The inspection took place on 14 and 19 December 2017 and was announced. We gave the service short notice in line with our current methodology about inspecting domiciliary care agencies. The service was registered with the Care Quality Commission in April 2017. Although this was an established service, inspected under a previous registration, there was a new provider, Accord Housing Association Limited. This was the first inspection of the service under this registration.

Direct Health (Doncaster) provides personal care to people living in their own homes in the Doncaster area. At the time of our inspection there were 90 people using the service.

We carried out the inspection a little earlier than planned due to concerns raised with us about the way the service was operating. However, we found improvements had been made since the concerns were raised and the majority of people were very happy with the service provided.

At the time of our inspection 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.

The service have had some operational issues within the last six months, which were related to a number of management and care staff leaving in a particular geographical area. This had a negative impact on the continuity and quality of care provided to some people who used the service in that area. However, there was evidence to suggest that since the new registered manager was appointed, improvements had been made resulting in significant progress being made in resolving the issues arising. The registered manager was experienced, competent and proactive. We saw that they were aware of every individual concern and continued to take positive and effective action to address them.

The service had also experienced a small number of occasions in the previous six months when scheduled calls had been missed. This was an issue that the registered manager had effectively addressed.

The majority of people praised the service and spoke very highly of the care and support provided by the staff. A small number of people and their relatives expressed concerns about the reliability of the service. When people had regular care workers they received consistent levels of care by staff who knew them. However, people told us issues had arisen when their regular care worker was not available and less experienced staff, who they did not always know, were allocated to provide their care. Some people told us that they felt the service had a high turnover of staff. These were issues that the registered manager was addressing and had made significant improvements in.

The service had arrangements in place for recruiting staff, and pre-employment checks were carried out prior to staff commencing work.

The registered manager had undertaken work to ensure people received their medicines safely and to ensure are plans included clear information about risks associated with people’s care and how to minimise the risks without unduly restricting people’s freedom.

The service had a policy in place for safeguarding people from abuse and neglect. Staff had received training in this area and knew what to do if they suspected abuse.

Overall, people were supported to have their assessed needs, preferences and choices met by staff who had the necessary skills and knowledge. If there were issues with any staff member’s competence or commitment, this was addressed in a fair and effective way.

People’s care plans identified the support they required during mealtimes, to ensure they were supported to eat and drink sufficiently to maintain a balanced diet.

People were supported to maintain good health, have access to healthcare services a