This inspection was announced and took place on the 22 and 23 August 2018.

This service 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. At the time of the inspection there were 33 people being supported.

The registered manager of the service was also the registered provider. They had been registered with the CQC for a number of years. 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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question, well led to at least good. This was because we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to relevant information not being recorded in relation to the authentication of references, staff training and people’s care records. At this inspection we found that the necessary improvements had been made.

Audit systems were in place to monitor the quality of the service being provided. These consisted of spot checks, reviews of people’s care and surveys. Where improvements were required action had been taken to address these.

People informed us that they usually received care and support from the same staff and that they turned up on time. The registered provider had an electronic monitoring system that required staff to log in and out when they attended a call. Where staff did not attend on time or missed a call, office staff followed up on this to identify the reasons why.

People each had a personalised care record in place. These contained relevant information regarding people’s likes, dislikes, the level of support they required from staff and any important details relating their physical and mental health needs. These had been reviewed to ensure information stayed up-to-date. This ensured staff had access to relevant and up-to-date information.

Risk assessments were in place which assessed risk factors posed by people’s needs and any action that needed to be taken to mitigate these risks. This included risks relating to people’s skin integrity and their risk of falls. Where people had been deemed to be at risk, appropriate action had been taken to address this.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and they had a good knowledge of how to identify and report any concerns they may have.

Recruitment processes were safe and ensure people were supported by staff who were of suitable character. Staff had been required to provide two references, one of which was from their most recent employer. They had also been subject to a check by the Disclosure and Barring Service (DBS) to ensure they were not barred from working with vulnerable groups of people.

Positive relationships had been developed between people and staff who used the service. People spoke highly of staff telling us that they were kind, respectful and treated them with dignity.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

This was an announced inspection that took place on 2 and 5 June 2017.

Haydock Community Care is a small domiciliary care agency that provides care and support to people within their own homes and around the local community with the St Helens area. At the time of this inspection the service was supporting 37 people.

There was a registered manager in post who was also the registered provider. 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.

At the last comprehensive inspection in April 2016 we identified a number of breaches under the Health and Social Care Act 2008 (Regulated Activities) 2014 as a number of improvements were required. The registered provider was not ensuring that care was personalised specifically to the people being supported, the registered provider was not obtaining consent to care in relation to the Mental Capacity Act, there were no effective systems and processes in place to assess, monitor and improve the service provided and improvements were needed to the recruitment procedures.

During this inspection we found that a number of improvements had been made.

Improvements had been made as to how people’s medicines were recorded. The service had introduced records to people’s care plans that detailed the name of their medicines and when they were prescribed to be taken. In addition, a new formatted medication administration record had been devised to provide clearer recording of information.

A policy in relation to the Mental Capacity Act 2005 and what it meant for people had been introduced. In addition, a new form had been developed for people to sign giving their consent to the care they received.

Systems had been developed to monitor the quality of the service that people received. These systems included the monitoring and review of people’s care plans, medication records and the times that people received their care and support.

Two senior members of staff had received training to enable them to deliver training and support to the staff team. Records showed that staff had received training for their role and where training was needed, arrangements had been made to provide this. Having a staff team that receives regular up to date training helps provide safe care to people.

People’s care plans had been revised in order to demonstrate that person centred care was planned. People’s individual needs were recorded to help ensure that they received their service as they wanted it.

We found that improvements were needed as to how information is recorded within the service. This was due to a lack of recording in relation to recruitment references, a lack of names on people’s care records and no formal reporting system in relation to the events and happenings within the service. This was a breach of Regulation 17(2)(c)(d) of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because the provider did not have robust of effective recording system in place.

Safeguarding procedures were in place to support staff in identifying and protecting people from harm.

People were happy with the care and support they received from the staff team. Many compliments were received about the caring nature of the staff. People received their call when planned and staff stayed at the visit for the time they needed to.

A complaints procedure was available within the service. People told us that if they were unhappy they knew who to contact to raise a concern.

The policies and procedures within the service were under review and new procedures had been developed in relation to The Mental Capacity Act, the reporting of accidents and complaints.

This was an announced inspection, which took place on the 06 April, 09 April and 10 April 2016. Notice of the inspection was given to make sure that the relevant staff and people we needed to speak with were available. Contact was made with people, their relatives and staff on 09 April and 10 April 2016 for their opinions.

Haydock Community Care is a small domiciliary care agency that provides care and support to people in their own homes within the St. Helens area. On the date of the inspection the service supported 35 people and employed 38 staff including the registered manager.

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 and associated Regulations about how the service is run.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations 9, 11, 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We checked medicines management. We found that clear and accurate records were not being kept of medicines administered by care workers. It was not possible to determine what medicines were given, or if medicines had been given safely and at the correct time. Care plans and risk assessments did not support the safe handling of some people’s medicines.

We checked how the service followed the principles of the Mental Capacity Act 2005 (MCA). The MCA governs decision-making on behalf of adults who may not be able to make particular decisions for themselves. The requirements of the MCA were not being followed.

There were no systems in place to monitor the quality of the service. There were a number of areas not monitored such as management of medicines, daily records and care plans, risk assessments, staff training, staff recruitment and staff supervision.

Safe recruitment procedures were not followed. Staff did not have references in some instances, not all staff had a clear police record and where concerns were identified on the police check no action was taken to reduce the potential risks.

Training was not always in place, some staff reported that training for new staff was not sufficient. Supervision of staff was not planned or delivered in order to make sure that staff continued to develop in their job role.

Care and support was not planned and delivered in a person centred manner. We saw examples of task orientated care planning that did not assess people’s individual needs and preferences.

There were safeguarding policies and procedures in place. Staff were knowledgeable about what actions they would take if abuse was suspected. They were all able to state that they would appropriately report concerns for them to be dealt with.

The service is a small service with the majority of staff working there for several years. This means that staff develop caring and supportive relationships with people. As a result we received many complimentary comments from people and their relatives. We were told by everyone we spoke with that staff were kind, caring and had good relationships with the people they support.

People and their relatives told us that most of the time they received support from consistent members of staff. They also told us that staff arrived promptly, and that they stayed for the right amount of time. They told us that this gave them confidence in their staff and they felt safe with the care and support they received.

People and their relatives were extremely complimentary about the caring nature of staff. They told us that staff were knowledgeable about the people that they were supporting and that care was provided with patience and kindness. People also commented that their privacy and dignity was respected.

We visited the office of Haydock Community Care to review our findings of non-compliance in two outcomes at our inspection of June 2013.

At this unannounced inspection in October 2013 we found that the Registered Manager was on holiday. We carried our inspection with the assistance of the office manager, who was the person in charge in the absence of the Registered Manager.

We were informed that there were 25 people receiving a service from the agency and there were 24 members of staff employed, with another three waiting for their criminal record bureau (CRB) checks to come through, before commencing employment. These security checks are to identify if a person has a previous conviction and are suitable to work with vulnerable people.

We looked at the care files of three people receiving a service and at the files of three newly appointed members of staff.

We spoke with two people employed by the care agency. We found the staff to be cooperative and helpful.

We obtained prior information from the local authority contracts monitoring unit. The monitoring officer for Haydock Community Care provided us with their recent monitoring update and informed us that they had seen some improvements with the service delivery.

We also found that improvements had been made by the agency and they had taken on board the previous issues and had appropriately dealt with the non –compliance.

We visited the office of Haydock Community Care to look at records and talk to the Registered Manager. At the time of our inspection we were informed that there were 28 people receiving a service from the agency and there was a full staff compliment.

We looked at the care files of four service users and visited three people in their own homes.

We spoke with three of the care workers employed by the care agency. We found the staff to be cooperative and helpful. The staff demonstrated that people using the service were at the centre of the care being provided.

We visited people to gain their views and opinions about the quality of the service provided. We looked at care files in people's homes and found they contained relevant documents to support a person safely.

The people we spoke with said care workers treated them with dignity and respect. Some comments from people using the service were, "I get different girls during the day, but I always know who is coming”,” They (staff) always stay.”

We visited the office of Haydock Community Care to look at records and talk to the registered manager. The agency relocated premises in August 2012. The registered manager said, “It is much better being here and the office is more accessible for everyone."

At the time of our inspection we were informed that 24 carers were employed, providing care and support to 30 service users living in their own homes. We looked at the care files of four service users and visited three of the service users in their homes.

We spoke with three of the carers employed by the care agency. We found the staff to be cooperative and helpful. They answered the questions raised by us and demonstrated that the people using the service were at the centre of the of the care delivery.

We made home visits to three people who used the service to gain their views about the quality of the service provided. We looked at care files in people's homes.

The people we spoke with said support workers had always treated them with dignity and respect. Some comments from service users were, “My main carer is the best in England, she is a lovely girl,” “Everything is ‘honkey dory’. The same carers come most of the time, except for illness or holidays” and “I am very happy with the service I get.”