About the service: Eagle care Alternatives Ltd is a domiciliary care agency. It provides personal care to people living in their own houses or flats. At the time of the inspection eight people were using the service. Everyone using Eagle Care Alternatives received personal care.

People’s experience of using this service:

¿ People received safe care and they were protected against avoidable harm, abuse, neglect and discrimination.

¿ People’s individual needs, risks and diverse needs had been identified. People were involved in the planning of their care.

¿ People’s care needs were managed and reviewed regularly.

¿ Staff recruitment procedure was followed to ensure suitable staff were employed.

¿ There were improvement to the system to ensure staff were trained and supported to carry out their roles and their performance was monitored.

¿ Staff supported people with their medicines, ensured they had enough to eat and drink and attended health appointments as needed.

¿ 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 were encouraged to make decisions about all aspects of their care.

¿ There were improvements made to people’s care plans. These were personalised to reflect people’s wishes about how they preferred to be supported and their interests.

¿ Care plans and other information was produced in easy read format to help people understand.

¿ People were supported by kind, caring and consistent staff who respected their diverse needs.

¿ People’s privacy and dignity was protected. People’s independence was promoted where possible and they were supported to develop new skills; maintain relationships and socialise.

¿ People knew how to raise a concern or make a complaint. There was a system in place to respond to complaints and advocacy support was available.

¿ People, their relatives and staff were encouraged to give feedback on the service and to influence how the service develops.

¿ The registered manager understood their regulatory responsibility and were transparent in in line with the Duty of Candour.

¿ The provider had policies to support practices. Audits were completed and reviewed regularly to monitor the quality of service.

¿ The registered manager demonstrated a positive approach to learning and development. Any lessons learnt from incidents and feedback was shared with the staff team.

Rating at last inspection: Requires Improvement (published 7 December 2018).

Why we inspected: This was a planned inspection based on the rating of the last inspection. We checked whether the provider had made improvements to meet the legal requirements and regulations with the Health and Social Care Act 2008.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an announced comprehensive inspection of this service on 25 and 26 July 2018 where breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found. They included breaches in Regulation 12, Safe care and treatment and Regulation 17; Good governance. We served a warning notice for Regulation 17, Good Governance, to the provider and told them they must be compliant by 24 October 2018.

We met with the provider to confirm what they would do and by when to improve the key questions safe, effective, responsive and well-led to at least good.

We carried out an announced focused inspection on 1 November 2018. This inspection was done to check that the provider had made improvements to meet the legal requirements.

We inspected the service against two of the five questions we ask bout services: is the service safe? And is this service well led? This is because the service was not meeting some legal requirements.

This report only covers our findings in relation to ‘Safe’ and 'Well-Led'. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring so we did not inspect them. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eagle Care Alternatives Limited on our website at www.cqc.org.uk

Eagle Care Alternatives Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in a supported living setting, 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. At the time of our inspection visit eight people were using the service.

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.

We found improvements had been made to ensure risks to people’s health and wellbeing had been assessed and took account of people’s preferences and health conditions. Measures were put in place to manage risks safely whilst promoting their independence. Care plans provided clear guidance for staff to follow to keep people safe. Staff supported people to receive their medicines in a safe way.

Improvements had been made to staff recruitment procedure. Records showed pre-employment checks had been carried out to reduce the risks of employing staff unsuitable to work in care. There were enough staff to support people.

Staff had completed training in safeguarding and other relevant safety procedures to ensure people were safe and protected from avoidable harm and abuse. Staff understood their responsibilities to report concerns. Staff followed infection prevention and control practices.

The provider had met all the conditions of their registration; registered the service correctly and notified the Care Quality Commission of significant events which occurred, which they are required to by law.

The provider had made some improvement to the governance systems. The provider’s policies, procedures and processes had been updated and shared with the staff team. New electronic care planning system was fully operational.

A system was in place to ensure staff training was kept up to date and they were supervised and supported in their role.

The registered manager had provided leadership and support to staff. System was in place to log all accidents and incidents, these were analysed and action taken. Any lessons learned from inspections, incidents and complaints were shared with the staff team to improve safety.

People were given

Eagle Care Alternatives Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in a supported living setting, 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.

This is the second comprehensive inspection of the service. We inspected the service on 25 and 26 July 2018 and both days were announced.

At our last inspection in September 2015 we rated the service overall as ‘Good’. At this inspection the service had not maintained the rating and had deteriorated to ‘Requires Improvement’.

At the time of our inspection visit eight people were using the service. Not everyone using Eagle Care Alternatives Ltd receives the regulated activity of personal care.

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 provider had not fully met all the conditions of their registration. The provider had moved to new premises and had not submitted the relevant notification and applications. They were operating from an unregistered location.

The provider did not have systems and processes to assure themselves about the quality of service provided. There was a lack of oversight on the service and inconsistences in practices. The provider had not notified Care Quality Commission of significant events which occurred and affected the safety and wellbeing of people as they are required to by law. They had also failed to display the rating following their last inspection in September 2015.

People were at risk of receiving unsafe care. Risks associated with people’s needs and safety was not assessed, managed and reviewed. Care plans lacked guidance for staff to follow.

Staff recruitment processes were not always followed to ensure suitable staff were employed.

Staff understood what abused looked like and the action they should take. Staff training was not up to date and records showed some staff had not received the essential training needed for their role such as safeguarding, health and safety and moving and handling.

Staff respected people’s human rights. Staff gained people's consent before they were supported. Policies were in place but the procedure was not followed. The registered manager did not meet the Mental Capacity Act 2005 requirements. Therefore, people were not supported to have maximum choice and control of their lives and were deprived of their liberty.

People were supported with their medicines and their nutritional needs were met. People were supported with their health care needs when required. The service worked with other organisations to ensure that people received coordinated care and support.

There were enough staff to meet people’s needs. People felt staff treated them with care and kindness. Staff knew people well; understood their wishes and diverse cultural needs. People’s dignity and privacy was respected.

People and staff told us that the registered manager was supportive and approachable. The registered manager had shared with the staff team lessons learnt from events that affected the management of the service.

Staff had a good understanding of people's needs, and their preferences, daily routines and diverse cultural needs. Information was made available in formats that people could understand.

People knew how to raise a concern or to make a complaint. The provider had a process in place which ensured people could raise any complaints or concerns.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regu

This inspection took place on 16 and 18 November 2015 and was announced. The provider was given 48 hours’ notice because the location provides domiciliary care service and we needed to be sure that someone would be at the office.

Eagle Care Alternatives Ltd is a domiciliary care service providing care and support to people living in their own homes. The office is based in the city of Leicester and the service currently provides care and support to people living in Leicester and Leicestershire. At the time of our inspection there were 15 people using the service.

Eagle Care Alternatives Ltd 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 told us they felt safe with the care staff and the support they received. Care staff were confident to report any concerns about people’s safety, health or welfare to the registered manager or to the relevant external agencies.

People were involved in making decisions about their care and support needs and in the development of their care plan. Potential risk to people’s health had been assessed and measures in place were detailed in the care plans for care staff to refer to.

There were sufficient numbers of care staff employed who had undergone a robust recruitment process before they worked unsupervised with people who use care services.

People were prompted to take their medication where their plan of care had identified that the person required support. We found people’s medicines were managed well.

Care staff had received induction and training that equipped them to support people safely. However, the staff training records were not reflective of the training completed. The registered manager told us that all staff involved in care were required to complete the mandatory training this month and start the new Care Certificate training to ensure their knowledge was kept up to date. All staff were supported through unannounced spot checks. Staff meetings and supervisions were being planned to provide continued support for all staff.

People made decisions about their care needs and support needs. Care staff sought consent before they were helped and that staff always respected their choices and decisions.

People’s plans of care reflected the support they required and where appropriate social support, which helped to ensure people, received effective care which recognised and promoted their independence.

Care staff supported some people with their meals and drinks in order that they maintained a balanced diet. People were supported with grocery shopping, meal preparation and cooking.

Care staff supported people to liaise with health care professionals if there were any concerns about their health.

People told us that they were happy with the support they received and that they had regular care staff, and had developed positive relationships with them. People were complimentary about the care staff and found them to be kind and caring. People’s privacy and dignity was maintained, their choice of lifestyle was respected and their independence was promoted.

Care staff were knowledgeable about the needs of people and took account of their preferences such as times, cultural and diverse needs. People told us care staff arrived on time and stayed for the agreed length of time in order to ensure they were safe and their needs were met.

People told us they were aware of how to raise concerns. They were confident that any concerns raised would be responded to by the registered manager and the provider.

People who used the service and relatives told us that their views about the service were sought regularly. People told us that they were happy with how the service was managed.

There were systems in place to assess and monitor the service, which included checks on care staff delivering care and review of people’s care. People told us that regular home visits were carried out by the management team who checked on their wellbeing and also monitor the care and support provided by the staff.

We received positive about the care and the management of the service from social workers who had been involved in commission services for some people who used the service.