This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older people and younger disabled adults. People living with mental health conditions; learning disabilities, sensory and or physical disabilities. At the time of the inspection there were 43 people using the service, 20 of those people received support with the regulated activity of ‘personal care.’

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.

The service had a registered manager in place. 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 service was last inspected in December 2016, the rating awarded was required improvement overall.

People and their relatives told us they felt they received a safe service. They said they were cared for by staff who were kind and caring and who were trained. The service they received was responsive and met their needs and there was continuity in the staff that supported them. People valued this as it enabled them to build relationships and develop trust. They told us they felt the service was well managed and they would recommend it to others.

The staff received induction, training, supervision and appraisals in order they could carry out the role to the expected standard. They received support from a team of three senior staff, who they reported were accessible, knowledgeable and effective.

People’s needs were assessed prior to receiving care, a care plan and risk assessments were documented to ensure that any risks were minimised and care was appropriate. The care was regularly reviewed and where required, changes were made.

Where people required assistance with medicines this was provided. However, we found the senior staff were not aware of some aspects of best practice. For example, the information from prescriptions was not always transcribed with sufficient detail onto the Medication Administration Record (MAR). Body maps were not always used to demonstrate where creams should be applied. We discussed this with the registered manager, they took immediate action to rectify the situation and were going to discuss with the franchisor how their training needed to be updated.

The service had safe recruitment systems in place to ensure as far as possible only suitable staff were employed to work with people.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People were assisted 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 supported this practice.

Training was provided on equality and diversity and the registered manager and senior staff told us they would be happy to provide care to anyone with protected characteristics. We found care to be person centre and people were treated equally by the provider. Where appropriate people’s interests and hobbies were supported. Community involvement played a large part of the service provided. The registered manager worked hard to encourage community involvement for the people they cared for.

A quality audit and feedback from people and staff highlighted areas the service could improve in. Where appropriate action was taken to address issues and adjust the service being provided.

This inspection took place on 22 and 30 December 2016. It was an announced visit to the service.

We previously inspected the service 6 and 7 May 2014. The service was meeting the requirements of the regulations at that time.

Home Instead Senior Care is registered to provide personal care. It supports people in their own homes in Aylesbury vale and north east Oxfordshire. The head office is in Long Crendon with another office in Aylesbury town centre. At the time of our inspection the service was supporting 14 people with personal care.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 time of our inspection the owner was awaiting a registered manager’s interview with CQC. We have taken this into consideration in our judgement.

People told us they felt the staff were trained to provide safe care. However, staff told us they felt the training could be improved. One staff member told us “Any practical training was non-existent.”

Staff did not always receive support in line with the provider’s policy. There had been a number of changes in management which staff told us had contributed to the lack of support they received. We have made a recommendation about support for staff in the report.

The service had access to a wide variety of policies and procedure to help manage the service; however senior staff did not always know the content of them. The service did not always follow its own procedure on monitoring the service, for instance, reviews of care were not always undertaken within the time scale stated. Care plans were either not always present in a person’s home or had not always been updated to reflect the needs of a person. Spot checks on staff were not always undertaken when required. We have made a recommendation about support for the management team in the report.

People were supported with medicines when needed. Staff had received training on how to administer medicine. We found gaps in the records relating to medicine. We have made a recommendation about improvements in record keeping around medicine administration.

People were protected from avoidable harm. Risks to people had been assessed and actions to reduce them were detailed.

People were protected from abuse as staff had a good understanding of how to recognise signs of abuse. Staff had confidence in management to respond appropriately to safeguarding concerns.

People were pleased with the professional relationship they had with their member of staff. The provider tried to match staff to people with similar interest. One person described the staff member who visited them as “Absolutely wonderful.” Another person told us “They (staff) are very very good, they (staff) are more like friends then carers.”

The service tried to promote independence in people. They had arranged an afternoon tea with entertainment for people they supported. This was an opportunity for people to get out of their home and met other people.

People were supported by staff who were passionate about their work. Staff told us they liked working for the organisation and welcomed the fact they were not rushed.

The inspection was carried out by an inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice is identified and people are protected.

People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The provider sought the opinions of staff and people who used the service to ensure people were protected from the risk of harm or injury.

Staff were not able to apply the information they had received in their induction training regarding the Mental Capacity Act 2005 to their role as care workers. The provider told us they had taken action to address this with future training. This ensured people would receive safe and appropriate support.

Is the service effective?

People told us the service was effective. The provider engaged with them and respected their wishes, acting promptly to change aspects of their care when appropriate.

Staff told us they felt the service was effective as the provider allowed time to meet people’s needs and offer the service people wanted.

Records showed staff recorded in detail the care provided which allowed for services to be monitored, changed and improved when necessary.

Is the service caring?

People told us the service was caring. One person told us ““We are lucky to have found them.” Another told us “There is nothing I can’t ask them to do.”

One staff member said of the provider “They are really nice to all of us, not only the clients; they are really nice; kind and honest.”

Another staff member told us the service was person centred in its approach, and they had time to carry out the care, which meant they were not rushing to complete tasks, but could concentrate on the person. This meant people were valued.

Is the service responsive?

People told us the service responded well when change was needed to their care.

We saw documentation which showed people’s wishes had been recorded and responsive and appropriate action had been taken.

People had been provided with information regarding complaints, but had not had to make any.

Is the service well-led?

The service had only been operational for six months at the time of our inspection. Some parts of the service were still under development such as training for senior staff and contingency plans for emergencies which may affect the delivery of the service.

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff and people who used the service told us they were impressed by the management of the service and believed it was well led.