We inspected this service on 8 November 2016. The inspection visit was announced.

Crystal Care Home Care delivers personal care to people in their own homes. At the time of our inspection, 83 people were receiving the service. The service predominantly supports older people and can support people with complex and specialist support needs.

We last inspected the service on 7 August 2014 where no concerns identified

There was not a registered manager in post. 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. On the day of the inspection visit, the provider supported this manager to explain how the service operated and was managed.

People told us they felt safe with the staff that came to their home. Staff were trained in safeguarding and understood the signs of abuse and their responsibilities to keep people safe. Recruitment practices were followed that helped ensure only suitable staff were employed at the service.

Risks of harm to people were identified at the initial assessment of care and their care plans included the actions staff would take to minimise the risks. Staff understood people's needs and abilities because they had the opportunity to get to know people well through shadowing experienced staff during induction before working with them independently. Equipment used to support people was regularly tested to ensure it was safe to use

People were supported by regular members of staff who supported people in a timely manner. Staff were trained in medicines management, to ensure they knew how to support people to take their medicines safely to keep accurate records.

Staff received the training and support they needed to meet people's needs effectively. Staff felt supported by management team and were encouraged to consider their own personal development.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of MCA and DoLS. People made their own decisions about their care and support. When people lacked capacity the best interest process was followed.

People were supported to eat meals of their choice and staff understood the importance of people having sufficient nutrition and hydration. Staff referred people to healthcare professionals for advice and support when their health needs changed.

People told us staff were kind and respected their privacy, dignity and independence. Care staff were thoughtful and recognised and respected people's wishes and preferences.

People and relatives said that the service was responsive to their needs. The service proactively assessed people’s needs so they received support when they needed it. The service worked with other providers to provide care to people so they could either stay in or return to their family home.

People received person centred care from a service that had a flexible approach and was responsive to unforeseen circumstances

People knew how to complain and were confident any complaints would be listened to and action taken to resolve them. When areas of improvement were recognised plans were put in place to resolve them.

People and relatives agreed that the service was managed well. Management understood the service being provided. Staff and management talked about the open door policy in place, which made the management team approachable.

The provider's quality monitoring system focused on the experience of people. It included asking people for their views about the quality of the service and field supervisions and observations. The computer system in place informed the management team when tasks, such as a review of care, wer

This was a follow up inspection because at our inspection on 09 January 2014 we found the registered person was not fully meeting Regulation with regard to supervising staff and monitoring the quality of the service being provided. The registered person sent us an action plan telling us what actions they would take and gave 13 March 2014 as the date when they would become compliant with the regulations.

We looked at the arrangements that had been put in place to provide formal supervision and appraisal for staff. This was now being maintained on staff files and electronically which alerts the provider when the next supervision is due.

We saw that systems were in place to monitor the quality of service being provided. This had been uplifted to a new IT system which enabled the service to undertake monthly audits and to maintain records appropriately.

We visited the office of Crystal Care Home Care Ltd and looked at the care and welfare of people using the service. We sampled records and spoke with the registered manager, proprietor and six staff. We spoke with five people using the service and six relatives. Most were pleased with the service. People said staff followed care plans which they had agreed to. Comments included, “All the staff are respectful and look after me well”. “I am absolutely delighted with the agency; I couldn’t get better care and have good relationships with staff”. Relatives were mostly happy with the service thought two raised some concerns.

Staff told us that they had received appropriate training although records did not fully substantiate this information. The registered manager told us that this was due to IT problems preventing access to training records. Also because training had not been certificated by training companies used. Though most staff felt supported by managers we found shortfalls in supervision and appraisal systems. People said they trusted staff and felt safe in their presence. Staff told us they had received safeguarding training.

Whilst the views of some people had been sought about the service received, there were not effective systems for regularly assessing and monitoring the quality and safety of services. A business continuity plan ensured that services were maintained in emergencies, also arrangements ensuring the safety and suitability of equipment.

During our inspection we spoke with five people who used the service and two relatives of people. We also spoke with five members of staff and the staff manager.

The people we spoke with all told us that they felt the care they received was of a very high standard. One person told us "I have nothing but praise for the girls." Another person told us "They are all very kind girls who do more than enough for me."

We spoke to some relatives of the people who used the service. They told us that they had great confidence in using Crystal Care and that they felt the staff always treated their relatives with dignity and respect. We saw that people were given an information pack prior to their care starting which contained information about complaints, fees, who to contact in an emergency and details of the care package being provided.

We spoke to staff about their understanding of safeguarding and the majority of staff were able to verbalise warning signs of abuse and the procedure for reporting such issues. However, one member of staff out of the five that we spoke with told us that they had not had any training.

We found that the agency had a very thorough and robust employment procedure and we saw that all appropriate checks were undertaken before any member of staff started work at the service. We also saw that all new members of staff undertook an induction and a period of shadowing prior to taking on their own client list.