About the service: DT Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our visit 95 people were in receipt of personal care.

People's experience of using this service: People felt safe and remained living in their own homes in line with their wishes. Procedures were in place to protect people from harm and staff understood the risks associated with people's care to keep them safe. Strong emphasis was placed upon continually developing the safety of the service.

Staff were recruited safely, and enough staff were employed to ensure people received all their care calls, from familiar staff at the times agreed. Staff felt valued and received the support and training they needed to be effective in their roles.

People and relatives spoke highly of the caring nature of the staff and staff knew people extremely well. Peoples needs had been assessed before they started using the service and people were involved in planning and agreeing to their care. Care plans contained information staff needed to provide personalised care.

People took their own medicines or were supported by family members to do this. Peoples nutritional needs were met, and the management team and staff worked in partnership with health and social care professionals to ensure people received effective care.

The service was compliant with the Mental Capacity Act (2005). 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 felt respected and their independence was promoted. Care and support was provided in a dignified way. People's end of life wishes had been discussed and recorded.

Systems were in place to manage and respond to complaints. People were happy with the service they received, and the way DT Care Services was managed. The registered manager led by example and was committed to providing high quality care. Effective systems continually monitored and evaluated the quality and safety of the service provided. Feedback gathered was used to drive improvement.

Rating at last inspection: In October 2016 we rated the service as ‘Good’. At this inspection evidence supported a continued rating of 'Good' in all areas. More information in 'Detailed Findings' below.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 11 October 2016 and was announced. At the last inspection in January 2016 the service was compliant with all the regulations we looked at however we noted that the registered provider’s record keeping systems and quality monitoring processes could be improved. At this inspection we found that the registered manager had taken effective action to address our past concerns.

DT Care Services provides personal care to people in their own homes. At the time of our inspection the service was supporting 64 people.

There was a registered manager in place who was present during our inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe. Staff received regular refresher safeguarding training and knew how to report allegations or suspicions of poor practice.

People who needed support with their medicines were supported appropriately. Staff knew how to dispense medicines safely and there were regular checks to make sure this was done properly.

People were supported by staff who had the appropriate skills and knowledge they needed to meet their care needs. People were supported by staff who reflected their cultural heritage and religious beliefs.

People were supported to eat and drink enough to stay well. There were processes in place to protect people who were at risk of malnutrition.

People were supported to have their mental and physical healthcare needs met. The registered manager sought and took advice from relevant health professionals when needed.

People said staff were caring and had built up close relationships with the members of staff who supported them. People were involved in deciding how they wanted their care to be delivered and were supported in line with the Mental Capacity Act 2005. People said staff treated them with dignity and respect.

Staff were responsive to people’s needs and delivered care in line with people’s wishes. People had access to a complaints system and the registered manager responded appropriately to concerns.

There was effective leadership from the registered manager and senior members of staff. People and staff told us the service had improved. The registered manager had a clear vision of the service which they shared with staff.

The registered manager assessed and monitored the quality of care and introduced a robust system to monitor if people received their calls on time.

The inspection took place on 7 January 2016 and was announced. We last inspected the service in September 2014 and found it was complaint with all the regulations we looked at.

The service provided domiciliary care to 55 people in their own homes, three of whom were currently in hospital. There had been a registered manager in place since December 2011. 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 told us that they felt the service kept them safe. Staff were aware of how to protect people from risk of harm and how to raise concerns when necessary. The registered manager was currently reviewing people’s risk assessments to ensure they contained effective guidance for staff to keep people safe from the risk associated with their specific conditions. After our visit the registered manager sent us further information to demonstrate that risk assessments and staff deployment were being reviewed.

There were enough staff to keep people safe and to meet their needs. People confirmed that they were always supported by the number of staff identified as necessary in their care plans. The provider had established a resource of bank staff who were employed to provide occasional cover when regular staff were unavailable. Staff told us that they had undergone robust checks to ensure they could support people safely and records sampled confirmed this.

People who required assistance to take their medication said they were happy with how they were supported. Staff were able to explain how they supported people to take their medication in line with their care plans.

Staff had the skills and knowledge they needed to meet people’s care needs. Staff received regular observations of their practice and supervisions to ensure they remained competent to support people in line with their care plans and best practice. Systems for monitoring that staff had received the appropriate training to ensure they were up to date with the skills and knowledge they needed to support people, were not robust.

People had been asked how they wanted to be supported. When requested staff involved those who were close to people in order to help them make decisions. The registered manager told us that all the people who used the service had mental capacity to decide how they wanted their care to be provided. People told us that care was delivered in line with their wishes.

People told us that staff supported them to eat and drink enough to stay well. Staff knew what people liked to eat. People had access to other health care professionals when necessary to maintain their health.

All the people we spoke with said that staff were caring and they were happy to be supported by the service. People had developed positive relationships with the staff who supported them and spoke about them with affection. The service promoted people’s privacy and dignity.

People told us the service would respond appropriately if their needs and views changed. We saw that records were updated to reflect any changes. Records contained details of people’s life histories and who they wanted to maintain relationships with so that staff could provide the support people wished.

The provider had systems in place to support people to express their views about the service and people were aware of the provider’s complaints process. People felt their concerns were sorted out quickly without the need to resort to the formal process.

People we spoke with said they were pleased with how the service was managed and felt involved in directing how their care was developed.

The registered manager had clear views of the actions they wanted to take to improve the service and staff we spoke with were confident in their abilities to lead the service.

The provider had processes for monitoring and improving the quality of the care people received which included observational audits of how staff provided care to people in their own homes. Existing practices had failed to identify recent concerns raised by other agencies however the registered manager was introducing systems to improve the quality monitoring of the service.

Two inspectors visited the service’s office and spent time talking to the manager and staff and sampling the records. After the visit we spoke to several people who used the service and several members of staff.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We spoke with several people who used the service. They told us that they felt safe. One person said, “We feel very safe.” People confirmed that they knew how to report any behaviour on the part of staff which made them feel uncomfortable and they had confidence that the manager would take appropriate action.

We saw that appropriate checks were made on people working for the service to make sure that they were suitable to do so.

We saw that there were risk assessments which provided descriptions of the possible dangers to people from the environments or activities. There were clear recordings of the measures taken to minimise these and keep people as safe as possible.

We spoke with several members of staff and they showed that they understood how to report suspected abuse. One member of staff said, “The manager told us, ‘anything you don’t feel comfortable with let me know, don’t hesitate’ and I know she would want to know.”

We found that the service’s safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults.

Is the service effective?

People told us that they were happy with the care they received and the care workers who supported them. We found that care staff knew the people they supported well.

Staff training records showed that staff had received appropriate training in a number of relevant topics including: food hygiene, dealing with dementia, moving and handling and infection control. This meant that staff had the appropriate skills and knowledge to ensure that people received safe, appropriate and effective care.

We checked people’s care plans and found them to be detailed, relevant and up to date. This meant that members of staff had appropriate information to provide an effective service to people.

Is the service caring?

People were supported by kind and attentive staff.

We spoke with four people who used the service. They all said that they were pleased with the standard of care provided. One person told us, “I am perfectly happy.” Other people said, of the care workers, “They are very, very obliging” and “they treat us with kindness.”

We spoke with several members of staff. They all displayed a positive attitude towards their role and a caring attitude towards the people for whom they provided a service.

We concluded that people had a good experience of care and support which was delivered with compassion and respected their dignity and human rights.

Is the service responsive?

People told us that they felt comfortable asking for changes to their routines or the tasks which staff carried out.

Records showed that people were consulted about the plans for their care and support and they had opportunities to make changes to their care plans when circumstances changed.

We found that care workers had regular one to one supervision meetings. This meant that care staff had the opportunity to discuss their training and development needs, welfare and any concerns they might have about the people they were caring for.

People using the service told us that they would have no hesitation in telling the manager and staff if they were unhappy or had any complaints about the service they received. We were told that the manager was approachable and helpful and where they had made requests or raised minor concerns, these matters had been responded to promptly and to their satisfaction.

Is the service well-led?

We found that the manager had made improvements to the organisation of the service since our last visit.

We saw that the manager was well known to the people with whom we spoke.

People who used the service were complimentary about the manager. Comments included, “I know her well and I could ring her at any time if I wanted things changing”.

Care staff employed by the service told us that the manager was approachable. One care worker told us, “The manager comes and does spot checks on me. She is really good. I know that she is just a phone call away if I have any problems.”

The manager told us about and showed us evidence of spot checks which she carried out on staff as they carried out their duties.

We saw records which showed that the manager monitored the records and there were systems for making sure that calls were not missed.

We concluded that there was effective leadership in this service, which ensured that people were provided with safe and responsive care.

When we visited, the service was providing personal care to 14 people in their own homes, some of whom were not able to give us their views because of their complex needs and conditions. We used a number of methods to understand the experiences of the people who used the service. We spoke to two people and the relatives of two people who used the service. We also spoke to the manager, office administrator and four care staff. We also looked at records and spoke to a person who commissions the service for the local authority.

People told us that they were generally happy with the service but some people also expressed concerns. One person told us, “The staff are fine, but not organised. They don’t always let you know if they are going to be early or late.”

Care was not always planned and designed to meet people’s individual health and welfare needs or always delivered as agreed.

We saw that the provider had not made suitable arrangements to ensure that service users were safeguarded against the risk of abuse.

We found that the provider had a robust recruitment processes in place to ensure people were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider was unable to protect people from unsafe care and treatment because they did not regularly assess and monitor the quality of the service provided.

The provider was taking steps to improve the quality of their record keeping but further improvements were needed.

People using the service were happy with the care they received from the service. We were able to speak to four people who used the service.

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They said the carer's were very friendly and helpful. They had no complaints at all. Comments included: " I am happy with my carers and feel very comfortable with them" " Very pleased with the service" "They do a very good job".

The manager reviewed each person's care documentation on a monthly basis. They spoke to the person and their family to make sure the service provided was of a good standard, and was meeting the needs of the individual.

People who used the service were supported by friendly staff.

People who used the service felt comfortable with talking to the manager or any member of staff if they felt things could be improved. They all said they were very satisfied with the service provided.

The record keeping at the agency was very inconsistent. A number of the documents we saw were either incomplete, blank, lacked detail or had poorly written entries. We informed the manager that this outcome would be non-compliant and a compliance action would be issued.