The inspection took place on 15 and 24 November 2017 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the main office.

When we completed our previous inspection in September 2015 we found concerns relating to the way the service was managed and we made recommendations for improvement in the Well led section of the report. During this inspection we checked and found the provider had implemented improvements.

Elizabeth Homecare Limited provides care and support to people who live in their own homes in Goole and surrounding areas. This service is a domiciliary care agency. The service is registered to provide the regulated activity of personal care to people with dementia, learning disabilities or autistic spectrum disorder, mental health, older people and people with a physical disability. The provider also provides an intermediate care service that is designed to help people regain their independence. At the time of our inspection 91 people were receiving a service from this provider.

Not everyone using Elizabeth Homecare Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’, which is help with tasks related to personal hygiene and eating. Where they do receive this type of support we also take into account any wider social care provided.

There was a registered manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

As part of the legal requirements of their registration, providers must notify us about certain changes, events and incidents that affect their service or the people who use it. During the inspection we found that notifications had not been submitted about an incident relating to the service that was reported to or investigated by the police. We have written to the provider regarding this.

Systems and processes were maintained to record, evaluate and action any outcomes where safeguarding concerns had been raised which helped to keep people safe from avoidable harm and abuse.

The provider ensured there were sufficient skilled and qualified care workers to meet people's individual needs and preferences. People confirmed they received care and support from regular care workers who they knew. Continuous monitoring helped to ensure that visits were not missed.

Risks for people and for staff from their environment were assessed and managed through individual risk assessments. These provided care workers with information to help keep both people and themselves safe from avoidable harm with minimal restrictions in place.

Procedures were in place to guide staff on the safe administration of medicines and staff had received medicines training. People confirmed, and the records we checked showed, that people had received their medicines as prescribed.

The provider had systems and process in place to ensure care workers were appropriately recruited into the service.

Care workers had received support through a regular system of supervisions and appraisals. Competency observations had also been completed to monitor staffs performance and ensure they were providing safe and effective care and support.

Care workers had access to a policy and procedure that provided with them guidance on working with people who might lack capacity under the MCA. Care workers had completed training on the Mental Capacity Act 2005 (MCA) as part of their induction training and were able to discuss the importance of supporting people with their independence.

People had received an assessment of their need to ensure they were suitable for the

People told us that their experience was a positive one. They were involved in the decisions about using the service and staff discussed their care and treatment with them. One person said “I cannot praise the staff enough. They work hard but always listen to you and make time for a chat.”

The provider used the local authority’s medication system to administer medicines to people who used the service. Staff had received training in its use and the provider carried out regular audits to ensure staff practice was safe and effective.

Robust employment and recruitment practices were in place. One relative who spoke with us said “The agency must use good recruitment techniques because my parent has received care from a number of staff and they have all been excellent workers and are extremely pleasant towards my parent”.

The agency employed sufficient staff to ensure people were looked after by staff who understood their needs and who were competent in their roles. People whose care included use of equipment such as a hoist told us “The staff know what they are doing. They are very competent when using the equipment. Some of the newer staff might need a few reminders but they usually pick things up quickly”.

People were aware of the complaints procedure and knew how to use this if needed. People said they had completed satisfaction questionnaires and were part of the care planning process.

As part of our inspection we asked people who used the service about their experiences of the service provided by Elizabeth Home Care. We visited three people in their own homes and spoke with a further four people on the telephone.

People and relatives who met with us and spoke with us were very satisfied with the service being provided to them. Individual comments made to us included

“The staff always treat my mother with respect and dignity and I am very satisfied with her care.”

“I have no problems with my care. I was a little nervous initially about using a home care service, but the quality of the service and the staff has increased my confidence in this type of care.”

“The agency tries hard to provide me with the same care staff each day and they arrive on time. They also let me know if there are going to be any changes.”

“The level of contact with the office is good. The managers are quick to act on any requests for change. The service reviews my care regularly and I am delighted with the standard and quality of the care I receive.”

“ I feel safe in my home and the provider has put into place systems that keep me safe such as name badges, known staff, good communication with the office and my home access arrangements.”

People told us that the agency carried out reviews of their care on a regular basis. People were also aware of the complaints procedure and knew how to use this if needed. People said they had completed satisfaction questionnaires and were part of the care planning process.

This inspection took place on 23, 27 and 28 September 2015 and was announced. We previously visited the service in April 2013 and we found that the registered provider met the regulations we assessed.

The service is registered to provide personal care and other types of support to people living in their own homes, such as assisting with the administration and the preparation of meals. The agency office is located in Goole, in the East Riding of Yorkshire and staff provide a service to people living in Goole and the surrounding villages. The agency also provided an intermediate care service that was designed to help people regain their independence.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was registered with the Care Quality Commission (CQC). 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 safe whilst they were receiving a service from staff working for Elizabeth Homecare Limited. People who required assistance with the preparation of meals and drinks told us they were happy with the support they received.

We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. The training records evidenced that all staff had completed induction training and that all staff had completed training on the administration of medication and moving and handling. Some staff had also achieved a National Vocational Qualification (NVQ) at Level 2 or 3.

New staff had been employed following the agency’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people had been employed.

We saw that there were sufficient numbers of staff employed to meet people’s individual needs, although there were some issues with the deployment of staff and in the lack of travelling time allowed between calls. This had resulted in staff hurrying from call to call meaning some people received less time than they had been allocated.

People told us that staff were caring, pleasant and helpful and that the support they received enabled them to remain living in their own home. However, some people expressed concerns about the efficiency of the agency’s office staff.

There were systems in place to seek feedback from people who received a service. Feedback had been analysed to identify any improvements that needed to be made. Complaints received by the agency had been investigated appropriately although we noted that some were recorded as notes in people’s care records rather than in a complaints log.

The quality audits undertaken by the registered provider were designed to identify any areas that needed to improve in respect of people’s care and welfare. We saw that, on occasions, incidents that had occurred had been used as a learning opportunity for staff.