We inspected this service on 31 January and 1 February 2017. This was an announced inspection and we telephoned the week prior to our inspection in order to arrange home visits and telephone interviews with people. The service provides care in people’s homes to older people and people with debilitating illness and long term conditions such as dementia. The service is available in the Long Eaton and surrounding Derby area. At the time of the inspection 163 people were being supported by the service.

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.

Our last inspection took place in March 2016 and at that time we asked the provider to make improvements in communication, effective systems to monitor the service and develop improvements. At this inspection we saw the appropriate improvements had been made.

The provider had a range of audits to monitor the service provided and make improvements where needed. For example, new methods were in place to communicate information to staff and maintain their safety.

Staff felt supported and received training for their role. Care plans were completed with the person so their preferences and choices could be included. People received a review of their care and they had the opportunity to comments on the service they received. There was a complaints policy and any complaints were investigated and addressed.

People felt safe and received care that had been risk assessed to ensure measures were taken to reduce any risks. When people received support with their meals they were given choices. When they required assistance with medicines this was risk assessed and the administration was completed safety.

There was sufficient staff and people were informed who would be attending weekly. People made decisions about their care and when they lacked capacity an assessment was completed to support decision in their best interest.

People received care from staff who respected them. When they contacted the office with any changes or additional support this was supported. The manager understood their responsibilities and notified us of any concerns or incidents. The home had displayed their rating conspicuously in the office and on the website.

We looked at the comments included within reviews, daily logs, surveys sent in to the agency and spoke with two people. We found the overall view of the agency was mixed. Comments were good about care when it was delivered. Comments were less favourable when the care workers were either late or missed a call and failed to let people know about the changes. In general people felt their care needs were met by respectful and helpful staff.

One person said “I have had no bother with my needs being met. Care workers always come in and say hello first they are respectful and friendly”.

Another comment included “the care workers will follow the duties on the care plan”.

“I think the team of care workers that I see are wonderful. They really care about my parent and meeting their needs”.

New staff did not always receive the information they needed from the agency and this could leave people receiving care vulnerable. Such staff may not be fully equipped to meet people’s needs as their levels of competency had not been checked.

People using the service were aware of how to make a complaint. We saw people were free to make comments about the agency and they did so as required.

We contacted people by telephone following the site visit to ask them about the service being delivered to them and we spoke with people’s family members. We spoke with three people who told us they found some of staff to be young and inexperienced in care and this could spoil the overall impression of the care provided.

One person told us, “when staff are good they are very good and have my relative’s best interest at heart. I have always found staff to be respectful at all times towards me and my relative”.

Another person told us, “I have not known the care workers to miss a call and will work as expected”.

During our visit we saw staff wearing their uniform with their name badge. This would be helpful to people as this would identify staff and would add protection to people receiving a service. We looked at the staff records. In some cases appropriate checks were not completed before starting work for the agency.

We asked two relatives about staff training. One person explained they found it difficult to comment on this as they found the young staff to lack experience in care. When we looked at the staff training records we saw that care workers had been provided with training to help them in their roles.

We looked at the surveys sent to people and spoke with people using the service. The comments were mainly favourable. One person told us the office management could be better, new staff needed time for them to learn their roles.

We visited the organisations main office and looked at documentation and spoke with the provider and the manager. As we were unable to visit people in their own homes we contacted two people using the service and two relatives [representatives] by telephone and held discussions with them. We also consulted four members of staff in respect of their job roles and the support they offered to people using the service.

Both people using the service and representatives said someone from the agency had visited them prior to arranging the care package so their needs could be assessed and it would be assured that these could be met. All but one representative said they had received all the necessary information about the service before they made a decision to use the agency.

Both people using the service and all representatives said they could express their views and they were involved in making decisions about the care package.

Both people using the service said there was enough information available within plans of care for staff to support them in a way they preferred. One representative said there was sufficient information within the plan of care to ensure their relative’s needs were met. Whereas the other representative said a plan of care had not been supplied by the agency. They also said it took a while for staff to meet their relative’s diverse needs however they did feel these were now met, “It took a while but my [relatives] diverse needs are now met.”

Both people using the service said they felt safe with the staff and they would be able to contact the office if they had any concerns. Both representatives also said their relatives were kept safe.

One of two people using the service said they had not experienced any problems with their calls. The other person using the service said they had only had one missed call but it was because of the circumstances at the time. They said, “Calls are often late at teatime but I expect this due to busy traffic at that time.” Both representatives said they did not have any concerns in respect of their relative’s calls.

One of two people using the service said, “I have felt once or twice that one or two carers that have been here have not had enough experience to support me and they could do with more shadowing to develop this.” One of two representatives said although it did not happen very often, when staff who had less experience attended this was reflective in their practice as they tended to be less proactive. Whereas when more experienced staff attended they had more involvement and dialogue with their relative and knew instinctively what to do to support them.

One of two people using the service said, “The staff are very polite and I am pleased they are trained to meet my needs.” One of two representatives said, “The staff are definitely well equipped to do what they are supposed to do.” The other said although infrequent, there were times when there was a variant in respect of staff’s knowledge and understanding and therefore they were not sure if they had received all the necessary training.

Both people using the service said they could offer feedback to the agency via the telephone if they wanted. Neither had any concerns about the service at that time. One representative said they had not yet had the opportunity to give feedback about the service but if they had concerns they felt these would be listened to.

We inspected this service on 13, 14 and 18 January 2016. This was an announced inspection and we telephoned the week prior to our inspection in order to arrange home visits and telephone interviews with people. The service provides care in people’s homes to older people and people with debilitating illness and long term conditions such as dementia. The service is available in the Long Eaton, Ilkeston, Castle Donnington and the surrounding areas. At the time of the inspection 145 people were being supported by the service.

Our last inspection took place in 10 and 11 December 2014 and at that time the provider was rated as requires improvement to the service. At our last inspection we asked the provider to make improvements in the safe section, which required ensuring people were safe from identified risk, medication administration and sufficient regular staff. In the responsive section we required improvements in relation to the care plans reflecting the care needs and complaints being investigated and acted upon. We found the improvement in these areas had been made.

Within the well led section we had required the provider to complete auditing processes to improve quality and identify any shortfalls. At this inspection we found the required improvements had not been made. The provider and manager did not have a comprehensive approach to auditing the quality of the care being provided. Where auditing was in place it had not been followed through to ensure actions had been completed. Communication was not always clear from the office which had an impact on messages being relayed which had affected the care provided. This meant the provider had breached the legal requirements.

There was a registered manager in the service. 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.

All the people we spoke with said they received a safe service. Staff providing the support were able to identify any concerns to ensure that people received a service that was safe and protected them from harm. Risk assessments had been completed to minimise any risks to the person receiving a service. The provider had procedures in place to ensure that there were sufficient numbers of staff recruited to meet the needs of people and keep them safe. There was an established team which supported the manager and staff told us they felt supported by them.

People told us they always received someone to support them and where possible it was by a small team of staff. Everyone that used the service felt the staff that supported them were trained and competent. People told us that where required staff supported them with their nutrition and health care needs. All the people we spoke with told us they had a good relationship with the staff that supported them. People said they were able to make decisions about their care and were actively involved in how their care was planned and delivered.

People were able to raise their concerns or complaints and these were investigated and responded to, so people were confident they were listened to and their concerns taken seriously. The manager understood their registration requirements and had reported notifications and areas of concerns to us in a timely and appropriate way.

You can see what action we asked them to take at the back of the full version of the report.