Esteem Homecare Services is a small domiciliary care agency covering the Hambleton district of North Yorkshire. It provides personal care to people living in their own houses and flats in the community and specialist housing. Care visits are offered between 6:30am and 10pm. At the time of the inspection 15 people were using a service, most of whom were older people.

Inspection site activity started on 30 May and ended on 19 June 2018. The registered manager, who was also the nominated individual and director of the company, was present 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.

At the last inspection there was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities Regulations) 2014, good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do to address this breach. We found some improvements had been made, however, further improvements were needed.

The provider was not following systems and processes to monitor and improve the quality and safety of the service. The registered manager was not formally reviewing audits to review actions identified by the care coordinator and ensure a consistent approach was adopted. Policies did not reflect current legislation and best practice guidance. This was a continued breach of regulation 17. You can see what action we told the provider to take at the back of the full version of the report.

We found the service had sufficient numbers of staff to support people to be safe. The service completed appropriate checks on its own staff and agency staff prior to them starting work.

People told us they felt safe when care was being provided. Risk assessments were in place to help manage commonly occurring risks to people such as falls. Where people had specific risks affecting them support was being provided to meet these. However, relevant individual risk assessments were not in place.

Where people had specialist equipment in place their care files did not detail who was responsible for maintaining and providing this to ensure it was safe for use by the person and staff. We have made a recommendation about specialist equipment and risk management.

Consent was routinely being considered when people were provided with care. The service understood how to help people make decisions for themselves as much as possible. Where people chose to make unwise decisions, these were respected.

People were involved in deciding their support plans. Staff understood what mattered to people. The service provided care at people’s preferred call times and changes to visit times were accommodated.

People were supported to take control of their lives and be independent. Staff negotiated with people which parts of their care they could and wanted to do for themselves. Staff understood how to adapt their approach to supporting people depending on their presentation on a given day. People’s dignity and privacy were respected when they were being supported.

People knew how to complain and had access to the registered manager by telephone or in person. When complaints were made these were investigated and acted on to make improvements.

Staff received training appropriate to their roles. New members of staff had an induction and opportunities to shadow the registered manager to enable them to become familiar with people’s care needs and preferences prior to supporting them.

The service had effective working relationships with other professionals and involved them as required. When information was provided by professionals this was shared amongst the staff team and advice was followed.

We inspected Esteem Homecare Services on 19 April 2017. This inspection was announced. We informed the registered provider 48 hours before we would be visiting, because we wanted them to be present on the day to provide us with the information we needed. This was the first inspection of the service, which became registered in September 2015.

The service is registered to provide personal care to people living in their own homes. At the time of inspection, ten people were provided a service.

The service did not have a registered manager; however, the registered provider had applied to become registered with us. 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 provider took over the day to day management of the service after the previous manager left the organisation. At this time, the registered provider was asked to develop an improvement plan with the local authority to develop the systems in place to ensure people were cared for safely. The registered provider had worked hard to improve areas such as care plans as well as staff training and support in this period. The registered provider was committed to the on-going development of the service. We found improvements were needed to ensure the service could deliver safe support to more people in the future.

We found the systems to ensure the quality and safety of the service required development. The registered provider did not ensure they understood and implemented good practice robustly as they made changes. We made a recommendation in the area of medicines management that good practice guidance is implemented to ensure the system is robust and people receive their medicines as prescribed safely.

We saw that records in relation to the management of the service were not always kept or were not complete enough to evidence safe process. This related to records around recruitment, rotas, incidents, accidents, safeguarding and communications the staff had with health professionals, people and their relatives. The registered provider purchased a system and developed suitable forms following the inspection to enable this to happen in the future.

New assessments had been undertaken and care plans completed, which contained details around how a person liked to be supported and their preferences. We saw the registered provider had assessed the risks involved in supporting people. The risk assessment process was still being developed and the registered provider told us they would start to use recognised tools to aid the process in the future.

There were enough staff employed to provide support and ensure people’s needs were met. There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice. The registered provider evidenced during and after the inspection that they had safely recruited their staff.

Staff told us the registered provider was supportive. Records confirmed staff had received recent supervision and the registered provider was developing a system of group supervision and appraisal to further support staff to fulfil their role. Staff told us the service had an open, inclusive and positive culture.

Staff told us they had received training, which had provided them with the knowledge and skills to provide care. Records confirmed that staff had received the training the registered provider felt was necessary. A plan to provide more training in topics not yet delivered was in place.

The registered provider had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. Staff were able to demonstrate how they empow