This announced inspection of Delta Care Ltd took place on 21 April 2017.

Delta Care Ltd is a twenty four hour domiciliary care provider. The agency provides care and support to people in their own home. The office is close to the centre of Southport with car parking close by. The agency offers an 'out of hours' emergency on call service for people in their own homes and their relatives. The service covers weekends and bank holidays.

At the last inspection in March 2015, the service was rated ‘Good’. We have rated the well - led domain for this report as 'requires improvement' due to the manager not being registered at the time of our inspection.

The manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Staff were able to describe the course of action they would take if they felt anyone was at risk of harm or abuse this included ‘whistleblowing’ to external organisations. Rotas showed there was an adequate number of staff employed by the service to fulfil all contractual obligations. Risks were well accessed and information was updated as and when required. People were supported to manage their medication by staff who were trained to do so.

There was a designated person who had a specific role in relation to the training of staff and coordination of refresher training. This person had only been in post for few weeks, and explained some refresher training had expired. We were provided with a detailed action plan for when staff would be re-trained which we saw was due to take place in the next few weeks. All newly appointed staff were enrolled on the Care Certificate as part of their induction process. Some supervisions were out of date, however, most had been completed. The manager had been in post for a three months prior to our visit, and showed us their schedule for ensuring all staff were up to date with supervisions in the next few weeks.

The service was working in accordance with the Mental Capacity Act 2005 (MCA) and associated principles. Where people could consent to decisions regarding their care and support this had been well documented, and where people lacked capacity, the appropriate best interest processes had been followed.

People we spoke with were complimentary about the staff and the service in general. People told us they liked the people who supported them. Staff were able to give us examples of how they preserved dignity and privacy when providing personal care.

Care plans contained information about people’s likes, dislikes, preferences and personalities. Staff we spoke with demonstrated that they knew the people they supported well, and enjoyed the relationships they had built with people.

Complaints were well managed and documented in accordance with the provider’s complaints policy. The complaints policy contained contact details for the local authorities and commissioning groups.

Quality assurance systems were effective and measured service provision. Regular audits were taking place for different aspects of service delivery. Regular action plans were drawn up when areas of improvement were identified. Staff meetings took place on a regular basis.

Further information is in the detailed findings below

At previous inspections we had found that appropriate arrangements for managing medicines safely were not in place. At this inspection we found significant improvements had been made and overall we found medicines were now being safely and appropriately managed. We saw the provider (owner) had received a complaint that alleged some care workers did not have the skills needed to handle some medicines safely. The provider had responded to this complaint and ensured care workers completed additional medicines training.

A regular system of spot checks was also in place. During these checks, daily care notes and medicine records charts were reviewed to ensure that any medicines administered, had been administered safely and in accordance with prescribed instructions.

We saw that the provider had put in place systems to audit and review the quality of service that people received. At our previous inspection we found there had been a high number of missed, late or calls cut short due to time constraints. This had led to a high number of complaints. On our return visit to check on improvements the provider was required to make, we found the number of missed or late calls has dropped significantly. The provider had systems in place to allow for travelling time between care calls and staffing numbers had increased to meet rise in demand for care calls. Complaints received had reduced as a result of this work. We found staff were better supported by their manager in their delivery of care to people in their own home.

We spoke with nine people and four relatives who used the services of the agency to obtain their views about the standard of care and support; this included meeting four people in their own home.

People who received care and support from the agency told us they had been consulted about their care provision. People had mixed views about receiving a visit from a care worker at the allotted time and having the same care workers to support them. One person told us the care and support was "First class, I cannot fault any of the help I get; I feel safe in their hands and the carers work hard." Another person said, I don't always get the same carers." People had a plan of care though the amount of information recorded varied in detail and had not been picked up when reviewed.

At the time of the last inspection in March 2013, the agency was found not to be meeting the standard for the safe management of medicines. At this inspection we found some improvements had been made. People however were still not protected against the risks associated with medicines, as the provider did not have appropriate arrangements in place to ensure that medicines were always recorded and managed safely.

Monitoring systems for assessing the service provision were not robust to ensure people received a safe effective service. This included checks on how medicines were administered safely to people.

People had access to a complaints procedure should they wish to raise a concern.

Delta Care Ltd is a 24 hour domiciliary care provider. The agency provides care and support to approximately 200 people in their own home. The office is close to the centre of Southport with car parking close by. The agency offers an 'out of hours' emergency on call service for people in their own homes and their relatives. The service covers weekends and bank holidays.

This was an announced inspection which took place over five days 12th, 13th, 16th, 17th and 19th March 2015. The inspection team consisted of two adult social care inspectors and an ‘expert by experience’. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The service had 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.

People who used the services of the agency told us they felt safe when receiving care and support.

We received positive feedback about the agency from people and relatives we spoke with. A person said, “The staff always stay as long as they are supposed to and do everything I need; they`re great” and “The carers are always kind and considerate and the regular ones understand my needs.” Relatives said, “I could not speak more highly about the carers, they do everything we ask and more” and “I have been here when the carers are here and they are always on time and do what they have to.”

Staffing levels were determined by the number of people using the service and their individual needs. People told us they were happy with the staff and got to know them well. Their comments included, “The carers who normally come are absolutely wonderful, they are so helpful and caring.”

There were processes in place to help make sure people were protected from the risk of abuse and staff were aware of safeguarding vulnerable adults’ procedures.

Risk assessments had been completed and these showed the actions needed by staff to minimise the change of harm occurring. The risk assessments included information around potential environmental hazards, the use of key entry codes and risks associated with the use of aids/ equipment to help transfer people safely.

Medicines were administered safely. Audits were carried out to check on the safe management of medicines and to ensure safe standards were maintained.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people.

Care staff were supported through staff induction, an on-going training programme, supervision and appraisal. The training programme helped to ensure staff had up to date knowledge and skills related to their job role to provide safe support.

The agency liaised with health and social care professionals to support people if their health or support needs changed.

People were supported at meal times in accordance with their plan of care.

With regards to people making their own decisions, people we spoke with informed us they were able to do so and were involved as much as possible regarding decisions about their welfare.

The care plans we saw varied in detail, however overall they provided information to the care staff to help support people. We discussed with the manager the need for more ‘person centred’ plans (care plans tailored to the individual), so that the care staff had a fuller more detailed picture of how people wished to be supported.

Speaking with care staff confirmed their knowledge about the people they supported and how they would respond if a person was unwell.

A complaints policy and procedure was in place and details of how to make a complaint had been provided to people who used the service. We saw the complaints’ file which recorded complaints received and the response. People we spoke with knew how to raise a complaint with the agency.

Systems were in place to monitor the quality of the service provided. This included audits (checks) on areas such as, care documents and medicine administration. Meetings with people were conducted to ensure they were satisfied with the service, along with the provision of feedback questionnaires.