We inspected the service on 14 and 16 February 2017. ENA Care Call provides a care and support service to people who live in their own homes. At the time of our inspection 33 people were receiving a service. The organisation provides other support that is not regulated by us which includes personal shopping, domestic services and support in the community.

At our previous inspection in March 2016 we rated the service as Requires Improvement as systems were not in place to ensure people received all their medicines at the right time. Safeguarding incidents were reported to the local authority but agreed safeguarding procedures were not always followed. People generally received the support visit on time but some people did not receive their support for the agreed length of time. Travelling time was not included in the staff roster which impacted on the support people received. On this inspection we saw improvements had been made.

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 2008 and associated Regulations about how the service is run.

People received their medicines when they were needed. The staff knew when to give these and what to do if they were concerned or medicines were missed. People were protected from the risks of abuse. Staff knew how to recognise the signs of abuse and knew what actions to take if they felt people were at risk of harm. People were protected from risks associated with their health and care provision and measures to reduce or prevent potential risks to individuals were taken.

People had developed good relationships with staff, who recognised where care needed to be reviewed to reflect changes with their support. The provider had identified that more staff needed to be recruited to ensure people received greater consistency in care from the staff team.

People received care and support from staff who were well trained and knew how people liked things done. Staff received effective supervision and their work was reviewed through regular checks on their performance and their work was appraised.

People's were able to make decisions about how they wanted to be supported. Where they needed supported, they were helped to make decisions that were in their best interests.

People received support that was individualised to their personal preferences and treated with care and kindness and supported to be as independent as possible. They were supported to express their views and be involved in decisions related to the planning of their care and the running of the service.

People were provided with information about raising concerns or complaints and were happy to speak with staff about any worries. Staff felt supported by the registered manager who was committed to improving care services.

We inspected this service on 15 and 17 March 2016. This was an announced inspection and we telephoned the provider two days’ prior to our inspection, in order to arrange home visits with people. At our last inspection in August 2014 we identified concerns with how people were support to keep safe as risks to people had not been identified. At this inspection we saw improvements had been made to ensure staff knew how to support people and minimise risks.

The service provides care and domiciliary support for older people and people with a learning disability who live in their own home in and around Swadlincote. At the time of the inspection 44 people were receiving a service.

There was a registered manager in 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.

People received their medicine and were supported to apply any creams or ointments they needed to maintain their health. Where medicines were not administered in blister packs, systems were not in place to ensure people received all their medicines at the right time.

People were protected from the risks of abuse as staff knew how to recognise the signs of abuse and would report their concerns. Safeguarding incidents were reported to the local authority but agreed safeguarding procedures were not always followed.

People generally received the support visit on time but some people did not receive their support for the agreed length of time. Travelling time was not included in the staff roster which impacted on the support people received. This information was shared with commissioners of the service.

There were processes to monitor the quality of the service provided although these systems had not identified concerns with medication and receiving the correct length of support time.

People received effective care and support from staff who were well trained and knew how people liked things done. Staff received supervision and had opportunities to develop their skills to meet people’s needs.

People were treated with care and kindness and they were supported to be as independent as possible. People received support that was individualised to their personal preferences and needs. Positive and caring relationships had been developed between staff and people who used the service.

People benefitted from receiving a service from staff who worked in an open and friendly culture and were happy in their work. People were supported to express their views and be involved in decisions related to the planning of their care and the running of the service.

People had capacity to make decisions about their own care and people were asked about how they wanted to receive support. People usually received support from the same staff team and they knew who was providing their support in advance. The provider was flexible and responsive to changes for support times. There were sufficient numbers of staff to ensure visits were made when they should be and to meet people’s care needs.

People knew how to make a complaint if they needed to. People and staff were confident they could raise any concerns or issues with staff in the office and the registered manager, knowing they would be listened to and acted on.

We found a breach of the regulations and you can see what action we told the provider to take at the back of the full version of the report.

At the time of this inspection there were 56 people using this service. As part of our inspection we spoke with four people, and with two close relatives of people, receiving care and support. We also spoke with the manager and three carers working at the service. Below is a summary of what we found.

Is the service safe?

People who used the service told us that they felt safe with the service’s carers and knew who to speak with if they were worried about anything. They said that carers talked things over with them while carrying out their care and support.

Although people felt safe with the service’s carers we found that recorded risk assessments did not always include procedures to safely manage risks. We have asked the provider to tell us what they will do to ensure risk control measures are identified and recorded on every person’s support plan.

Most people told us they thought the service employed enough staff. One person said, “They’ve never let us down.”

Carers had received training on keeping vulnerable people safe.

Is the service effective?

People told us that carers encouraged them to be as independent as possible. One person said, “I [am encouraged to] make a cup of tea.” Carers also confirmed this and one told us, “I offer a flannel to people to wash their face.”

People were fully involved in planning the support provided by the service. Support plans detailed people’s needs and guided carers in how these needs should be met.

Is the service caring?

People’s privacy and dignity were respected. One family member told us that carers were, “very good…they leave the room while [my relative] showers.”

Most of the people we contacted thought that their care and support was personalised for them. One person told us, “[My carers] treat me as I would like to be treated.”

Is the service responsive?

People we spoke with thought that their needs were understood by their carers and that the service employed enough staff. One person said, “They’ve never let us down.”

Carers thought they were usually allocated enough time to provide the care outlined in people’s support plans. Carers told us they felt listened to by the manager.

The manager acted on the views of people who used the service. For example, weekly staff schedules were sent to those people who asked for them, following requests for improved communication.

Is the service well-led?

The service had a quality assurance system to regularly assess and monitor the quality of service that people receive.

Carers had positive views on the service. These views included treating people who used the service with respect and being caring, honest and reliable.

We spoke with two people using the service and two relative’s. One person told us,” I am able to have a regular care worker who knows my needs and responds to my requests. My care worker treats me with respect. I am not rushed and I am kept informed of my care, the information about my care is recorded by the care workers and this is kept in my home for them to use each time”.

We spoke with three people who told us they were more than satisfied by the care provided. One person offered, “I have regular care staff that visit me and they know what to do and how to care for me. I think they are excellent”.

We spoke with another person and they confirmed staff knew what to do and used their care plan to meet their needs.

People we spoke with told us they felt safe with the staff provided by the company who visited them at home.

One person added “I feel pretty safe with the staff who visit my home”.

“I have regular care workers who attend to me. When my regular care worker is on holiday I am sent another care worker. I tend to get the same care worker during this time”.

A person using the service told us, “I think care workers are well trained, take their time and there is no rushing. I see staff adding to the care records about me. I think my care worker listens to me”.

A relative told us “I think the service is better than expected. We are very satisfied with the service provided”.

We spoke with three people using the service and their relatives.

One person told us,”when my care worker is off on leave or days off she tells me who will be covering. When she is off I get the same care worker”.

One person told us,“I am not keen to have new starters and I get loads of staff sent to my home to care for me which I do not like. I find my regular care workers are good but when my regular care workers are off I get new staff. They tend to keep asking me what they should do. I was sent two care workers who were not use to the night routine”.

A relative told us, “I find staff treat my relatives home with respect”.

One person told us, “I am happy with the care provided. However I find the care workers do not always arrive on time they are sometimes too early or sometimes late. I find my regular care worker to be really good and very nice”.

People using the service told us they could talk to office staff when they needed them and did so and for more serious concerns they would raise them through the complaints procedure.

We spoke with six people using the service and with their relatives. We also spoke with three care workers. One person told us, “I tend to have regular care workers to attend to me which I like as this give me continuity in my care. The rest of the time my family support me”.

One relative told us “the care workers are polite and very patient. We ask staff during the day to give medicines to our parent and we give the medicines at night. This arrangement works well. This allows all of us to be independent and helps to meet our relative’s needs. We have found the agency staff to have been very helpful”.

People using the service told us they had no concerns about the care workers who provided care to them and relatives also confirmed this.

We saw the agency liaised with other agencies to help provide care to people in the community. This included sharing a care package with another care agency and working with the different nursing teams.

Care plans included different assessments including medications to show how care workers would provide care.

One family representative told us “We are able to give feedback on any matter about care at regular intervals and we do so”. The family representative told us they were able to judge how care was being provided during the six weeks review where they were invited to attend and take part in the review about their parent. They were aware they could speak to the manager at any time during the care package if they needed to do so.