular training, supervision and appraisal to support them. Staff gave positive feedback about the quality of the training and people who use the service said staff were well trained. Appropriate pre-employment checks had been completed before staff began working for the provider.

People's care and support needs were assessed and routinely re-assessed. Care plans were developed to detail how these needs should be met. People and their relatives told us they felt involved in their care. Most people’s care plans were detailed and provided clear guidance to staff to be able to provide the individualised care. People knew how to make a complaint or raise concerns with the registered manager. There was an appropriate complaints system in place.

People told us they were supported by friendly, reliable and caring staff who respected their privacy and promoted their independence. People who needed it were supported to eat and drink enough and staff knew what to do if they thought someone was at risk of not eating or drinking sufficient amounts. People were supported with their day to day health care needs.

Incidents and accidents were investigated and action taken to reduce the risk of them being repeated.

The service was well led by an effective reg

We went on two home visits and spoke with the people who used the service as well as their principle carers. We also spoke to a member of the local community nursing team. We spoke with a variety of staff that included the manager, two deputy managers, office staff and four care workers. Following the inspection we spoke with seven people who used the service and one principle carer.

We found that people felt involved in their care and support. Staff understood the importance of communicating with people to ensure that they agreed and consented to the care and support provided. People’s needs were assessed and care plans regularly reviewed and updated. One person told us that they received a, “Very good service all round.” Another said, “Mum gets on well with them.”

We found evidence that the agency and their staff worked in cooperation with others providing care and treatment to people who used the service. Staff told us that they liked working for the agency and felt well supported. Effective recruitment processes were in place. We saw that there were effective systems in place to monitor the quality of the service provided and that people were asked for their views and comments.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We visited four people in their own home as part of this review and spoke with them and their relatives about their experiences of the support they had received. We spoke with three senior staff at the time of our visit to the office as well as four care workers.

We spoke with 12 people who received a service from this agency over the telephone, as well as two relatives. Without exception, people told us that they felt respected by the care workers from the agency.

Everyone we spoke with told us that their care was personalised to their needs. One person told us that care workers should learn all about a person from that person themselves and felt that the agency did this well. People's preferred names were used even when there were changes to care workers. People were happy that their care workers adapted very well when changes were made to care. One person said that their regular care worker "never forgets anything".

A few people could not recall or were not aware of the detail of their care plan. However, most confirmed they had been involved in discussing and reviewing their care with senior staff from the agency. One person and their relative told us that they were "fully involved in the original assessment".

People felt that staff were well trained and understood their needs when providing personal care. People told us that the agency responded to any comments or concerns raised with them. People told us that they felt safe, and if they had concerns they would speak with a family member, friend or somebody from the agency.

This inspection took place between the 15 December 2015 and 5 January 2016. We visited the office of Country Carers on 15 and 16 December 2015. This was an announced inspection. This means the provider was given notice due to it being a domiciliary care provider and we needed to ensure someone was available. The inspection involved visits to the agency’s office and telephone conversations with people, their relatives and staff, between the beginning and end dates.

Country Carers Limited (Ltd) is a domiciliary care company based in Rye. They provide support and care for predominately older people living in their own homes. The age range of people was 45 to 104 years of age. Some people were at risk of falls and had long term healthcare needs. The service also provided support to people who were at the end of their lives. Country Carers Ltd provide their services within an approximate 15 mile radius from their office in Rye. The catchment area is predominately rural. At the time of our inspection 52 people were using the service. There was a registered manager in post, a registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At Country Carers Ltd, the registered manager was also the provider.

We last inspected Country Carers Ltd on 15 August 2013 where we found they were compliant with the regulations inspected.

People spoke positively about Country Carers Ltd and told us they felt safe using their services. However we found there were areas that required improvement in regard to how the provider managed the administration of medicines. All staff had an understanding of safeguarding and different types of abuse, however not all staff knew the procedure for reporting abuse beyond the provider.

People told us they were usually supported by staff who knew them well and had the appropriate level of experience and knowledge to meet their needs. However due to a staffing issue we found some administration around staff training and induction had begun to impact of the frequency of training delivery.

Peoples care plans were reviewed regularly however they did not consistently reflect the care that was being provided by care staff. Care plans were focused on specific tasks care workers were to complete and did not provide detail on how the individual could be best supported for each identified need.

Although the feedback received on the provider was positive we found they did not have robust quality assurance systems in place which were capable of identifying the areas of improvement we found during the inspection. For example routine quality checks on people’s care and medicine documentation were not being completed to see where improvements could be made.

We found further issues which required improvement were related to the leadership of Country Carers Ltd. These were in regard to the submission of statutory notifications to the Care Quality Commission and to the having the correct registration.

When people started using the service they underwent a pre-assessment which identified their care and support needs. Risk assessment was completed for areas where people could be at risk of harm, such as with their walking and medicines. People’s care needs were reviewed on a regular basis.

Staff told us they felt supported in their roles. A supervision programme was in place which was used effectively to support them in their roles. People were cared for, or supported by, sufficient numbers of experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work for Country Carers Ltd.

The provider and their staff were familiar with the requirements of the Mental Capacity Act 2005 (MCA) and care documentation reflected action had been taken and appropriate agencies involved where necessary.

People told us they felt their care needs were met by friendly, reliable and caring staff. People had been consulted about their care and were clear how to raise concerns if they had any. The feedback we received about the provider was positive. There was a clear philosophy of care at the service which was understood by staff. This included the importance of privacy, independence choice.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.