Focus Care Agency provides personal care to people in their own homes. They care for people with learning disabilities and provide tailored care packages which include 24 hour care. They provide care to people in Suffolk, Essex and East Sussex with a head office based in Peterborough in Cambridgeshire. On the day of our inspection there were 24 people receiving care from the service.

This inspection was carried out on 16, 17 and 18 May 2017. At our previous inspection on 16 March 2015 the service was rated good.

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 provided people with extremely well planned person-centred care. Comprehensive assessments of their needs were completed before they started their care package to ensure the service was able to meet their needs and wishes. The provider worked closely with the person to ensure they were living in the best environment for them and to create care plans with the person which helped them to develop towards their individual goals. Staff members worked very closely with people to ensure their person-centred needs and preferences were upheld which helped people to develop their independence and achieve new challenges and opportunities in their home and the community.

People and their family members were encouraged to provide the service with feedback, including making complaints if they were unhappy with the care they received. Complaints were handled sensitively and in full and used to help develop the service. Feedback was also sought in the form of regular surveys which were used to help further develop the service.

People were protected from abuse or improper treatment. They felt safe at the service and staff took action to ensure any incidents were recorded and reported. If necessary, further action was taken to ensure people's safety. There were also risk assessments in place to guide staff in ways to keep people safe whilst also maximising their independence. Staffing levels were sufficient to meet people's needs and staff had been robustly recruited to ensure they were of good character and were suitable for their roles. Where necessary, staff supported people to take their medicines and maintained accurate records to support this.

Staff members received regular training and refresher sessions to help equip them with the skills they needed to meet people's needs. Training was based on people's specific needs and staff also received induction training and supervisions to provide them with the support they required. The service sought people's consent to their care and had systems to ensure the principles of the Mental Capacity Act 2005 were followed if people lacked the mental capacity to consent to their care. People were supported with the dietary and nutritional needs where necessary and staff worked with them to ensure medical appointments were booked and attended as and when required.

There were positive relationships between people and members of staff. Staff members worked closely with people and spent time getting to know their individual needs and preferred communication to help ensure they received the care they needed and wanted. People and their family members were involved in planning their care to ensure it was person-centred and they were provided with the information they needed about the service. Staff also worked hard to ensure people were treated with privacy, respect and dignity.

The provider and registered manager had generated a positive ethos and culture which all staff members were committed to upholding. They worked hard to ensure people received person-centred care and helped people to meet their goals

Because not all of the people who used the service were able or available to tell us their views about the service, we spoke with some of their family members and gained their views.

People were treated with respect and had no concerns about how they were treated. Their decisions and choices about how they wanted to spend their time were respected.

All of the people that used the service were provided with opportunities to engage in a range of meaningful, social, recreational, educational and work-related activities. People said that they enjoyed what they did and looked forward to spending their leisure time in the local community.

People were supported to maintain and promote their level of independence and confidence and were satisfied with how this was managed. They were also supported to maintain their mental and physical wellbeing.

Staff were supported and trained to safely do their job, which they said they found rewarding. The quality and range of staff training had improved and was relevant to the work members of staff were employed to do.

Quality assurance systems were in place so that people were provided with safe and appropriate care and their views were listened to. The results of a 2013 survey demonstrated that people who used the service were satisfied with how they were being looked after. There were other systems in place that monitored and reviewed the standard and quality of support and care provided to people who used the service.

People were treated with respect and were supported in the decision-making process about their support and care. Information about people's individual support and care needs was presented in a way that the person could understand and agree to.

We found that people were supported to live a quality of life which promoted their sense of well-being and maintained and promoted their health. People who we spoke with said that they were satisfied with the standard and quality of the support and care provided by the service. A family member of a person who used the service said, “The care is good and my (relative) is well looked after.”

People were protected from the risk of abuse due to effective safeguarding systems in place. All of the people that we spoke with had no concerns about the safety of people who used the service.

Adequate staff recruitment and training systems were in place to ensure that people who used the service received safe and appropriate care from suitable staff. Relatives of people who used the service had confidence in the skills and knowledge of the staff to provide people who used the service with safe and appropriate support and care.

There was an effective system in place for people to make a complaint and to be listened to. Although all of the people that were spoken with knew how to make a complaint, they had no cause to do so. Any concerns that they had had, they were satisfied with the service’s response.

Focus Care Agency Limited is registered to provide personal care to people who live in their own homes. The agency offers 24-hour support and care to people who have a learning disability, acquired brain injury and mental health needs and covers a wide geographical area which includes Suffolk, Essex and East Sussex. There were 18 people using the service when we visited.

The inspection took place on 16 March and 18 March 2015 and we gave the provider 48-hours’ notice before we visited. The last inspection was carried out on 04 September 2013 when we found the provider was meeting the regulations we assessed against.

There was a registered manager in post. 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.

People were safe as staff were knowledgeable about reporting any abuse. There were a sufficient number of staff employed and recruitment procedures ensured that only suitable staff were employed. Risk assessments were in place and actions were taken to reduce these risks. Arrangements were in place to ensure that people were supported and protected with the safe management of medication.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS applications had been made to ensure that people’s rights were protected. Staff were supported and trained to do their job. People were supported to access a range of health care professionals and they were provided with opportunities to increase their levels of independence. Health risk assessments were in place to ensure that people were supported to maintain their health. People had adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

People’s privacy and dignity were respected and their care and support was provided in a caring and a patient way.

People’s hobbies and interests had been identified and they were supported to take part in a range of activities that were meaningful to them. A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People could raise concerns with the staff at any time.

The provider had quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. People and their relatives were able to make suggestions in relation to the support and care provided and staff acted on what they were told. There were strong links with the external community. A staff training and development programme was in place and procedures were in place to review the standard of staff members’ work performance.