The inspection took place on 4 October 2016. We contacted the service before we visited to announce the inspection so we could ensure that the registered manager would be available.

Elite Care provides a domiciliary care service to a total of 39 older people, some of whom may be living with dementia. The service delivers care and support to people in their own homes in Cromer and the surrounding area.

There was a registered manager in post who was also the proprietor. 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 registered manager was also the registered provider of the service.

The organisation had checks in place to reduce the risk of employing staff that were not suitable to work in their service. There were enough staff to meet people’s needs in a person centred manner.

Staff received a comprehensive induction, regular training and checks to ensure their competency to perform their roles. They received regular supervision sessions and told us that they were supported by the management team and organisation. Staff told us that they felt valued and appreciated.

People benefited from staff that worked well as a team and understood the responsibilities of their role. A culture of inclusion, transparency and support was encouraged that respected people’s diversity.

The service had processes in place to help protect people from the potential risk of abuse. Staff had knowledge of how to protect, prevent, identify and report abuse. Staff demonstrated that they understood what symptoms may indicate a person was experiencing harm.

The individual risks to the people who used the service and staff had been identified, assessed and managed. The risks associated with the premises had not been fully identified at the time of the inspection but this was rectified by the service shortly after.

Although there was no formal analysis of accidents and incidents in place, the service had so few that the management team were able to discuss these with us and describe the appropriate actions they had taken.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service adhered to the five principles of the MCA and the management team had an understanding of this. Staff had received training in MCA but their knowledge was variable.

People had been involved in the planning of the care and support they received and told us that they received a service that met their needs in an individual manner. Care plans were detailed, accurate and person centred and had been reviewed on a regular basis. Any change to a person’s needs was reflected in the care plan and staff were made aware of these changes in a timely manner. The service met people’s preferences and staff had a good knowledge of those they supported.

Staff maintained people’s privacy and dignity and people told us that they showed the utmost respect at all times. The service understood the importance of encouraging and promoting people’s independence.

The service appropriately liaised with healthcare professionals as required and assisted people to access healthcare services as required. Staff were proactive in encouraging people to maintain their health and wellbeing and this included assistance with nutrition, hydration and medicines administration.

Suggestions and feedback on the service was encouraged and used to improve the service. A variety of accessible formats was used to meet people’s individual needs. Staff met regularly with the management team on a group basis where the service was discussed and where they had the opportunity to voice their views. The care manager met with people who used the

We conducted this inspection to establish whether Elite Care now provided a safe service regarding the administration of medicines.

Below is the summary of what we found. This summary is based on our observations during the inspection, speaking with staff and from reviewing records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We established that since our inspection in February 2014 that the provider had worked hard to address previous non-compliance.

Staff and been trained in new methodologies and were now working to new standards. The agency was now working within local government 'best practice' requirements. Regular audits of medication administration records (MAR) charts was taking place and a new senior member of staff was taking responsibility for leading on medication matters.

We checked MAR charts and found them all to be correct, signed, dated and with relevant comments when required. These corresponded to people’s care plans.

People were complimentary about the service received. Comments made included, “I’m very happy, the company is fantastic.” “They were responsive from the word go.” “They go the extra mile and a half.” People told us that new staff members were always introduced to them and they felt that the agency tried to ‘fit’ them to carers whose company they might prefer.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care need plans were reviewed every three months or sooner if the person’s needs had changed.

The service supported people and their representatives to obtain appropriate health and social care support. We were given an example of how one person was put in contact with an organisation which provided health care to them later the same day.

The agency was administering medications for one person only at the time of our inspection. However, we found that these medications weren't being administered safely, omissions were noted on medication administration (MAR) charts, robust checking arrangements were not in place and there was limited guidance for staff regarding the person's medication.

Checks were in place to ensure that staff recruited were suitable to work with vulnerable adults.

The provider had effective systems in place to obtain people's views about the quality of the service provided. Staff views were also taken into account.

This was the first inspection of Elite Care since the service was registered in January 2012. We visited the office base and looked at polices and care records. We also spoke with six staff and four people who had used, or were using the service. We found that people were very satisfied with the service they received and that they knew how to raise any concerns they may have. One person told us that their relative "...looked forward the the carer visiting." Another person described the service as "Absolutely fantastic."

We found that effective arrangements were in place to assess the needs of individuals and to deliver appropriate, individualised care. Care records were maintained so that all staff understood people's needs and how to meet them. People and there families were able to influence how care and support was provided.

Staff told us that they felt well supported and we saw records that confirmed that they had the opportunity for one to one and group support from the service managers. Staff training was in place for core subjects, with the exception of safeguarding vulnerable adults. However, this was addressed before our inspection was completed.