This inspection took place on 10 and 11 January 2019 and was announced. The service was last inspected on 31 August and 1 and 5 September 2017. At that time, we found three breaches of regulations and the service was rated as requires improvement.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions safe, responsive and well-led to at least good. At this inspection we found that improvements had been made and the provider was no longer in breach of the regulations. We have rated this service as good.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults, children. There were 68 people using the service at the time of the inspection.

Not everyone using Homecare 4U Cheshire 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.

There was 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.

People were positive about the support they received because they knew the carers well and told us they benefitted from consistent and familiar staff. There were sufficient staff and care calls were usually on time and rarely missed. The provider had implemented a new app which enabled staff to easily access the rotas and other important information.

Relevant checks continued to be completed before staff worked unsupervised at the service.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to if required. Improvements had been made to risk assessments, which were undertaken and further action taken to mitigate risks where necessary.

Medicines were managed safely. Staff were trained and were supplied with personal protective equipment (PPE) such as gloves and aprons. We noted some minor recording issues relating to medicines, which the registered manager addressed straight away.

People's needs continued to be assessed before they started using the service and were reviewed to develop their care plans. People received appropriate support to meet their nutritional needs.

Staff had the appropriate skills and knowledge necessary to deliver effective care and support. Staff undertook an induction when they started with the service. They had ongoing supervision and appraisals to support their development.

Carers asked for people’s consent before providing any care. We found the service was working within the principles of The Mental Capacity Act 2005 (MCA).

People were supported to maintain their health and wellbeing through access to a range of community healthcare services and specialists. Where necessary staff contacted health care professionals to provide support.

People were positive about the approach and attitude of staff. They told us that overall, they received support from caring staff who knew them and their needs well. Staff respected people’s dignity and privacy.

People continued to be involved in decisions about their care and were involved in the development of their care plans. They were supported to make choices and staff respected their routines and preference.

The provider had taken action to improve care plans and had included further information which was person centred and contained details about people’s preferences, likes, interests and personal histories.

People received care and support

This inspection took place on 31 August, 1 and 5 September 2017. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we wanted to ensure that staff were available in the office to support the inspection, as well as giving notice to people who received a service that we would like to speak with them.

The previous inspection was carried out in February 2016. The overall rating was “requires improvement” and we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection, we found that whist some improvements had been made the provider remained in breach of two of the regulations and we found a further breach. You can see what actions we have told the provider to take at the back of this report.

Homecare 4U is a domiciliary care service, providing personal care and support to people living in their own homes, in the Crewe area of Cheshire. The service provides general care and supports people with health and social care needs and end of life care. At the time of our inspection there were 61 people using the service, in receipt of personal care.

There was a registered manager in post. 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.

Overall people and their relatives were complimentary about the service and told us that they were satisfied with their care.

We saw that risk assessments had been implemented since the last inspection around specific issues such as falls, diabetes or smoking. Each person had a care and risk assessment plan, which included risks to the individual, including environmental risks in people's homes. However, we found that certain risk assessments did not provide sufficient detail or robust information about all actions taken to mitigate the risk. The information would be insufficient for staff who may not know the person well.

We found that improvements had been made to the management of medicines and medication risk assessments were now in place for each person who used the service.

The service employed sufficient numbers of suitable staff to meet people’s needs. People told us that staff usually arrived to support them as expected. There was an on–call service for emergencies outside of normal working office hours. Staff told us that they felt well supported and could contact senior staff at any time for support and guidance. The service had undertaken appropriate checks to ensure staff were suitable to work with vulnerable adults.

Since the last inspection, the service had taken action to ensure that where possible, people always signed to consent to their care plan. We saw that within each care and risk assessment, information had been recorded about the person’s capacity to make decisions.

Staff received an induction and regular training to enable them to carry out their roles effectively. Staff also received regular one to one supervision sessions and annual appraisals with their line manager to support their learning and development.

We found that staff had developed positive and caring relationships with the people they supported. Staff spoken with were able to tell us about the people who used the service. People told us that staff were kind in their approach and that they were treated with dignity and respect.

People’s care plans contained sufficient information and enabled care staff to the support the people who they cared for. However, we also found the plans did not always contain individualised information and would benefit from further detail about the way the person liked care tasks to be undertaken, including their background and preferences.

We found that the service aimed to respect people’s wishes

Homecare 4U is a domiciliary care service, providing personal care and support to people living in their own homes, in the Crewe area of Cheshire.

The service provides general care and supports people with health and social care needs and end of life care. At the time of our inspection there were 48 people using the service.

This inspection took place on the 3, 4 and 5 February 2016 and was announced.

There was a registered manager in post. 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 found that most people were positive about the service that they received and people told us they felt safe.

CQC monitors the application of the Mental Capacity Act (2005). There was evidence to show that staff understood their responsibilities under this act and training related to this had been provided to care staff. However, the service had not considered people's capacity during assessments of their needs and had not consistently sought information from the local authority when they received initial referrals. There was insufficient evidence to demonstrate that where necessary decisions had been made in people's best interest's.

Staff supported people at home with their care needs and the service had assessed some risks. However, not all risks had been identified and had not always been assessed. There was evidence that reviews of people's care needs had taken place.

We found that medicines were not always administered safely. Where errors had occurred the provider had not always ensured that such errors had been investigated and lessons learned so that this did not happen again in the future. We also found that where medication risk assessments were in place, these were not detailed enough to address the areas of risk.

The provider had not consistently notified CQC of certain events, which they are legally required to do so.

The provider had taken steps to address staffing difficulties and had recruited new staff. They had introduced a call monitoring system to support improvements in the timeliness of care calls. People told us that calls were occasionally not at the planned time but overall had seen improvements in the time that care staff arrived

The provider had a robust recruitment process in place, which helped to reduce the risk of unsuitable people being employed by the service.

Staff received suitable induction and training to meet the needs of the people who used the service. Regular supervision and spot checks were carried out to support and monitor practice.

People told us that care staff were caring, compassionate and treated them with dignity and respect. We observed care staff respecting people's privacy and treating people in a caring manner when we visited them in their homes.

We saw that assessments of people's needs were carried out and care plans and some risk assessments were put in place. The management met with people before the service commenced to discuss their care needs. We saw that care plans were in place but did not contain detailed person centred information. There was sufficient detail to enable staff to meet the care needs of people.

Clear information was available to people in their homes about the service and people knew how to make a complaint. People told us that the registered manager responded appropriately to any concerns that were raised.

People told us that the registered manager and management team were very approachable and supportive. Staff told us that they felt able to raise any concerns and that these would be dealt with.

We found that the provider was aware of areas within the service that required further improvement and had started to take to action to address these areas. New docume

Homecare 4U Cheshire provides personal care and support to people who live in their own homes. The service operates from an office located in Crewe town centre. At the time of our inspection the service employed 19 staff and was providing care and support to approximately 38 people. The number of daily visits and support provided varied depending on the individual needs of people.

The manager has been in post since 2013 and was registered with the Care Quality Commission (CQC) in January 2014. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People using the service were safe because staff had received training on how to recognise signs of abuse and possible harm and knew what to do if they had any concerns. Assessments had been completed to minimise areas of potential risk to people where hazards had been identified.

Safe and effective recruitment systems were in place, all checks were completed before new staff commenced work. Staff spoken with were positive about their employment and confirmed they were well supported by the manager. A programme of on-going training and support was provided for new and existing staff. This helped staff to develop the knowledge, skills and understanding needed to support people.

People told us usually had the same group of carers, who on the whole staff arrived on time and had the skills and experienced to meet their needs.

People were regularly involved in the assessment, planning and reviewing their care and support so that it met their changing needs. Care plans clearly directed staff in the support people needed and showed relevant healthcare professionals, such as GP’s, were involved so that people’s current and changing needs were addressed.

People were confident about the management of the service as the manager listened and acted on what they said. Systems were in place to regular monitor the quality of the service provided to people. These were kept under review so that any improvements needed were addressed.

The issues with the recruitment and induction of new staff members identified at the previous inspection that had taken place on the 11 and 14 October 2013 have now been addressed. Staff members are being recruited appropriately and they are receiving an appropriate induction prior to starting work.

We carried out this inspection to follow up Warning notices that we issued after our inspection in June relating to requirements for recruitment and supporting workers. During this inspection we looked at these outcome areas again but we were not satisfied that appropriate action had been taken by the provider to improve these areas.

We spoke to three people who used the service and five relatives. They told us that the service had improved in the last three months and that they were happy with the care that they received. We saw that changes had been made to the care plans and reviews were taking place on a regular basis.

We looked at the arrangements in place for complaints and saw that these had been improved. The people who used the service told us that they knew how to complain and had received a copy of the complaints procedure. The staff we spoke to told us that they knew how to manage complaints.

We looked at the quality assurance arrangements in place and saw that these had been improved and that the service had been carrying out audits to make changes to the service they offered. The provider was advised and accompanied during the inspection by The Care Standards Consultancy.