First Care DCA is a domiciliary care agency. It provides personal care to people living in their own houses. It provides a service to older adults, younger disabled adults, and people living with dementia or a sensory impairment. At the time of our inspection, First Care DCA was providing personal care to 95 people. The organisation provides other support that is not regulated by us which includes personal shopping, domestic services and support in the community.

At the last inspection in January 2016 the service was rated Good overall, however it was rated Requires Improvement for the question, ‘Is the service Safe?’ After this inspection the service maintained its overall rating of Good and the rating for the question ‘Is the service Safe?’ improved to Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People received personal care that was safe, and risks associated with their health conditions were assessed and mitigated. There were enough staff to support people at the times they needed. People’s medicines were managed safely.

People were supported by staff who had the skills, knowledge and experience to meet their needs. 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. Staff worked well with community health and social care professionals to ensure people received effective personal care, and accessed medical service when needed.

People and their relatives were consistently positive about the staff supporting them with personal care. They felt staff were kind, considerate and caring, and treated them with dignity and respect. People were involved in making decisions about their care, and felt their views and preferences were respected.

People received individualised care that was responsive to their needs, and were involved in planning and reviewing their care. People and relatives felt they had opportunities to provide feedback about the service, and were confident complaints would be taken seriously and resolved.

People and relatives felt the service was managed well. There was an open and inclusive culture, and staff had clear guidance on the standards of care expected of them. The provider had systems to monitor and review all aspects of the service, and used this to maintain and improve the quality of care.

Further information is in the detailed findings below.

This announced inspection was carried out on 19 January 2016. First Care DCA - Suite 27, Enterprise House provides support and personal care to adults living in north Nottinghamshire. On the day of the inspection there were in the region of 90 people using the service who received personal care.

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 were supported by care workers who did not take every precaution to prevent someone from being injured when they provided them with their care and support. Care workers knew to report any concerns of abuse or harm they identified when they visited people.

People knew the care workers who supported them. People received a flexible service that suited their individual circumstances. However people’s medicines were not always managed according to best practice.

People were provided with the care and support they wanted by care workers who were trained and supported to do so. People’s human right to make decisions for themselves were respected and they provided consent to their care when needed.

People were supported by care workers who understood their health conditions and ensured they had sufficient to eat and drink to maintain their wellbeing.

People were treated with respect by care workers who demonstrated compassion and understanding. People were involved in determining their care and support and were treated in the way they wished to be.

People received their care and support in a way they had chosen. People were encouraged to express any issues of concerns they had so these could be acted upon.

People who used the service and care workers were able to express their views about the service which were acted upon. The management team provided leadership that gained the respect of care workers and motivated them as a team. There were systems in place to monitor the quality of the service and make improvements when needed.

We spoke with four people who used the service and one close relative. One person said, "My carers are all very good, very nice and they do what they're supposed to." Another person said, "I am very happy; I have no complaints." No one we spoke with raised any concerns about the care and support provided.

We observed that before people received any care or support they were asked for their consent and the provider acted in accordance with their wishes. We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents, which supported them to deliver appropriate and safe care. Staff recruitment systems were robust and staff were supported to do their jobs properly through appropriate training and monitoring.

The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff in line with individual care plans, and that people were satisfied with the service they were receiving.

Prior to our visit we reviewed all the information we had received from the provider. As part of the inspection we spoke with one person who used the service and two relatives. We also spoke with the registered manager and three members of staff. We looked at service information and support records and documentation for four people.

People we spoke with told us they felt the staff respected their opinions and decisions. Comments included, "I have used the service a long time. I’m enabled to remain at home, where I want to be.”

People told us their needs were assessed and they were involved in developing their care plans which were reviewed at least every six months. Comments included, "We have recently started to use the service. We had a visit from a member of staff from the office that assessed my relative’s needs. We feel fully involved; we are thrilled with the service."

The people we spoke with talked positively about the staff that supported them. They told us they felt confident the staff had the appropriate skills, experience and that they were suitable, honest and trustworthy. Comments included, "They (staff) do what I ask them to do, and you can see they have been trained. My wife’s spirits lift when she sees the girls (staff)."

We found the staff we spoke with appeared knowledgeable about the care needs of people they supported. Staff spoken with knew what their responsibility was towards protecting and safeguarding people.

A person told us that staff knocked on the door before entering their house. Another person told us that staff announced that they had arrived before entering the house.

A person told us they discussed their needs with staff and a written care plan was in their house. Another person told us a care plan was in their house and they knew how to request extra support if they needed to. They said, “The staff have all been very nice.”

A person told us that the staff hadn’t turned up for their appointment on the day of inspection. They said, “This is a one-off.” We informed the agency of this and a carer arrived at the person’s house shortly after. There had been an emergency at the carer’s previous appointment which had delayed them arriving at their next appointment.

A person said, “They look after me ever so well.” Another person told us they felt safe.

A person told us there were enough staff. Another person told us there were normally enough staff but said, “Yesterday a carer didn’t arrive.” They had called the office and a carer arrived shortly after. They told us they thought there had been an emergency with carers.

A person told us that staff were well trained and said, “They are ever so nice but there’s the odd one that’s a little bit different.” Another person told us that staff were well trained and understood their needs.

A person told us they had not received a survey or questionnaire but would contact the service if they needed to. They said, “I am satisfied with the service.” Another person also told us they had not received a survey or questionnaire but knew who to contact if they wanted to make a complaint. They said, “I have no complaints at all.” They also told us there were no ways in which the service could be improved and said, “I am quite satisfied with the service.”