The inspection took place on 13 February 2018.

Hanover Care Limited 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 adults, but predominantly to older adults, including people who may have a physical disability, a learning disability, sensory loss, mental health problems or people living with dementia living in Brighton and Hove. At the time of our inspection around 45 people were receiving a service, not all of whom were receiving the regulated activity of personal care.

At the last inspection on 9 November 2015 the service was rated overall Good. At this inspection we found the service remained overall Good. At the last inspection we found robust systems were not in place for reviewing, monitoring and assessing the delivery of care and support. The provider was not undertaking their own internal audits, therefore they were unable to demonstrate how they monitored and identified where standards were falling. At this inspection we found significant improvements had been made, however there were still areas in relation to the quality assurance process in need of being addressed and embedded into the practice.

Systems had been maintained to keep people safe. People told us they felt safe with the care provided. One person told us, “The carers have a friendly but professional manner and that gives me confidence and makes me feel safe.” Another person told us, “Having a regular carer makes me feel safe.” A third person said,” The carers have a friendly but professional manner and that gives me confidence and makes me feel safe. I know they are there in the background.” They felt they could raise concerns and they would be listened to. People remained protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had been developed. Staff told us they had continued to receive supervision, and be supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People told us care staff had the knowledge and skills to provide their care and support. One member of staff told us, “Training is kept up to date. We are told in advance we have to do it and have to submit answers to show we have understood. They tell us of additional training that can be available and they invite us to apply if we want. I see someone with Parkinson’s and was able to have some training about it.”

People's individual care and support needs continued to be identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. People told us they felt listened to, supported to be independent and they were involved in decisions about their care. Staff had an understanding of consent. A relative told us, “I have been delighted that the carers are able to manage my relative’s condition. They know how to manage her moods and keep her happy. They always take care to tell (Person’s name) what they are doing. They never take her by surprise.”

People were happy with the care provided. Comments from people included, “This agency is better than any I’ve seen and between my wife and I we’ve seen a lot,” “They come out trumps,” “I am perfectly happy with the care that I get,” and “I would whole heartedly recommend them, no hesitation.”

People continued to be supported by kind and caring staff who treated them with respect and dignity. A relative told us, “My wife had different carers and if they crossed over, the carers were very respectful and they always included my wife in our conversations which I thought was good as we were all in it together.” They were spoken with and supported in a sensitive, respectful and professional manner. One person told us, “I was recently bereaved and my carer came to the funeral and it has helped to be able to talk to her about my loss.

We inspected Hanover Care on the 9 November 2015 and it was an announced inspection. Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available. Hanover Care is a domiciliary care agency providing personal care to a range of people living in their own homes. These included people living with dementia, older people, people with a physical disability and people with a learning disability. At the time of our inspection, the service was supporting up to 47 people and employed 22 members of staff.

A registered manager was 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.

People, relatives and care workers spoke highly of the service. One care worker told us, “I feel part of the team. It’s a friendly atmosphere and if you have a problem they are always on the end of the phone or will come and find you.” One person told us, “One of the best carers that I’ve had, a very nice carer, very jolly, keeps me on my toes.” Relatives and people told us they would recommend Hanover Care to a friend.

Systems were in place to review, monitor and assess the delivery of care and support. These included spot checks, satisfaction surveys and reviews. However these were not consistently robust or consistently recorded. For example, the provider was not recording their own internal audits, therefore they were unable to demonstrate how they monitored and identified where standards were falling. In the absence of a formal quality assurance framework, the provider was unable to demonstrate how improvements to MAR (Medicine Administration Records) charts were made when they were completed incorrectly and when care workers were arriving to care calls without wearing appropriate uniform. We have made a recommendation for improvement in this area.

Systems were in place to protect people from abuse and harm and staff knew how to use them. Care workers understood the needs of the people they were supporting and had received training on safeguarding adults.

People were assured that care workers had been appropriately recruited as their employment procedures protected people by employing care workers that were suited to the job. There were sufficient numbers of care workers that had the skills they needed to provide people with safe care and support.

There was an open culture and the management team demonstrated good leadership skills. Care workers spoke highly of the registered manager. One care worker told us, “The manager is lovely, really nice and laid back and he’d let you know if anything was wrong.”

Care workers received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. The management team undertook unannounced spot checks to ensure training was embedded into practice.

People confirmed staff respected their privacy and dignity. Care workers had a firm understanding of respecting people within their own home and providing them with choice and control. One person told us, “They always cover me up when giving me a wash.” With compassion, care workers spoke about the people they supported. One care worker told us, “This is a wonderful job. I am on the go all the time visiting some fabulous characters.”

People said the service met their needs and encouraged them to be as independent as possible. People were asked for their views of the service and said they knew how to make a complaint about the service if they needed to.

Care workers recognised the importance of leaving people’s properties secure at the end of a care call. People confirmed they felt safe with the care workers entering their home. One person told us, “They always lock the door after themselves, I feel very safe when they leave.”

At the last inspection in April 2013 we found Hanover Care non-compliant with Regulation 13 of the Health and Social Care Act (HSCA) 2008. This was because shortfalls were identified in the recording of medication administration. At this inspection we found that the provider had taken the steps they needed to achieve compliance with Regulation 13 of the Health and Social Care Act (HSCA) 2008.

During our inspection we spoke with five members of staff, these included the registered manager, two members of care staff and two care co-ordinators. We spoke with three people who used the service and one relative.

People we spoke with confirmed they were happy with the support they received with medication. One person told us, “The carers are very helpful, they always put my cream on my legs for me.”

Appropriate arrangements were in place in relation to the recording of medicines, and the provider had taken clear actions to improve the recordings of Medication Administration Charts (MAR).

We found that people had been involved in making decisions about their care and treatment.Records showed that people’s care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. Staff understood the importance of gaining consent and people’s right to make choices. People who used the service told us they were listened to and their consent had been gained before they had been provided with care. “They tell me what they are doing or plan to do and we discuss it”. People told us that they were happy with the level of support that they received with medication. We found that although staff were trained to administer medicines their recording needed to be better to ensure people’s safety. There were effective recruitment and selection processes in place and this protected people who used the service. People who used the service told us they were satisfied with all aspects of the service and they knew who they could speak to if they wanted to make a complaint.

Positive comments that we received from people who use the service and their relatives indicated a high level of satisfaction with the agency and the care and support provided:

‘They are just wonderful. My husband and I are very happy with the care that he receives. Nothing seems to be too much trouble’.

‘I have been receiving a service from Hanover Care for more than 5 years. And in all that time they have provided competent, enthusiastic and reliable staff who have been able to meet all my needs’.