We conducted an announced inspection of Ezer Leyoldos Domiciliary Care Agency on 7 March 2017. We gave the provider 48 hours’ notice to ensure the key people we needed to speak with were available. At our last comprehensive inspection on 15, 19 and 27 October 2015 we found three breaches of regulations in relation to safe care and treatment, staffing and good governance.

The service provides care and support to people living in their own homes. There were six people using the service when we visited. The service provides care to people both over and under the age of 18.

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

Risk assessments and care plans contained detailed information for care staff. All records were reviewed within six months or sooner if people’s needs changed.

Care staff did not assist people with their medicines. Relatives assisted people to take their medicines.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults and children training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated a good level of knowledge about their responsibilities under the Mental Capacity Act 2005.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. Care records contained a good level of detail about people’s needs and preferences.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role.

Care workers were provided with adequate training to help them carry out their duties. Care workers received regular supervision and appraisals of their performance. There were enough staff employed to meet people’s needs and visits were appropriately arranged to ensure people’s needs were met.

Care workers did not provide assistance with people’s meals as this did not form part of the care packages they were commissioned to provide. However, people’s care plans contained sufficient information for staff about how to meet people’s needs in relation to their health and nutrition. When questioned, care workers were knowledgeable about people’s nutritional needs despite not having responsibility for providing this service to people.

The service was proactive in encouraging people to socialise and maintain their independence. Care records contained a good level of detail about people’s hobbies and interests and staff encouraged them to participate in these and try new activities they thought they would enjoy.

People using the service and staff gave positive feedback about the registered manager and told us they provided feedback about the service. They knew how to make complaints and told us they felt listened to and there was a complaints policy and procedure in place.

The organisation did not have consistently adequate systems in place to monitor the quality of the service. The registered manager reviewed various areas of the business on a regular basis. Information was reported to the CQC as required. However, spot checks were not conducted for all staff to check their performance and the outcomes of these checks were not always recorded.

At the previous inspection on 07/01/2014 we found non-compliance in Outcome 4, which is care and welfare of people who use the services. We judged that the non-compliance had a minor impact upon the people using the service. People told us they were pleased with the care and support they received; however, there were no recorded individualised risk assessments with in the care plans. This meant that staff did not have written guidance about the actions to take to keep people safe if they experienced healthcare or behavioural problems due to their medical condition and/or disability. Following the previous inspection, the service sent us an Action Plan which stated how they planned to achieve compliance by 30/04/2014, which was the agreed timescale.

At this inspection we found that the service had developed a risk assessment policy and procedure, and had carried out risk assessments for the five people using the service. Through looking at the risk assessments and speaking with a relative of a person using the service, we saw that this work had been carried out through involving people and their representatives.

The agency was providing personal care to six families. We spoke to two people whose families were receiving support. We also spoke with the service manager, client services co-ordinator and two care workers. Both people were happy with the care and support they received. One person told us, "the care is brilliant." Another person told us, "the care workers do their best for my son. If I did not get the help we would not be a normal family."

People told us they were consulted about how their care was provided. The care records contained a care plan and a home environment risk assessment. Although a risk assessment for people using the service had been carried out, they were not specific to people’s needs beyond their home environment.

We found there were effective systems in place to reduce the risk and spread of infection. One person told us, "I see the care workers washing their hands." Another person told us, "I see the carers wearing gloves and different clothing when they giving care to my relative."

People were made aware of the complaints system. Both the people we spoke with said they were confident about how to make a complaint. They told us they had not had a reason to complain, but thought the service would respond promptly and effectively if they made a complaint. One person said, "I would complain to the agency and they would definitely do something."

We found that the provider had taken action to ensure office-based staff and managers had information to hand to check that care plans took account of identified risks or that identified risk had been reviewed appropriately. The provider had addressed the concerns we raised at the previous inspection about risk assessments being stored in the office.

The agency was providing personal care to five families. We spoke to three people whose families were receiving support. We also spoke with the manager, the senior care coordinator and a care worker.

People using the service were pleased with the service provided by Ezer Leyoldos. They praised their care workers. One person said, "[the care worker] really is attentive." Another person said, "I am very happy. I really depend on them." People said their care workers were reliable and arrived on time. People knew which care workers to expect and any changes were communicated in advance. The care worker told us she had enough time to spend with the family without needing to rush.

The agency provided culturally appropriate care for people from the Orthodox Jewish community. Care workers were trained in Jewish custom and practice. People using the service valued this. One person said, "My care worker isn't Jewish and is very respectful."

We saw evidence that people's needs were assessed and care was being planned and delivered in line with people's needs and wishes. However, important information about people's care was not always accessible in the records that the agency kept centrally.

The agency had robust systems for recruiting care workers who were suitable to work in people's homes. There were systems in place to safeguard children and vulnerable adults from the risk of abuse. People using the service told us they trusted their care workers.

The inspection took place on 15, 19 and 27 October 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service for children and adults; we needed to be sure that someone would be in.

Ezer Leyoldos provides personal care to children and adults in their own homes. The agency specialises in supporting Orthodox Jewish families. At the time of this inspection five people were receiving a service.

There was a registered manager at the service; however she was not managing the service at the time of our inspection. Another manager had taken over the day to day running of the service but the provider had not begun the process of registering this manager with the Care Quality Commission. 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 not always protected from risks to their health and wellbeing because risks to people who used the service were not appropriately assessed and managed to protect them from avoidable harm.

The practice of prompting people to take their medicines was not always managed safely because the type of medicine and the time it was prompted was not recorded.

There were enough staff at the service but the provider could not be assured that they had received all training necessary for them to carry out their duties. In addition, newly appointed staff were not given time to shadow more experienced staff to ensure they were clear about how to meet people’s individual needs.

The service was not organised in a way that always promoted safe care through effective quality monitoring. Contrary to the provider’s policy, the provider had not implemented a system to audit different aspects of the service. Care records were not personalised and did not contain enough information to ensure staff knew the appropriate care to provide, for example when helping people to eat and drink.

People were protected from the risk of potential abuse. Relatives told us that the service was safe and a thorough recruitment system meant people were supported by staff who were suitable for work in the caring profession.

People’s health needs were generally met by their relatives and there was evidence that the provider worked collaboratively with healthcare professionals when required.

The provider followed the latest guidance and legal developments about obtaining consent to care. Staff used a range of communication methods to support people to express their views about their care.

Staff developed caring relationships with people using the service and relative’s opinions of the care staff were overwhelmingly positive. People were supported to maintain their hobbies and interests. Care staff respected people’s diversity and privacy and provided care that was based on individuals’ preferences.

The provider gave opportunities for people to feedback about the service and staff and relatives felt that the culture at the service was open and approachable.

We made one recommendation in relation to the prompting of medicines. We found three breaches of the Regulations around safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.