This inspection took place on 13 November 2018 and was announced as Heather Day Care (known as Heather Care) is a small service and we wanted to ensure staff would be available to speak with us.

Heather Care is registered to provide personal care to people in their own homes. Not everyone using the service receives a regulated activity; The Care Quality Commission (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. At the time of the inspection the service was providing personal care support for two people.

Heather Care also provides a day care service for older people and an educational service for people with a learning disability. These parts of the service are not regulated by the CQC and were not part of this inspection. The care staff who supported people in the domiciliary care service also worked in the day care service.

Heather Care 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. We were told the office manager was due to apply to become the new registered manager for the service.

At our last inspection in October 2017 we found three breaches in Regulations because care staff had not received the relevant training for their role, medicines administration was not recorded and the governance of the service had not identified these shortfalls.

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 questions of safe, effective and well led to at least good.

At this inspection we found improvements had been made and all regulations were now being met.

Medicines were safely managed. Staff were aware of what constitutes prompting people with their medicines and administering them. All medicines that were administered were recorded.

Staff had completed training relevant to their role. They received support from the office and registered managers through supervision and staff meetings.

Due to the small nature of the service formal quality assurance systems were not currently in place. The office manager planned to introduce unannounced spot checks to check the care files in people’s houses and ask them about the support they receive.

We discussed how the quality assurance systems would be developed if the service expanded.

Person centred care plans and risk assessments were in place and regularly reviewed. People and their relatives or representatives were involved in agreeing their care plans.

Where assessed as part of the care plan, people were supported to maintain their health and nutritional intake.

Care staff knew people’s needs well, including the tasks people could do for themselves and how to maintain their privacy and dignity when providing personal care.

People, relatives and legal representative said the staff were kind and caring. They said the care staff would contact them if there were any changes in people’s needs or health.

Heather Care was meeting the principles of the Mental Capacity Act (2005).

There had not been any accidents or incidents in the domiciliary care service. A policy was in place to review these if any did occur. The office manager told us they reviewed any accidents or incidents that had occurred in the day centre service. We have made a recommendation for the service to follow best practice guidelines with regard to recording the outcome of any review of an accident or incident.

The service had not recruited any staff since our last inspection. A procedure was in place for the safe recruitment of new staff.

This was an announced inspection that took place on 4 October 2017. This was the first inspection after the service registered with the Care Quality Commission in September 2016.

The service had a registered manager in place, 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. The registered manager was supported by a domiciliary care manager and a recently appointed administration manager.

Heather Day Care is registered to provide personal care to people in their own homes. At the time of the inspection the service was providing personal care support for four people. Heather Day Care also provides a day care service for older people and an educational service for people with a learning disability. These parts of the service do not provide any regulated activity and were not part of this inspection. One staff member who supported people in the domiciliary care service also worked in the day care service.

The one person and relatives we spoke with were complimentary about the support provided by Heather Day Care. They said that they felt safe being supported and found the staff were always on time and did not miss any calls. They said the staff were kind and caring.

We found that staff had not received any formal training from the service. All staff had completed a recognised course in health and social care and had undertaken training with previous employers. However this had not been refreshed since joining Heather Day Care. The service had agreed a series of distance learning courses to be undertaken by staff; however these would take a long time for the staff to complete them.

We were told that the service did not support people who required staff to administer their medicines on their behalf. However staff described how they supported two people who had used the service the service to ‘pop’ out of the tablets from their blister packs and assisted them to do this. This meant staff were administering people’s medicines, but had not had the relevant training. Furthermore, we found safe documentation such as Medication Administration Records (MARs) had not been used to ensure medicines were accurately recorded.

Care plans were person centred and included details of the agreed support required at each visit. Risks had been identified and guidelines put in place in order to mitigate the risks. Care plans included information about people’s likes, dislikes and hobbies. Staff knew people and their needs well and were able to describe to us the support each person required.

Care plans and risk assessments were reviewed every six months or earlier if people’s needs changed.

Consent forms were used for people to agree to the care and support to be provided; however these had not always been signed. Where people had involvement from the local authority social services department they assessed the person’s capacity to agree to their care and support.

We saw people’s relatives were involved in developing and reviewing the care plans. Relatives are not able to sign consent on behalf of their loved one unless they have the legal authority to do so. We have made a recommendation to record the relevant people’s agreement to the care and support being provided in people’s best interests.

A system was in place to recruit suitable staff to be employed supporting vulnerable people.

Staff said they felt well supported by the domiciliary care manager and registered manager and they were approachable. Formal supervisions had been introduced in September 2017 and were due to be held every three months. The staff spoke with and met their mangers informally at the service’s office on a regular basis.

A system was in plac