We undertook an announced focused inspection of Grace 24/7 on 30 and 31 October 2018. This inspection was carried out because we received information that care staff were undertaking a high number of calls whilst on their shifts. We inspected the service against two of the five questions we ask about services: is the service safe, and is the service well led.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection in January 2018 for these Key Questions were included in calculating the overall rating in this inspection.

Grace 24/7 is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults, and children across Manchester, and is managed from a base in Failsworth, Oldham. Not everyone using Grace 24/7 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.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that staff were allocated work schedules which meant that the times of visits overlapped and would be impossible to complete. The service management had no oversight of this, nor were they always aware of the times people were receiving their calls, or which staff were providing care. This was in breach of regulation 17 (good governance) of the above act. We also found a breach of regulation 12 (safe care and treatment) of the above act, as medicines were not always safely and properly managed. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we found that the service carried out appropriate recruitment checks to ensure staff were suited to work with vulnerable people and the staff employed by Grace 24/7 had a good understanding of how to protect people from harm. They also showed a good understanding of risk. We saw that where risks had been identified measures were in place to minimise harm.

People told us that the staff were personable and cheery. One person told us, “They are always pleasant, not grumpy at all.” People told us that they were consulted about their care and maintained contact with the managers and care coordinators and we saw that they were regularly involved in surveys and questionnaires aimed at improving the service.

There were some systems in place to monitor service delivery and work performance, including spot checks, staff supervision and appraisal.

The service had a range of policies which were up to date and in line with current legislation and guidance. They attended local authority forums, where they were kept up to date with any developments or changes in the care sector.

The service had sent us notifications telling us about any important events that had happened in the home and we saw that the last CQC rating was displayed in the main office as is required of all services registered with CQC.

Grace 24/7 is a domiciliary care agency which provides care and support to people living in their own houses and flats in the community. The care agency, which is run from an office in Failsworth, Oldham offers a variety of services, including assistance with personal care, meal preparation and domestic tasks. Not everyone using Grace 24/7 receives a 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.

We last inspected the service in September 2016. At that inspection we found breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines management and recruitment. At this inspection we found improvements had been made and the service was no longer in breach of any of the regulations.

We carried out this announced inspection on 17 January 2018. 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.

People we spoke with were complimentary about the care and support they received from Grace 24/7. They told us they felt safe, and that all the staff were caring and kind. Staff treated people who they were assisting with dignity and respect.

Recruitment checks had been carried out to ensure staff were suitable to work with vulnerable people. Two discrepancies we found were rectified during our inspection.

The service managed medicines safely. Staff had been trained in medicines administration and medicines records we checked had been completed correctly.

All new staff received an induction to the service and their role. Staff had undertaken a variety of training which enabled them to carry out their roles effectively. They received regular supervision which gave them with opportunity to voice any concerns and discuss any training needs.

Risk assessments, both environmental and personal had been completed and were reviewed regularly, to minimise risks to staff and people who used the service. Assessments of people’s needs were thorough and care plans were detailed. They provided staff with sufficient information to guide them on how to care for each person in a person-centred way. Work rotas were arranged so that people were generally supported by a regular team of carers who were familiar with their needs.

People and their relatives were involved in the assessment and care planning processes. The service was working within the principles of the Mental capacity Act 2005.

Accidents, incidents and complaints were recorded and dealt with appropriately. People knew how to contact the service and to make a complaint if they needed to.

The registered manager showed good leadership skills and staff told us they worked well together as a team. There were systems in place to monitor the quality of the service, such as audits and ‘spot check’s’.

This was an unannounced inspection which took place over three days on 19, 21 and 22 September 2016.

Grace 24/7 is registered to provide homecare services to people in their own homes in the community. There was a registered manager in post. 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.

Complaints were handled and investigated effectively. Complaints were responded to, and the investigation processes addressed matters effectively.

Governance systems were being developed that helped identify service risks to people's welfare and actions to address identified risks were taking place.

Care assessment and planning incorporated the views of people using the service and their representatives where appropriate. Care plans were good for guiding staff on addressing people's needs and preferences.

People were involved in care planning and reviews and were generally happy with the support they received.

The service responded appropriately to safeguarding concerns raised to help ensure people were protected against unsafe care and treatment. Investigations were carried out in a timely manner and safeguarding’s were raised by the service where they felt further protection was needed to keep people safe.

People who used the service said that they felt some staff needed more training around specific care needs they had. We found improvement was needed in relation to staff training and supervision and we will check progress of this at the next inspection.

We found improvement was needed to ensure proper records were kept in relation to medicine management. We found breaches in relation to this regulation.

People were not protected from the risk of unsafe care and treatment because proper checks were not done when new staff were recruited. We found breaches in relation to this regulation.

You can check to see the action we have asked the provider to make on the back page of this report.