This inspection visit took place on 18 December 2018 and was announced. The service started to provide care in February 2017 and this was the first time it had been inspected.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection 12 people were using the service.

Not everyone using Heart to Heart Care Agency 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. Ten people were receiving personal care.

There was a registered manager working at 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. The registered manager at this service was also the provider and will be referred to as such throughout this report.

Systems were in place to protect people from the risk of abuse. People were assessed to establish whether they were at any particular risk and staff provided care which mitigated any risks. More detailed documentation relating to risk management was needed in people’s files though to reduce the likelihood of harm occurring. The service demonstrated that it responded to, analysed and learnt from unexpected incidents.

Medicine administration and recording was not undertaken in a consistently safe manner. Staff were not competency assessed to manage people’s medicine and medicine management was not audited. The service committed to making the necessary improvements. Staff helped people to receive medical assistance from healthcare professionals.

Staff were recruited safely and provided with a robust induction. They had enough training and supervision to provide people with effective care. Staff worked flexibly to ensure continuous care provision and visits were consistently covered. The service had contingency plans to ensure continuity of care in the event of an adverse event, such as bad weather.

People were supported by people who were kind and caring. They treated people with dignity and respect. Staff ensured that people were given support to eat and drink in line with their health needs and their preferences. People were involved in their care planning and staff delivered care that responded to their needs and wishes. Staff routinely sought people’s consent before undertaking tasks and they offered people choice. Staff supported people to be independent where possible. Where people were unable to make their own decisions, staff provided the appropriate support. The files we reviewed lacked information concerning best interests’ decisions taken under the Mental Capacity Act 2005 (MCA).

Management strove to ensure the service was well led. They created an open and trusting culture. Staff and people felt they could raise concerns without fear. People knew how to complain if they wanted and felt confident that management would resolve any issues arising. Staff were happy working at the service and they felt supported.

The service’s governance systems required some improvement to ensure the quality of care delivery was routinely and formally monitored. The documentation in people’s care files required additional information to inform staff how to manage risks safely. Formal feedback systems were also required. The service advised they would implement these improvements as soon as possible.