This inspection visit took place on 30 November 2018 and was announced.

Heron Care Limited also is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using Heron Care Limited receives a regulated activity. 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.

Majority of the people supported by this service live in their own homes. However, the service also supported people who lived in a supported living set up. There were 85 people using the service at the time of our inspection.

At our last inspection in April 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Any concerns that had been raised had been adequately responded to ensure people’s safety. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. They had responded adequately to safeguarding concerns raised by people and professionals. Recruitment checks were carried out to ensure suitable people were employed to work at the service.

Staff skills, knowledge, training and support demonstrated a commitment to providing good standards of care that were embedded into the practices of the staff and the management team. Improvements were required to ensure staff received supervision in line with the organisation’s policy. The registered manager took consideration of people’s views.

Risk assessments had been developed to minimise the potential risk of harm to people who used the service. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care. However, improvements were required to the process for assessing mental capacity. We found mental capacity assessments had not been completed to demonstrate how decisions had been reached about people’s ability to make decisions about receiving care. We asked the registered manager to address this and made a recommendation about the assessment of people’s mental capacity. People’s independence and choice was promoted.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us their medicines were safely managed.

We found people had been assisted to have access to healthcare professionals and their healthcare needs were met and reviewed regularly. People’s independence was promoted, and staff ensured people remained active members of their local community.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available, and people said they were encouraged to raise concerns and complaints had been addressed. Staff had received compliments from people's relatives.

The majority of the feedback we received from staff and people who used the service was positive. However, we also received mixed feedback from two staff members and two people about the way care visits were arranged, management and staff competences. We shared the views with the registered manager.

The registered manager used a variety of methods to assess and monitor the quality of service provided to people. These included regular internal audits of the service, surveys and staff meetings to seek the

This was an announced inspection, carried out on 15 and 22 April 2016. We gave 48 hours’ notice of the inspection because we needed to be sure that the registered manager or someone who could act on their behalf would be available to support our inspection.

Heron Care is a domiciliary care agency, providing personal care and support to people living in their own homes. The service operates from an office based in the Prescot area of Knowsley, close to the town centre.

The service has a manager who was registered with CQC in October 2010. 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 last inspection of Heron Care was carried out in January 2014 and we found that the service was meeting all the regulations that were assessed.

People felt safe using the service and had no concerns about how staff treated them. There were systems in place to protect people from abuse and to keep people safe. This included training for staff and policies and procedures for them to follow. Staff were confident about reporting any concerns they had about people’s safety and they said they wouldn’t hesitate to do so. People, family members and staff were provided with the details of services they could contact if they had any concerns about people’s safety, including an out of hour’s service operated by the registered provider. Risks people faced were identified and managed. Care plans included information about how to minimise the likelihood of harm occurring.

Staff were safely recruited and received the training and support they needed. Checks were carried out on all applicants before they started work to make sure they were suitable for the job. New staff were inducted into their role and they received on going training in key topics and topics specific to people’s needs. Staff understood their roles and responsibilities and spoke positively about their work and the people they provided a service to.

People received their medication on time by staff that had completed the relevant training. Staff had their competency checked regularly to make sure they had the right knowledge and skills to manage people’s medication.

People received support by the right amount of suitably, skilled and experienced staff. Staff arrived at people’s homes on time and stayed for the full duration of the contracted call and there was a system in place to monitor this.

Staff took time to get to know people, knew the people they were supporting well and provided a personalised service. Individual care plans, based on relevant assessments were in place and they detailed how people wished to be supported. People’s wishes and preferences were accurately reflected in the care plans. Contact records were maintained detailing the support people received and they were an effective way for staff to communicate onto relevant others important information about people’s needs.

People who used the service and family members described staff as caring, kind, patient and respectful. Family members gave examples of how staff used their knowledge to help people overcome difficult situations. People’s independence was promoted and encouraged and staff were careful not to take over and restrict people’s lifestyles.

There was a clear management structure at the service which included clear lines of accountability and responsibilities. People and family members understood the management arrangements and they had confidence in the way the service was managed. Systems were in place to monitor the safety and quality of the service and to gather the views and experiences of people and their family members.

During our inspection we spoke with five people that used the service and we spoke with four of their relatives. We also looked at the care files belonging to 10 people that used the service. People told us that staff were caring and respectful and that staff supported them to be as independent as possible. One person said, “The staff are really kind.” A person's relative commented, “They pamper her and she looks forward to seeing them (staff).”

We spoke with five members of staff who held various roles within the service. They had a good understanding of the needs of the people that used the service and were person centred in their approach. People who used the service and their relatives described staff as treating them like ‘individuals’ and having a good understanding of their needs. We found evidence which demonstrated there were sufficient numbers of staff to meet the needs of the people that used the service. People told us they were supported by the same regular staff and the provider could usually accommodate any requests they had made to change their support hours.

People were protected from inappropriate or unsafe care and support because Heron Care had systems in place to assess and monitor the quality of the service they provided.

People that used the service were not safeguarded from the risk of abuse because the provider had not appropriately responded to allegations of abuse. Some support staff had not received up to date training in safeguarding adults from abuse.