About the service: Home Instead Senior Care Ltd- Crewe is a domiciliary care agency providing support to people in their own homes. At the time of the inspection they were supporting 64 people, however only 34 of those people were receiving a regulated activity. This inspection only looked at the support provided to the people who received a regulated activity of personal care.

People’s experience of using this service: People told us they felt safe when care staff were in their home and that the support they received was also safe. Risks to people had been assessed and measure put in place to reduce the risks. The registered manager reviewed all accidents to look for any trends and actions that could be taken to prevent recurrence.

There were sufficient numbers of safely recruited staff employed to ensure people’s needs could be met. Staff were knowledgeable about safeguarding procedures and how to raise any concerns they had.

People were supported with their medicines safely, by staff who had been trained. People told us the service was flexible. When required, people’s scheduled call times had been altered to enable them to attend appointments.

Consent to care was sought and recorded in line with the principles of the Mental Capacity Act 2005. When people were unable to consent, best interest decisions were recorded.

Staff felt well supported in their role and able to raise any issues with senior staff and the registered manager. Regular training had been completed by staff and they received supervisions and an annual appraisal to further support them in their posts.

The service worked with other professionals and agencies to help ensure people’s needs were met effectively. Advice provided was clearly recorded and followed by staff.

Systems were in place to gather feedback from people regarding the service and action was taken to improve the service, based on the feedback. An effective system was also in place to manage complaints.

Care plans were in place that were detailed and reflected people’s needs and preferences. People were involved in the creation and review of these plans, to ensure they remained accurate and effective in meeting their needs.

People and their relatives told us staff were caring and compassionate and spoke positively of the quality of care they received. People were supported to be as independent as they wanted to be and their privacy and dignity was maintained by staff.

The registered manager completed regular audits on the quality and safety of the service and took action to address any issues identified.

Rating at last inspection: Good (Published 27 September 2016)

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

The inspection visit at Redshank was undertaken on 03 August 2016 and was announced. 48 hours’ notice of the inspection was given to ensure people who accessed the service, staff and visitors were available to talk with us.

Redshank provides personal care assistance for people who live in their own homes. The service supports younger adults; older people; and people who live with physical disabilities, sensory impairment, dementia or a learning disability. At the time of our inspection, Redshank was supporting 85 people.

A registered manager was in place. 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 last inspection on 19 and 25 November 2013, we asked the provider to take action to make improvements to care planning and risk assessment processes. We requested they reviewed their recordkeeping to achieve consistent and up-to-date care plans and risk assessments.

During this inspection, we found improvements in care plans and risk assessment were completed. People who lived in their own homes said they felt safe and secure when staff assisted them. One person said, “Carers always identify themselves before they come in.” Staff demonstrated a good understanding of safeguarding principles and knew who they should report concerns to.

People and relatives told us there were sufficient staff numbers to undertake their agreed care packages. They said consistency of staff was maintained to build supportive relationships. Records we reviewed evidenced staff received supervision and training to underpin their roles. We found the registered manager followed safe procedures to ensure suitable staff were recruited. A relative we spoke with confirmed new staff were properly inducted and added, “Someone new always comes along with another carer who knows my [relative]. It helps them, but also reassures me.”

Staff were provided with medication training and we found they were knowledgeable about related procedures. Where support was agreed as part of people’s care packages, this was care planned and risk assessed to manage their medicines safely.

Staff had a good appreciation of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. Care records we reviewed contained evidence people had signed their agreement to care and support.

We found care planning was based around people’s preferences about their care packages. They told us staff were responsive and met their needs with a personalised approach. We noted complaints were managed within established timescales and the registered manager provided people with information about raising concerns.

People and their relatives said staff were caring and kind when they provided their care packages. A relative stated, “The staff are kind and pleasant.” Care planning was geared towards assisting people to maintain their independence and lead meaningful lives.

People who accessed Redshank told us they felt it was well managed and organised. The management team sought people’s views in order to assess quality assurance as a part of the ongoing development of the service. A relative told us, “[My family member] has done a survey, so I know she gives her feedback.” Staff added they enjoyed working for Redshank and had confidence in its management. One staff member stated, “I have no worries about working for Redshank. I really enjoy helping people and they’ve given me that opportunity.” The registered manager completed a range of audits to assess quality assurance, as well as people’s welfare.

When we carried out our unannounced visit on 28 December 2012 we spoke to three clients of the care agency. They were all complimentary about the services provided and no-one raised any concerns. When we observed interactions between staff and clients it was professional and caring.

One person said their care workers were "excellent" and "very caring", another said the staff were "very nice people" and they were "very satisfied" with the service. When we spoke to people and looked at care records it was clear that people were involved in the planning and review of the services provided to them.

We looked at a selection of care records and found that assessments were appropriately completed taking into account each person's differing needs and the resulting care plans enabled staff to effectively deliver care.

We found that the provider had effective systems in place to protect clients from the risk of abuse and that it operated recruitment procedures that ensured people working for the service were of good character and suitably qualified.

Records were readily available but were stored securely and were accurate and up to date.

We spoke to four people who used the service and two relatives. They said they were happy with the care provided, staff were caring and attentive and that they were listened to. They said that the same carers visited which provided continuity and that they were reliable. Some comments made were:-

"They are brilliant. I cannot praise the carers high enough."

"The staff are very nice. Very reliable."

"It's a good service. We are happy."

Records showed that people had been assessed before they began to use the service and they had a care plan in place detailing the support they needed.

Staff were aware of the action to be taken to safeguard vulnerable adults from abuse.

Staff were appropriately supported to enable them to carry out their roles and responsibilities.

There were systems in place to monitor the quality of the service and to obtain the views of the people who used the service and their relatives about how the service operated.

We found some improvements were needed to record keeping to ensure staff had that the information needed to appropriately support the people who used the service.