This inspection took place over 2, 3, 6, 8 and 13 November 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to visit the office, talk with staff and review records. Telephone calls to people were completed on 2, 3 and 8 November 2017. Telephone calls to staff were made on 13 November 2017. We visited the office on 6 November 2017.

At our previous inspection in July 2016, we found one breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to complete an action plan to show what they would do and by when to improve the key question, ‘How are people’s medicines managed so they receive them safely.’ At this inspection we found improvements had been made.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger disabled adults, in and around the high peak area of Derbyshire. Not everyone using Cromwell House (DCC Homecare Service) receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The provider informed us 99 people received support with their personal care needs.

The service is required to 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. At the time of our inspection there was a registered manager in post.

People were kept safe and the risk of abuse was minimised because the provider had systems in place to recognise and respond to allegations or incidents. Other risks were assessed and actions taken to reduce known risks. Pre-employment checks were completed on staff to check their suitability for the role. Sufficient numbers of staff were available to care for people and further recruitment was planned to keep staffing levels sustainable. Medicines were managed safely and practices were in place to prevent and control any infections.

People made decisions in relation to their care and support; where they needed support to make decisions their rights were protected under the Mental Capacity Act 2005. People understood their care and support because they received information in a format that met their needs.

Staff received training in areas relevant to people’s needs and received support through supervision meetings. People’s health and any associated risks were monitored and responded to; referrals to other healthcare services were made where this would be of benefit. Where staff provided care with people’s meals, this was done in a way to help people maintain a balanced diet.

People were cared for by care staff who were kind and caring. Care staff respected people’s privacy and dignity. People were supported with their independence by staff who understood how important this was for people’s wellbeing.

People were involved in decisions, as well in the planning of their care and support. Staff were aware of people’s interests, hobbies and preferences. Assessment of people’s diverse needs, including in relation to protected characteristics under the Equality Act were considered in people’s care plans with them. This helped to ensure people did not experience any discrimination.

People knew how to raise issues and where they had done so these had been investigated and people had received a response.

A registered manager was in place and they understood their responsibilities for the management and governance of the service. Systems were in place to m

This inspection took place on 1 and 11 July 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to visit the office, talk to staff and review records.

The service provides personal care and support to people who live in their homes in and around the High Peak area of Derbyshire. At the time of this inspection nearly one hundred people received support from the agency.

The service is required to 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. The manager had been in post for three months and had applied to the Care Quality Commission to become a registered manager.

The service could not demonstrate all people received their medicines as prescribed. Medicine administration records were not always accurate and procedures were not always followed to ensure people receiving medicines were supported to do so safely. Audits, and steps taken to improve medicine administration records were not effective.

Not all staff had received up to date training identified as required by the provider. Systems and audits in place to ensure staff training was up to date were not always effective.

People told us they felt safe with the care provided by the service. Staff we spoke with had received training in safeguarding people, however not all staff had received up to date training. The service could not demonstrate staff were always deployed to meet people’s needs safely.

People were supported to raise any worries or concerns. However, some people had not experienced improvements to the service, despite raising their concerns.

Risks to people’s health or risks in their homes were identified and assessed in care plans with people. Staff recruitment was managed safely.

People were cared for by staff that were respectful and caring. Staff had developed positive and caring relationships with the people they cared for. Staff supported people with their independence and promoted people’s dignity and privacy. People were involved in planning their care and support.

The provider had a policy in place on the Mental Capacity Act 2005 and people’s consent to their care and support was obtained in line with guidance. People received support from staff who had the skills and knowledge to meet their needs, including how to support people with their nutrition and hydration needs. People were supported to access other healthcare provision when required.

People received personalised and responsive care and their views and preferences were respected.

The service promoted an open and inclusive culture. The manager demonstrated an open and inclusive style of leadership.

We found one 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 the report.

During our inspection we spoke with managers and looked at six care records. After our visit we spoke with staff and 20 people who used the service or their relatives. One person said, “I don’t know what I would do without them,” Another person said, “They are fabulous, it’s an excellent service.”

We looked at six care records and saw people’s written consent had been gained for planned care and support. These were written in a way that promoted each person’s independence and respected their privacy and dignity.

We saw people’s needs were assessed and individual personal support plans were developed. Risk assessments had been undertaken.

Procedures were in place for management of medication. Staff had received medication training and medication administration records were accurately completed.

We found that people received care from adequate levels of skilled and knowledgeable staff. People we spoke with told us that staff spoke to them with consideration and respect.

We found systems were in place to assess and monitor the quality of service provision. People’s views were obtained and acted on.

People we spoke with were happy with their care. One person told us, "It's a lifeline, really." Another person's relative said, "We are very satisfied."

We saw that complaints were dealt with satisfactorily by the provider and that staff were recruited using suitable procedures.

We saw insufficient evidence that people’s consent was being obtained for their care. We also saw that if people were unable to make decisions for themselves, for example due to dementia, that the appropriate procedures were not always being used to obtain and record consent for their care.

We found that although assessments were completed and there was some information in care files, that care planning systems did not fully describe people's personalised care and support needs. We saw that risks that could affect people were not always adequately assessed and managed. We also found that records did not always accurately describe the support people needed with their medication, and this could put them at risk. Because of this we found that people were not always fully protected from receiving inappropriate or unsafe care.

We saw that care records were held electronically and were not fully accessible for staff or people receiving care and support. It was also not possible to examine important care records, for example medication administration records and records of incidents and significant events as these were not available on the electronic storage system.

As part of this inspection we spoke by telephone to 10 people who were supported by the Homecare Service and saw groups of staff at every locality office. We also spoke with organisation’s operational managers and Domiciliary Service Organisers (DSO) at the locality offices and senior officers at the Adult Social Care Department’s headquarters; they all gave us a perspective about their work.

All of the people we spoke to expressed very positive relations with the staff who provided support and care, and good relations with the agency’s office based coordinator and management staff. They told us that staff worked sensitively and carefully and that ‘everything is done properly when they use my special bath and they write in the records which lets the next one know what’s been happening’, that ’I get a great deal of comfort from the work they do. They’re all professional carers and help me with my good days and bad days’ and that ‘if they’re new I sometimes have to show them what I want and in what order. They always do what I ask of them’.

Patterns of care delivery worked well for the people being supported. A very small number commented on the high numbers of staff supporting them but not that this was a particular problem. Nobody expressed any major concerns with the timekeeping aspects of the service.