About the service: Elmar Home Care Limited is a domiciliary care agency, providing services to older adults and people with physical disabilities and complex health needs. At the time of our inspection 61 people received personal care from the service.

Not everyone using the service receives the regulated service of personal care. CQC only inspects the personal care service provided to people, that is help with tasks related to personal hygiene and eating. Where personal care is provided to people, we also take account of any wider social care provided.

People’s experience of using this service:

At our last inspection in May 2018, we rated the service Requires Improvement overall with two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation. This was in relation to medicines management and good governance. Since this inspection, a new provider has recently taken over the service and a new management team put in place. At this inspection, we found sufficient improvements had been made and the service is no longer in breach of Regulations.

Although we saw some good practice in relation to medicines management, we have made a recommendation about further review of systems in line with good practice, to bring this to a consistently good level.

Safe recruitment procedures were in place. Sufficient staff were employed to make sure people’s care and support needs were met. People told us staff completed all required tasks, but they were not always informed if their visit was going to be late.

People's nutritional and healthcare needs were being met. The service liaised with healthcare professionals to ensure people’s care and support needs were met.

Staff knew people well, including their likes, dislikes and care needs. People were generally complimentary about staff. They told us staff were caring, gave them choices about their daily lives and supported their independence as much as possible.

People’s needs and risks to their safety were assessed, and detailed plans of care drawn up. People told us they felt safe and staff had been trained to recognise and report suspected abuse. A complaints procedure was in place and any complaints were taken seriously and investigated appropriately.

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 and/or their relatives were involved in the planning and review of their care.

Staff were receiving appropriate training and updates. Staff told us the training was good and relevant to their role. Staff were supported by the management team and had the opportunity to discuss any concerns and their ongoing development needs.

Some systems were in place to monitor the quality of care provided and further areas were being developed. People were positive about the new care provider and management team and said they were approachable and supportive.

The service met the characteristics of Good in most areas; more information is in the full report.

Rating at last inspection: At our last inspection, published in May 2018, we rated the service Requires Improvement, with breaches in relation to medicines management and quality assurance.

Why we inspected: This was a planned inspection based on the rating at our last inspection. At this inspection we found improvements had been made and the service is now rated good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection 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

Our inspection of Elmar Home Care took place between 5 and 9 April 2018 and the inspection was announced. At our previous inspection in February 2017 we had found one breach of regulation relating to 'Need for consent.' We asked the provider to complete an action plan to tell us what they would do and by when to improve the service. At this inspection we found improvements had been made to meet the relevant requirements.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of our inspection there were 61 people using the service.

A registered manager was in position. 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.

From our discussions with people, relatives and staff and from reviewing care records, we concluded 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 told us they felt safe in the company of staff. Mechanisms were in place to record and report concerns about any suspected abuse. Staff had received safeguarding training and knew how to recognise and report signs of abuse. Accidents and incidents were documented with clear actions taken as a result. Risk assessments were in place although some required further details to make these more person centred.

Medicines were not always managed safely. We saw numerous gaps where staff had not signed medicines administration records (MARs) and further sdtaff training had failed to prevent this continuing. MARs had not been returned to the office so these could be checked in line with the provider's policies and procedures. Medicines profiles did not always reflect people's current prescribed medicines.

Staff were recruited safely and sufficient staff were deployed to keep people safe. Staff completed required tasks during care calls and mostly stayed for the required amount of time. People told us staff were caring and kind and knew their care and support needs well. People were generally supported by the same team of care staff although some people told us this did not always happen. People told us staff respected their privacy and dignity and ensured they remained as independent as possible.

Staff received regular training to equip them with the required skills to provide safe and effective care and support. Staff were subject to regular supervision and spot checks to check their competency as well as annual review of their performance. Staff meetings were held monthly to keep them updated and to share best practice.

The service was compliant with the Mental Capacity Act 2005 and the registered manager understood their legal responsibilities under the Act. We saw evidence in people's care records of consent being sought and people's preferences respected. People we spoke with confirmed this.

People's needs were assessed and plans of care put in place. These showed a good level of personalised detail although more information needed to be added about people's advanced care plans. People and their relatives told us they had been involved with planning and reviewing their care and support needs.

People's health care needs were supported through staff liaising with a variety of health care professionals.

People understood how to raise concerns and complaints and generally felt these were handled to their satisfaction, although some people told us office staff could be more helpful when they raised issues.

A more detailed process of quality checks needed to be embedde

On the 10 February we inspected Elmar Home Care Limited and made phone calls to people and their relatives on the 22 February 2017. At the time of our inspection, there were 71 people using the service. This was an announced inspection which meant we gave the provider 48 hours’ notice of our visit.

Elmar Home Care Limited is registered to provide personal care to support people who want to retain their independence and continue living in their own home. The agency office is located in Silsden and staff provide support and personal care to people living in Craven and the surrounding areas.

The service had a registered manager in place at the time of 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 in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was present throughout the inspection.

At the last inspection on 16, 22, 23 and 24 August 2016 the service was rated Inadequate and in ‘Special Measures’. We asked the provider to take action to make improvements in a number of areas and this action had been completed.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However although the service had improved overall, we found there was still some work required to improve further. Areas where the service had addressed our concerns needed time to show the changes were sustainable.

People and their relatives were satisfied with the service they received and commented staff were kind and caring and treated them with respect. People felt safe when staff were around. All staff had undertaken training in safeguarding adults. They were able to describe what actions they would take if they suspected abuse.

The provider had risk assessments in place. Records showed risks to people had been identified, assessed and were reviewed on a regular basis.

We found people received their medicines when they needed them and the provider managed medicines safely and appropriately.

People were supported to eat and drink enough to help keep them healthy. Staff understood people's food preferences and acted in accordance with their wishes.

Staff received regular training and supervision and they felt supported by the registered manager.

There were systems in place to ensure staffing levels were appropriate to the needs of people using the service.

The provider had an effective recruitment procedure to ensure only suitably qualified and experienced staff were employed. However staff only had their criminal backgrounds checked when they started employment.

The registered manager and staff understood the principles of the Mental Capacity Act 2005. They knew how to support people if they lacked capacity to make decisions and who to involve. Some people had lasting power of attorney in place; however the registered manager was unable to show us paperwork supporting this.

People and their relatives commented positively about the care and support which were provided by staff.

We saw no new complaints had been received but the registered manager told us the actions they would take if a complaint was received.

People and their relatives told us they had been involved in the assessment and care planning process.

People received care which met their needs, choices and preferences. Staff had good knowledge of the people they supported and they encouraged people's independence.

Staff were clear about their roles and we found care plans identified p

We inspected Elmar Home Care Limited on 16, 22, 23 and 24 August 2016. We usually give the provider 48 hours notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager can be available. However, the registered manager had planned leave on the date we intended to inspect the office, so we rearranged the date which gave the provider five days notice.

The last inspection took place on 8 September 2014, when we found one regulatory breach which related to medicines.

Elmar Home Care Limited is a domiciliary care agency which provides care services to people in their own homes. When we visited the office the registered manager told us 88 people were receiving a personal care service. The agency provides a service to adults, older people, people living with dementia, people with physical disabilities, learning disabilities, sensory impairment and people with mental health needs.

There was a registered manager in post, who was also the nominated individual for the Company. 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.

Although people who used the service and relatives praised the kindness and caring attitude of the staff, they expressed concerns about the reliability of the service and the turnover of staff. They told us staff did not arrive at the times which had been agreed with the agency. We found agreed call times were recorded on the computerised system however there was no documented evidence to show when or who had been involved in discussing and agreeing these times. We saw issues around call times had been raised with the provider, sometimes repeatedly, but had not been resolved.

We found medicines were not managed safely as there were no records to show what medicines people were prescribed and administration records were incomplete. This meant we could not be assured people were receiving their medicines appropriately. These concerns had been identified at the previous inspection in September 2014.

The staff recruitment process was not robust as full checks had not been completed to make sure staff were suitable to work in the care service. Staff were not being provided with the necessary support and training to ensure they had the skills and knowledge to meet people’s needs.

Although people told us they felt safe with the staff we found safeguarding incidents were not always recognised, dealt with or reported to the appropriate authorities. The registered manager told us all staff had received safeguarding training. However, two staff told us they had received no safeguarding training and another said they had received safeguarding training five years ago.

Accidents and incidents were not always recorded correctly and there was a lack of evidence to show what action had been taken when these had occurred.

The registered manager confirmed they had received training in the Mental Capacity Act 2005 although our discussions with them showed they were not fully aware of their responsibilities under this legislation and they confirmed the staff had not received training in this subject.

Effective systems were in place which ensured people’s nutritional and health care needs were being met.

People’s care records did not always fully reflect their needs. Some people told us complaints they had raised had been resolved, whereas other said they had not. Although the registered manager told us they had dealt with any complaints raised, they acknowledged there were no records to evidence the actions they said they had taken.

We found a lack of strong leadership, ineffective quality assurance systems, weak communication and poor

We considered all the evidence gathered from reviewing records and speaking with people. We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes the records we looked at and what people who used the service and the staff told us.

Is the service safe?

At the time of our visit there were approximately 90 people who used the service. We spoke with eight people who all told us they felt safe, respected and well looked after when staff visited them. We also spoke with eight relatives who told us they felt staff provided people with safe and effective support. One relative said “I’ve got total confidence in them.”

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to manage those risks.

There were enough skilled and experienced staff to ensure people received a consistent and safe level of support. Staff recruitment procedures were rigorous and thorough.

We found evidence people were not always protected against the risks associated with medicines because there were not appropriate arrangements in place to ensure medicines were managed safely. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to the management of medicines.

Is the service effective?

People had individual care records which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

Overall people told us they received effective care and support from staff. However, some people said this was not always provided at the times they required it. We spoke with the provider about this and they gave assurances this matter would be addressed.

Is the service caring?

People told us the service provided a good standard of care to people. People said the staff were dedicated and appeared knowledgeable and well trained.

Our discussions with people and the records we looked at also told us that individual wishes for care and support were taken into account and respected.

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered.

Is the service responsive?

Care records were reviewed and any changes made either when people’s needs changed or as part of the annual review process. We saw evidence of this within the care records we reviewed. The staff we spoke with told us they would immediately alert the manager if they noticed a change in people’s needs.

From our review of records and from speaking with people we saw that people who used the service were asked for their views about their care and treatment and they were acted on.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service.

People who used the service told us if there were any problems they felt able to raise these with staff and were confident they would be listened to.

People who used the service were given appropriate information and support regarding their care or treatment. One person told us how they had made the decision to change to Silsden, having been unhappy with another provider. They said they were glad they had changed over. Another person told us they had been involved in planning their support package and that this had been tailored to meet their specific needs. The agency was described as ‘first class’, one person told us the agency was a ‘flexible and caring service'. All the people we talked to were satisfied with staff from the agency. Staff were described as, 'caring, sympathetic and professional.' One person said, "Some carers are amazing, others are just good."

People's needs were assessed and their care and treatment was planned and delivered in line with their individual support plans. One person told us their care worker ‘goes over and above what is needed'. Another person told us, "As I am improving, the carers do less for me but prompt me to do more for myself, that is how I want it." One person said the care worker who visited her was 'an angel, very very kind and sweet.'

People's needs were assessed and their care and treatment was planned and delivered in line with their individual support plans. One person told us "Sometimes they spend longer and they really brighten up my day". Another person told us, "They always do a good job." Another person said "Sometimes I ask them to do other tasks, they are very accommodating and brilliant, I am very pleased with the service." One person said "My carer did not turn up so I rang the office and someone was out straight away."

We found people were protected from the risk of infection as care was delivered in a clean and hygienic environment.

We also found the provider had an accurate Statement of Purpose (SoP) and it contained the necessary information including aims and objectives, the kinds of services provided, names of key individuals working for the service, legal status of the provider and details of the office address.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

There was an effective complaints system in place. The manager told us if complaints were made they would responded to them appropriately.