About the service: Facilitate Care Services is a domiciliary care agency registered to provide personal care to people in their own homes. At the time of this inspection the service supported 80 people with personal care.

People’s experience of using this service:

• People felt safe from avoidable harm. People felt at ease to raise safety risks with the registered manager for them to be resolved.

• Risks related to people’s health were identified and acted upon by staff. However, records were not always clear to show risks were managed.

• People’s needs were assessed before they started to use the service to make sure their needs could be met. • Most people were happy with the care and support they received and spoke positively of the service. However, care records, including medicine records, lacked detail to confirm care and support was managed safely.

• Enough staff were available to support people’s needs and staff knew people well.

• Staff were allocated to work in specific areas so that people experienced some consistency in the care staff that supported them.

• Recruitment records were not always detailed to confirm safe processes were followed.

• People told us they received their medicines as required.

• Staff completed regular training to ensure they cared for people safely and effectively.

• People were supported to be independent and were asked for their consent before care was provided.

• People were supported with food and drinks as required.

• People and relatives felt staff were caring and respectful in their approach.

• People knew how to raise a complaint and records were kept of concerns raised.

• There were quality monitoring systems to test people’s views of the service and these had resulted in some improvements.

• Staff felt valued and supported by the management team and spoke positively of the support they received.

Rating at last inspection: At our last inspection we rated the service as Requires Improvement overall. The report was published on 24 April 2018.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with the Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 20 February 2018 and was announced.

Facilitate Care Services is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection, 58 people were supported with personal care.

The service had a registered manager. 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 service was last inspected in July 2016, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the last inspection the service was rated ‘good’ overall, with ‘well led’ rated as ‘requires improvement.’ At this inspection we found improvements were required in how medicines were administered, and how risks were assessed and managed. Improvements were also required in how the provider checked and audited the service to ensure this was done effectively.

People did not always have their medicines administered safely and as prescribed. There were gaps in medicine administration, and mechanisms in place to record and audit when medicines were given were not effective which put people at risk.

Risks to people’s safety were identified, but risk assessments had not always been completed. Where these had been completed, they did not always give staff the information they needed to ensure risks were managed consistently.

People told us they felt safe with the staff who supported them. Staff received training in how to safeguard people from abuse and were supported by the provider who ensured staff followed safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. People were protected from the risk of infection.

There were enough staff to meet people’s needs safely. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

People told us staff asked their consent before undertaking any care tasks. Where people were able to make their own decisions, staff respected their right to do so. People’s care records included some information on the support they needed with decision making.

Staff had the right knowledge and skills to support people effectively, and this was monitored by the provider. Staff had some access to supervision meetings to keep up to date and discuss their practice, though these meetings had not always happened as often as the provider’s policy and procedure required.

People had access to health care professionals when needed and care records showed support provided was in line with what had been recommended.

People and most relatives told us staff were respectful and treated people with dignity. Staff respected people’s privacy, and supported people to be as independent as possible.

People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. People and most relatives told us the provider responded to requests to adapt their care effectively.

People and most relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way.

Systems to check and audit the quality of the service provided had either not been used or, where they had been used, had not been effective. They had not identified the issues we identified during our inspection visit. The provider ensured they took action following our inspection visit on the concerns we identif

We inspected this service on 16 June 2016. This was our first inspection to this agency and was an announced inspection. We telephoned 48 hours' prior to our visit in order to arrange access to the information we needed. This included making arrangements for us to meet with staff who worked for the agency.

Facilitate Care Services is a domiciliary care agency that provides personal care and support to people living in their own homes. Care staff call at people’s homes to provide personal care and support at set times agreed with them. At the time of our inspection there were around 25 people who received personal care through Facilitate Care Services.

During the inspection we met with the registered manager and provider. 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 they felt safe when supported by care staff. Staff understood how to protect people from abuse and knew about risks to people’s safety. They told us they reported any concerns they had to the staff based in the office so they could be acted upon. This ensured potential risks to people were managed appropriately. All care staff had been provided with a staff handbook containing information about the policies of the provider and what was expected of them when working for Facilitate Care Services. This helped to ensure they provided safe and effective care to people.

Care staff received training on how to manage medicines safely. People told us staff mostly prompted them to take their medicines to make sure they took them. Medication audit checks ensured medicines were managed appropriately.

Checks were carried out prior to care staff starting work to ensure their suitability to work with people who used the service, although these checks were not always clearly recorded. New care staff completed induction training and shadowed more experienced care staff to help develop their skills and knowledge. Staff completed training on an ongoing basis and were about to commence training to achieve the Care Certificate to help develop their skills.

People received a service based on their personal needs and staff usually arrived to carry out their care and support within the timeframes agreed. People were positive about the care they received from staff. People told us staff maintained their privacy and dignity and supported their independence. They commented that staff were respectful and caring in their approach.

People’s nutritional needs were met by the service where appropriate. People who were reliant on care staff to assist with meal preparation said the staff would prepare meals and drinks of their choice.

The registered manager understood the principles of the Mental Capacity Act (MCA) and how to put these into practice. Care staff told us they gained people’s consent before giving care.

The provider had some processes in place to monitor the quality of the service and to understand the experiences of people who used the service. This included regular communication with people and staff, and the use of ‘feedback’ forms to assess people’s views of the care and service they received. People knew how to raise concerns if needed and those people who had done so, felt they had been managed and resolved to their satisfaction.

We found overall that records were not always sufficiently detailed to demonstrate the processes and systems in place to ensure quality care and services were provided.