This comprehensive inspection took place on 17 July 2017 and was announced. We gave the registered manager one working days’ notice as the location provided a service to people in their own homes and we needed to confirm the registered manager would be available when we inspected.

The last inspection took place on 17 May 2016, when we identified breaches of Regulations relating to safe care and treatment, staffing and good governance. After the inspection, the provider sent us an action plan dated 25 August 2016 detailing how they would address the issues raised at the inspection. During the 17 July 2017 inspection, we saw improvements to the service had been made.

Dementia Concern provides a number of support services to people living with dementia in the local community. We inspected the Call and Care part of the organisation that provided a respite service for people with dementia who lived at home with a family carer as this was the part that provided personal care to people in their own homes. Respite was usually for three to four hours once a week. During this time, the care worker undertook a leisure activity with the person such as going out for a walk or reading. Although people using the service received most of their personal care from either family carers or agency care workers Dementia Concern care workers provided personal care if the circumstances necessitated it. At the time of the inspection, 64 people were using the Call and Care service.

The service had 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 inspection on 17 July 2017, we saw that care workers had the relevant training and knew how to raise safeguarding concerns to keep people safe from potential harm.

People and family carers we spoke with said they were very satisfied with the care provided by the service. Care workers told us they were respectful of people’s wishes and treated them with dignity.

Risks were assessed and action taken to minimise the risks to people using the service. Care workers knew how to respond appropriately to incidents and accidents.

There were a sufficient number of staff to meet people needs and care workers regularly supported the same people to provide consistency. Safe recruitment procedures had been followed to ensure suitable staff were employed.

The service had a medicines policy and procedure and an appropriate recording system for the administration of medicines.

Care workers were supported to have the skills and knowledge required to care for people through relevant training and supervision.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People’s dietary and nutritional needs were recorded on their care plan and care workers would alert the family carer and the registered manager of any health concerns if they had any about the person using the service.

People and their family carer contributed to the planning of their care. Reviews were signed by people or their family carer appropriately. Information on people’s files was person centred and people’s preferences and wishes were recorded.

People using the service knew how to complain but there had been no complaints to the service.

People using the service and care workers said the registered manager was approachable and responsive.

The registered manager had good links with the community and was aware of their responsibility of when to notify relevant bodies including the Care Quality Commission of some events and incidents within the service.

The provider had management sys

The inspection took place on 17 May 2016 and was announced. We gave the registered manager two working days’ notice as the location provided a service to people in their own homes and we needed to confirm the registered manager would be available when we inspected.

The last inspection took place on 07 November 2013 at which time the service was meeting the assessed five standards.

Dementia Concern provides a number of support services to people living with dementia in the local community. We inspected the Call and Care part of the organisation that provides a respite service for people with dementia who live at home with a family carer. Respite was usually for three to four hours once a week. At the time of the inspection, 71 people used the Call and Care service.

The service had a registered manger. 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 service was not always safe. The service’s policies and procedures did not indicate the service was doing all that was reasonably practical to mitigate risk. For example risk assessments were standardised.

The service did not have a staff appraisal system in place, which meant the service lacked a formal mechanism for setting targets for the year and monitoring the outcomes.

The service was not always well led because it lacked systems to monitor the quality of the service delivered and ensure peoples’ needs were being met.

We found breaches in 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.

Disclosure and Barring Service (DBS) were initially completed but the service did not renew DBS checks within a reasonable time period. We recommended the service renew DBS checks within a reasonable period of time to ensure staff are of good character.

The service had not always assessed people’s capacity to consent to care and treatment and we saw several care plans where family members had signed on behalf of the person using the service although there was no indication that the person was unable to sign the care plan. We recommend that consent is sought for care and treatment and where a person lacks mental capacity, the provider acts in accordance with the requirements of the Mental Capacity Act 2005.

Care reviews were not always signed. We recommended reviews should be signed by the person using the service or by an appropriate other person, for example a relative with Lasting Power of attorney in health and welfare matters

The service had a safeguarding policy and care assistants were aware of how to respond to any safeguarding concerns.

There was a medicines policy and staff attended medicines training.

There were an adequate number of staff to meet the needs of the people who used the service.

Family carers were happy with the level of support they received.

Care assistants had inductions, supervisions and relevant training to support the people who used the service.

Stakeholders we spoke with said the manager was accessible and responsive. Most care assistants told us they felt supported by their manager.

There was a complaints system and people felt able to raise concerns.

The service had good relationships with other professionals.

We spoke with seven people using the service or their representatives, four care workers and the agency’s registered manager. People told us they were happy with the care and support they received. Their comments included “it’s a superb service. They are absolutely wonderful.” Another person said “we get one visit a week and it means I can go out and not worry about my [relative].”

We looked at the care plans for eight people using the service. We saw the care plans detailed people’s care needs and the support their care workers should provide. The plans were updated regularly and people were involved in reviewing the care they received.

The provider had policies and procedures for supporting people with their prescribed medication. Care workers understood the procedures and were trained to provide appropriate support.

We looked at training and supervision records and saw care workers had access to appropriate training and support to enable them to care for people using the service. One care worker told us “the training is good, it really helps.”

There were procedures in place for responding to complaints. People using the service told us they knew how to make a complaint and they were confident they would be listened to. One person told us “they gave me information about complaints but I’ve never needed to use it.”

We spoke with five people using the service or their carers and five care workers.

People told us they were very happy with the Call and Care service provided by Dementia Concern. Comments included "we’ve had the same care worker for a few years. They always tell us if there’s any change”. “We have a consistent carer, someone we trust. We did have one person who was not right and she was changed very quickly”. “They are lovely people, so flexible. I can go out and not worry”.

Care workers understood the risk of abuse and were able to tell us how they would respond if they had any concerns about people’s welfare. Staff recruitment processes were followed to make sure care workers were suitable to work with people using the service. People said they were confident to raise a complaint and could speak with the organisation’s managers if they had any concerns. They also told us if they had any concerns or complaints they would speak with their care worker or the organisation’s managers about them.

We saw that systems were in place for monitoring the quality of service people received. The care plan records we saw were comprehensive, people were asked for their views about the service and these were acted on.