The inspection took place on 31 May 2018 and was announced. We gave the provider 48 hours’ notice because the service provides domiciliary care and we wanted to make sure the manager, or someone who could act on their behalf, would be available to support our inspection. The service provides personal care to people living in their own houses and flats in the community. It provides a service to 44 older adults.

The service was last inspected on 1 and 2 September 2016 and was previously rated as requires improvement. Action had been taken to address the breaches in regulation 12 and 18 identified at the previous inspection. At this inspection, we found the service to be rated as good.

Not everyone using Elite Care received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was 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 were told us they felt safe. Staff understood their responsibilities in relation to safeguarding and the service had systems in place to notify the appropriate authorities where concerns were identified. Medicines were administered and managed safely.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage those risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff had the training and skills required to support people effectively. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and applied its principles in their work.

People and their relatives told us the service was caring. There were sufficient staff to meet people’s needs. The service had safe recruitment practices.

People knew how to make a complaint if they needed to. We observed a complaints policy and procedure in place and any concerns were investigated thoroughly. Areas for development and learning were identified and actions taken to improve the quality of the service.

The service was well managed and sought people’s views and opinions and acted upon them. There was a good level of communication and people spoke positively about the management team and organisation of the service.

We carried out an inspection of Elite Care on 1 and 2 September 2016. This was an announced inspection where we gave the provider 48 hours’ notice. This was because the location provides a domiciliary care service and we wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

Elite Care provides a range of services to people in their own home including personal care, companionship, help with light household duties and shopping in Salisbury and the surrounding areas. At the time of inspection there were 51 clients using the service.

A registered manager was in place and available throughout the 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service told us they felt safe. Staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistleblowing procedure which was in place to report concerns and poor practice. People told us they felt confident staff would always arrive and would usually be informed if staff were going to be significantly delayed. People and staff told us it was not always possible for staff to arrive on time as there was often no allowance for journey times between visits. This meant that some visits were shorter than scheduled.

People said they saw regular staff although said this was not always the case at evenings and weekends when there were less staff available. During these times, other staff working for Elite Care would be asked to work additional shifts which meant people did not always see the same staff who usually cared for them.

People said they were satisfied with the support they received with regards to their medicines however; medicines were not always managed safely. The Medicines Administration Records (MAR) did not always provide sufficient information to enable the safe administration of medicines and documentation of medicines administered was not consistently completed. This meant people were at risk of not receiving their medicine as prescribed and according to the labelling.

People and their relatives spoke highly of the staff and said they always treated them with consideration and respect. Staff spoke about how they helped people retain their independence and encouraged them to be in control of their decision making and choices. People said they were cared for in a person centred way and said their regular staff knew them well. Staff spoke fondly about the people they supported and gave good examples of how they developed positive relationships with people using the service. People, their relatives and staff gave examples of when staff had gone the ‘extra mile’ to help and support people.

Systems to manage risk and ensure people were cared for in a safe way were not always effective. Although people had risk assessments in place and actions on how to monitor identified hazards and concerns, some actions had not been recorded to show that these risks had been reduced or managed. This meant there was a risk that people’s safety and well-being was not always protected.

Staff completed competency assessments as part of their induction followed by regular supervisions and training. Staff were knowledgeable about people’s needs and said they received the necessary training to equip them with the skills they needed to provide the care people required.

Staff had received training around the Mental Capacity Act 2005. Staff explained they understood the importance of ensuring people agreed to the support they provided.

Staff helped ensure people who used the service had sufficient food and drink to meet their needs. Some people were

In order to gain views about care provision, we met with three people who used the service in their own homes and spoke with twelve people on the telephone. We sent 61 questionnaires to people. Each person was sent an additional questionnaire to give to a relative, friend or advocate for completing, if they wanted to. A total of nineteen questionnaires were returned to us. Twelve questionnaires were from people who used the service, seven were from relatives, friends or advocates.

People told us they were generally happy with the care and support they received. They felt safe with staff and were supported in a caring and respectful manner. People had a copy of their care plan and were involved in its development. Care documentation was up to date and identified the support people required.

People generally had the same staff to support them with their care although this was not always the case. Whilst happy with the service, there were various comments that staff were often late arriving to support people. People did not have any concerns about missed calls.

Very few people needed the agency to support them with their medicines. Staff reminded people to take their medicines rather than administering them. They were aware of their responsibilities and safe systems were in place. Policies and procedures reflected the practice undertaken.

There was a clear staff recruitment procedure in place. Staff files contained the required information to evidence this. There were many positive comments about the staff team from people who used the service. Staff received a range of training to assist them to do their job effectively. They felt well supported by managers and each other.

People, their relatives, friends and advocates knew what to do if they were not happy with the service they received. Any complaints had been satisfactorily documented, investigated and addressed.

We visited four people in their own homes and spoke with six people on the phone in order to gain their views about the service.

Each person told us they were very happy with the support they received. They said staff were always friendly, supportive and caring. People told us they were generally supported by the same staff member which enabled good relationships to be established. They said staff arrived on time unless there was an emergency or a particular difficulty such as additional traffic. If staff were going to be very late, they said the office would call them to let them know.

People told us they were involved in developing their plan of care which staff always followed. They said they would have no hesitation in reporting any concern to staff or the office. People said they were often asked if they were happy with their service. They said they were encouraged to give suggestions about how the agency could be improved upon.

Staff were fully aware of their responsibilities to recognise and report any suspicion or allegation of abuse. All staff had recently undertaken training in safeguarding vulnerable people. Improvements had been made to ensure a more robust and rigorous recruitment procedure was in place. Improvements had also been made in relation to the standard of record keeping and the development of a detailed quality assurance system.