This inspection was undertaken on 27 June 2018 and 3 July 2018 and was announced on both days.

Domiciliary Care Agency Northwest is registered to provide personal care and support to people who live in their own homes. The agency office is based in Ellesmere Port and provides support to people with complex health needs or people who have a diagnosis of autism or a learning disability in the Manchester area. At the time of our inspection the service supported five people.

This service provides care and support to people living in four 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service has 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in November 2016 we found that there were a number of improvements needed in relation to the Mental Capacity Act and evidence of capacity assessments and how best interest decisions were recorded. Care plans were not always person centred and audit systems had not identified the areas of improvement that were required. These were breaches of Regulation 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Effective, Responsive and Well-led to at least Good. The provider sent us an action plan that specified how they would meet the requirements of the identified breaches.

This inspection was done to check that improvements had been made to meet the legal requirements planned by the registered provider after our comprehensive inspection in November 2016. One adult social care inspector visited the service and inspected it against all of the five questions we ask about services: Is the service Safe, Effective, Caring, Responsive and Well-led? We found that the registered provider was meeting all the legal requirements.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we found. We saw that the registered provider had policies and guidance available to staff in relation to the MCA. Staff demonstrated a basic understanding of this and had all completed training. Care records reviewed included mental capacity assessments and best interest decision records.

People supported had a person-centred care plan with risk assessments in place that reflected their individual needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. Clear guidance was in place for staff to ensure that people's needs were appropriately met.

Audit systems were in place that were consistently completed. Areas for development and improvement were identified where required and action plans were prepared and completed. Accidents and incidents were analysed to identify any trends or patterns within the service.

The registered provider had robust recruitment systems in place that were consistently followed. All staff had undertaken an induction before th

Domiciliary Care Agency North West is registered to provide personal care and support to people who live in their own homes. The agency is based in Ellesmere Port and currently provides support to people with complex health needs or people who have a diagnosis of autism and/or learning disability in the Cheshire West and Manchester area. At the time of our inspection the service supported seven people.

People lived in “supported living”. These are schemes where people are provided with regulated personal care as part of the personalised support that they need to live in their own home as independently as possible. Personal care is provided under separate contractual arrangements to those for their housing. The accommodation can be in shared houses and flats, but can also be in single household premises. Single household premises can be located together in shared schemes such as blocks of flats, but also singly anywhere in the community.

The service had two registered managers: one of whom has recently left the organisation. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager responsible for overseeing the services in Cheshire had left the organisation and an interim manager had been appointed by the registered provider. There was a registered manager in post responsible for overseeing the Manchester services.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

Staff practice showed that consent was sought from people prior to care being provided. Staff promoted choice and helped people to make decisions as much as possible. However, people's care plans did not always contain information guided by the principles of the Mental Capacity Act 2005 (MCA). Records did not always evidence how people’s capacity had been assessed and how decisions had been made in people’s best interests.

The registered provider had recognised where some improvements were required to be made at the service. However, this was not always robust and we found that not all areas of concern we had raised during our inspection had been identified or addressed in a timely manner through the registered provider’s quality assurance systems. The CQC were not always notified as required about incidents and events which had occurred at the service.

Records showed that people’s needs were assessed and basic information was available for staff. However, we found that some care plans were task orientated and lacked person centred information. Communication care plans for people who did not use the spoken word contained limited information to guide and support staff with meeting their individual needs. This meant that staff less familiar with a person may not have the information required to provide the correct level of support.

New staff underwent an induction programme, which included training relevant to their role and shadowing experienced staff, until they were competent to work on their own. Training records identified that staff had not always received supervision and training in line with the registered providers own timescales. This meant that people were at risk of receiving care from staff that did not have the relevant skills and knowledge necessary for their role.

People received support with their medication. Care staff had completed competency training in the administration and management of medication. Medication administration records (MAR) were appropriately signed and coded when medication was given. However, we noted that care plans for PRN (as required) medication were not always in place for staff guidance.

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