This announced inspection took place on 30 April 2018. This service is a domiciliary care agency and provides care and support to adults living in their own houses and flats. Not everyone using Forever Independent receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, 95 people were provided with ‘personal care’ by Forever Independent.

The service had a registered manager who had been in post since September 2015. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks to people safety were not always appropriately assessed or kept under review. People were supported to take their medicines by staff if needed but further information was required by staff to ensure medicines were managed safely.

People were supported by a sufficient amount of staff and told us they felt safe. Staff were aware of how to respond if they suspected abuse. People were supported by staff who understood their responsibilities for maintaining cleanliness and hygiene and to report accidents and incidents.

An assessment of people’s needs was carried out when they first started using the service but care plans did not always contain sufficient information about people’s health conditions. People were supported by staff who received an induction and relevant training but who did not always receive regular supervision.

People were supported to eat and drink and staff sought medical attention if people needed it. However, further information was needed for staff about how they should provide support to ensure that risks were reduced.

People told us they were able to make their own decisions about their care. However, some people were not able to consent to aspects of care and mental capacity assessments and best interest decisions had not always been completed in these instances.

Staff were caring and respected people’s privacy and dignity. Staff were provided with a sufficient amount of time on care calls to be able to provide compassionate care. People were supported by staff who knew their likes and dislikes and were involved in planning their care.

People’s care plans lacked detail about the support they required. Care plans had not always been regularly reviewed or updated when aspects of care provision had changed. There was limited information about any needs people had in relation to protected characteristics under the Equality Act and about their preferences about how they wished to be cared for at the end of their life.

Complaints about the service were responded to and people told us they had little cause to complain. They told us that their needs were met in a way and at a time that suited them.

Quality monitoring audits were not fully effective in identifying areas of improvement and sufficient action was not always taken in response to external audits and inspections. Staff felt supported by the management team but spot checks of their performance were not comprehensive. Feedback was sought from people regarding the service they received and people told us they were happy with the service they received.

This is the second time the service has been rated Requires Improvement. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

This inspection was announced and took place on 29 March 2017. Forever Independent is a domiciliary care service which provides personal care and support to adults, in their own homes, in Nottinghamshire. On the day of our inspection 74 people were using the service.

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 staff who understood some of the risks they faced, however the measures in place to keep people safe were not always clearly identified.

People could not be assured that systems in place to check they received their medicines when required were robust and understood by all staff.

People were kept safe by staff who understood their responsibilities with regard to protecting people they were caring for from harm or abuse.

People were being cared for by sufficient numbers of staff.

People were cared for by staff who received training relevant to their role and further improvements to the support and training staff received were being made.

People were encouraged to make independent decisions. However, improvements were required to ensure that people who were not able to make their own decisions had their rights protected.

People received the support they required to meet their nutritional and healthcare needs.

People had positive relationships with their care workers. People and their relatives felt that their relation was treated with kindness and people’s privacy and dignity were respected.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care and to give their views on the running of the service.

People described a service which was generally responsive to their needs and told us they were supported in line with their preferences and in a way which maintained their independence.

People told us they felt confident that any concerns or complaints raised would be responded to and records showed this to be the case.

The quality monitoring systems in place were not always effective in identifying and addressing issues.

People’s care plans did not always provide sufficient guidance for staff and had not always been regularly reviewed. We had not always been notified of events which had occurred at the service.

People and staff were complimentary of the management of the service and described an open culture which encouraged feedback.