This inspection took place between the 28 February 2017 and the 6 March 2017 and was announced. The inspection was carried out by one adult social care inspector.

Home Instead Senior Care is a service which provides personal care and support to adults in their own homes. In addition to providing personal care, Home Instead also provides a companionships service which supports people with activities and help with domestic duties. This element of the service, although provided by Home Instead Senior Care would not need to be registered with the Commission if this was their sole purpose. We focussed our inspection on the people in receipt of personal care only. On the day of our inspection there were people using the service, of which received personal care.

There is a Registered Manager at this location. 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 inspection in June 2016, we asked the registered provider to take action to make improvement. This included the safe management of medicines, acting in line with the Mental Capacity Act 2005, record keeping and ensuring good governance of the service. We found that these actions had been completed.

People were kept safe by staff. They had a good understanding of their safeguarding adult’s responsibilities to protect the people they were supporting from harm or abuse.

People’s needs were met effectively and they were supported by sufficient numbers of regular staff. The risks to people were identified and reviewed to ensure people remained safe. Records of support required were up to date and personalised which ensured people received their support in line with their preferences and wishes.

People had a positive relationship with the staff and were confident in the service. There was a strong value base instilled in the service which helped to ensure staff were caring and compassionate. People who used the service felt they were treated with kindness and said their privacy and dignity was respected.

Medicines were managed and administered safely by staff assessed as competent and confident in this role. Staff members understood their responsibilities in this area and policies supported this.

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.

The registered manager conducted regular audits and improvements were carried out when shortfalls had been identified. The quality of the service was monitored and assessed consistently. People who used the service, family members and staff were regularly consulted about the quality of the service they received.

People who used the service, family members and visitors were made aware of how to make a complaint and there was an effective complaints policy and procedure in place.

The announced inspection took place on 20 and 21 June 2016. We gave 48 hours' notice of our inspection to ensure that staff were available to provide the information we needed and to make arrangements to speak with people receiving a service. We last inspected this service on 12 February 2014 when the service was compliant with regulations.

Deva Senior Care Services Limited is part of the Home Instead Senior Care franchise which provides care and support to people in their own home. At the time of the inspection, the service provided support to around 140 people, of which 47 received personal care .This equated to approximately 950 hours per week. The service provided care and support for older people, people living with dementia, end of life care, long term conditions, respite care and night care.

There was a registered manager in place and she had held this position since the service started 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.

Whilst people were extremely happy and satisfied with the support they received, we found that the service was in breach of a number of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

We checked medicines management. We found that clear and accurate records were not being kept of medicines administered by care workers. Care plans and risk assessments did not support the safe handling of some people's medicines. This meant that there was a risk that people would not get their medicines as prescribed.

People told us that staff knew them well and met all of their needs. However, the care plans and risk assessment in place were not always accurate and up to date. Therefore, a staff member, less familiar with the person, may not know how best to meet someone’s needs and to support them safely.

People were asked for consent prior to care being undertaken. They were encouraged to make as many choices and decisions for themselves as they could. However, where a person potentially lacked in mental capacity to make certain decisions, the service had not followed the principles of the Mental Capacity Act 2005 (MCA) which meant that people's rights may not be protected. The MCA governs decision-making on behalf of adults who may not be able to make particular decisions for themselves.

The quality of direct care provided was continually reviewed by the service and people who used it. However, there were systems in place to monitor many aspects of the service that had not been fully implemented. There were a number of key aspects not monitored such as management of medicines, daily records and care plans. This meant that the concerns highlighted on this inspection had not been picked up and addressed directly by the service.

Each person had an environmental risk assessment. This enabled the staff to familiarise themselves with a person's home, and noted where important points were such as gas, water and electricity cut off points should they encounter any problems. The registered provider needed to ensure that the equipment staff used to assist a person with mobility was safe and serviced.

People were safe when using the service because staff had been trained and knew how to protect people in their care. Staff had access to safeguarding information, contact numbers and were confident that they would report concerns. There was a current safeguarding policy in place to guide staff but this needed to reflect the requirements of local policy to report specific concerns.

People were extremely satisfied with the level of support that they received. Relatives felt that the service was excellent and re

We spoke with 12 people who used the service. They told us they were happy with the service and had no concerns with the care provided. Comments included; "I can't speak highly enough of them. They do lots of little extra bits for me like making my meals" and "It is an impeccable service".

We spoke with five members of staff. They knew what action to take if they recognised signs of abuse and were aware of the whistle blowing process should they have any concerns. They also demonstrated they were knowledgeable about the different types of abuse that could occur and confirmed they had completed training in relation to safeguarding people from the risk of abuse.

People told us that give or take a couple of minutes, staff were always on time to provide the care and support in their homes. They also said that their needs were met in line with their individual plan of care.

We saw supervision sessions took place for all staff with the manager on a regular basis. Appraisals had also been completed annually. This meant that staff had the opportunity to review their roles and look at their personal development.

We found that people who used the service and their relatives were asked for their views about the care that was received. The people we spoke with told us they felt involved in assessing the service and helping them make improvements.

We found that people were able to express their views and were involved in making decisions about their care and treatment. We spoke with five people who used the service who confirmed they had been involved in the implementation of their support plans. We found that people were supported with their independence and community involvement. Comments from people who used the service included

"The girl's are excellent. I can't say anything bad about them"

"The carer's are like friend's to me but are very professional at the same time"

We looked at five care records and all had assessments of their health and social needs completed. There were individual support plans and risk assessments in place. There was evidence within them to show they were evaluated on a regular basis. This meant that the service could demonstrate they could meet people's needs and maintain their health and wellbeing.

We contacted Chester and Cheshire West Local Authority who confirmed there were no issues of concern with regards to the service.

We have received no concerns about the service.

We found that the provider has robust and effective systems in place in relation to the recruitment and training of its employees. We spoke to six members of staff. Comments from them included

"I love my job and making a difference to people's lives"

"I love meeting different people"

"I get on well with all my colleagues. We work well as a team"

People told us that the agency staff are able to deliver care and meet support needs effectively. They said staff are kind and considerate. One person said that staff are reliable and she is confident that they know what they are doing.

People told us that they are consulted about things that may affect them and they feel their wishes are listened to.

The people using the service were able to tell us that they were happy with the care and support they received.