We undertook an announced inspection of County Medicare a Domiciliary Care Agency (DCA) on 13 and 21 November 2017. We told the deputy manager before our visit that we would be coming. We did this because they were sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure they would be in. The inspection involved a visit to the agency’s office and telephone conversations with people who used the service and healthcare professionals.

At our previous inspection in November 2016 we asked the provider to make improvements in relation to people’s risk assessments and records. We found these improvements had been made.

County Medicare is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults and younger adults, people with a physical disability or sensory impairment. It also provides support to people living with dementia. People received support related to personal hygiene, mobility, nutrition and continence. Some people were living with early stages of a dementia type illness or other long-term health related condition. Most people lived reasonably independent lives but required support to maintain this independence. County Medicare also provided support for people who required end of life care. At the time of our inspection no-one was receiving end of life care.

There is a registered manager at the service. 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. At the time of the inspection the registered manager was temporarily not working at the service. In their absence the deputy manager was responsible for the day to day running of the service.

People received care that was responsive and had been tailored to ensure it was individual to each person. People and family members spoke highly of the kind and caring nature of the staff. They told us the care they received was person-centred and met their individual needs and preferences. Family members told us their needs were also taken into account when care was provided. People were involved in the planning of their care and supported to make their own choices. Care plans explained how to support people and provided clear guidance. Care plans were person-centred and reviewed with people to ensure they reflected their current needs. Staff understood the importance of providing good person-centred care.

Staff had developed positive relationships with people. They had time to spend with people to ensure all their needs were met. Staff treated people with kindness, compassion and respect. The care they provided helped people to maintain their dignity.

Risk assessments and guidance was in place and staff had a good understanding of the risks associated with the people they looked after. Medicines were well managed and staff ensured people received the medicines they had been prescribed.

There were enough staff working, who had been appropriately recruited, to meet people's needs. Staff received the induction, training and support they needed to enable them to meet people’s needs. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and ensured people’s legal and human rights were protected. Staff understood the procedures in place to safeguard people from the risk of abuse or discrimination.

People were supported to eat and drink a variety of food that met their individual needs and preferences. People’s health and well-being needs were met. People were supported to have access to healthcare services when they needed them.

People were regularly asked for their feedback, they were listened to and their comments acted on. There was an effective process for managing

We undertook an announced inspection of County Medicare a Domiciliary Care Agency (DCA) on 15 November 2016. We told the registered manager before our visit that we would be coming. We did this because they were sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure they would be in. The inspection involved a visit to the agency’s office and telephone conversations with people who used the service and healthcare professionals. This was the first ratings inspection for the service.

County Medicare provides support for people who require a range of personal and care support related to personal hygiene, mobility, nutrition and continence. Some people were living with early stages of a dementia type illness or other long-term health related condition. Most people lived reasonably independent lives but required support to maintain this independence. County Medicare also provided support for people who required end of life care. At the time of our inspection no-one was receiving end of life care.

There is a registered manager at the service. 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’s care was personalised to reflect their wishes and what was important to them. People were supported by staff who knew them well and understood their needs and preferences. They were visited at times that suited them. People were looked after by a team of regular staff who knew them well. People and their relatives spoke positively about the care, support and service they received from County Medicare. They spoke highly of staff and the registered manager.

Staff had a good understanding of the risks associated with supporting people; however we found risk assessments were not in place to reflect all identified risks. Care was personalised and reflected people’s individual needs. However, some care plans did not contain all the information staff needed to provide care or evidence the care and support people received.

People told us they received the medicines they had been prescribed, when they needed them. The systems in place meant medicines were well managed. There were enough staff who had been safely recruited to meet the needs of people who used the service. Staff had a good understanding of the procedures to follow to safeguard people from the risk of abuse. Staff were aware of their individual responsibilities.

There was an induction programme in place and staff received the training and support they required to meet people’s needs. Staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and were knowledgeable about the requirements of the legislation. Staff had an understanding of best interest meetings and told us these would take place when people lacked capacity to make their own decisions.

Where required, staff supported people to have enough to eat and drink and maintain a healthy diet. Staff knew people well and recognised when they may need to be referred to an appropriate healthcare professional for example the GP or district nurse.

There was an open and positive culture at the service. The staff told us they felt supported and listened to by the registered manager. The registered manager had a good oversight of the service and was working hard to improve and develop the service. There was an action plan in place to demonstrate the progress that had been made.

People were regularly asked for their feedback about the service and support they received and were aware how to make a complaint. People were put at the heart of the service and staff were focussed on providing high quality care.

On the day of our visit the manager was unavailable. We talked with the owner who was permanently involved with the running of the service and we spoke with five members of staff. We looked at seven sets of care plans, four personnel files, the services' policies and records, and spoke with six people who used the service or their relatives.

We found that there were comprehensive assessments of needs and risks carried out and that care and treatment was delivered in line with these assessments. People who used the service told us, "The staff is excellent, they give me excellent on-going care and support".

We looked at the service's policy and procedures in respect of the safeguarding of vulnerable adults. They were accurate and accessible by staff who had received appropriate training, one member of staff told us, "Abuse can take many forms, we learned that during the training and we know how to spot the signs".

We found there were enough qualified, skilled and experienced staff to meet people's needs. The owner told us, "We only take on new work when the service has sufficient capacity to cover the visits and when we have care workers with the relevant skills". People who used the service told us they were satisfied with the frequency, reliability and length of the visits they received. One person told us, "When they are here, they give the time they are supposed to or sometimes more if needed, they don't seem rushed, there seems to be enough staff around".

We found that the service had an effective system of internal and external audits in place. This assisted the provider in monitoring the quality of care that was provided. The service sent questionnaires to people who used the service and their relatives to seek their feedback. A person who used the service told us, "It is good that they send these questionnaires, this is when we reflect and give our opinion".

We saw that the services' records were accurate, regularly updated and fit for purpose. We found appropriate documentation was kept in relation to people's care, staff, policies, surveys and audits. There was an effective system for the storage, archiving and disposal of records that met legal requirements.

We spoke with the manager, four members of staff, two people who used the service and one relative. During our inspection we found that people's needs were comprehensively assessed before and during the service. The planning and delivery of care met people's individual needs.

We found that people were involved in their care plans and that their consent was sought. People who used the service commented "The staff are very respectful, thoughtful and efficient". One relative stated "My wife is extremely well cared for, I could not ask for more".

The staff had received all updated training relevant to their roles and could access additional training. One member of staff told us "I thoroughly enjoy working here, it is a privilege to help people at such difficult times and make a difference".The service operated effective recruitment procedures to ensure that staff were suitable for their role, provided appropriate training, supervision and appraisals, and encouraged them to improve their knowledge, skills and to obtain qualifications. One care worker said "We are given opportunities to develop and improve our practice, we can train, learn and study". Another member of staff stated "We speak out if there is a problem and we are always listened to".

The service took people who used the service's comments and complaints into account when delivering care, treatment and support. One relative commented "The staff are attentive to our needs and listen to our suggestions".

Not all of the people using the service were able to tell us about their experiences. People we spoke with told us that they were well supported by the staff providing their care.