We visited Homecarers Liverpool Limited on 18 and 21 September 2017. Homecarers Liverpool Limited provides care and support to people who need the services of a domiciliary care agency, care and support is provided for people with a range of conditions including people with dementia and physical disability needs. Homecarers Liverpool Limited was providing a service for 557 people at the time of inspection and employed 232 staff in total.

The service had a manager who was registered with the Commission. 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 had a registered manager who had been in place since 2010. The registered manager and the company director were in attendance throughout the inspection.

At our last comprehensive inspection of the service in October 2016 we found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care and ensuring the quality of the service. The provider had produced an action plan that had led to us seeing that during this inspection improvement had been made in both of these areas.

The care and risk assessment records we looked at contained good information about the support people required and recognised people’s needs. All records we saw were complete, up to date and regularly audited. We found that people were involved in decisions about their care and support.

The service had quality assurance processes in place including audits, staff meetings and quality questionnaires. Homecarers Liverpool Limited also had up to date policies in place that were updated regularly. The provider regularly checked the quality of care through home visits, spot checks and audits. This demonstrated the service had robust quality assurance systems in place and people’s care records were maintained to a good standard.

We saw that the provider had systems in place to ensure that people were protected from the risk of harm or abuse. There were procedures in place to guide staff in relation to safeguarding adults and all staff had undergone training about both safeguarding and whistleblowing. The feedback from people we spoke with was positive and people told us they felt safe with the staff visiting them.

Staff were recruited safely and there was sufficient evidence that staff had received a proper induction and suitable training to do their job role effectively. All staff had been supervised and appraised.

People's medicines were handled safely by trained staff and were given to them in accordance with their prescriptions. People's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary.

We saw that infection control standards were monitored and managed appropriately. We saw that the provider had an infection control policy in place to minimise the spread of infection, all staff had attended infection control training and were provided with appropriate personal protective equipment such as gloves and aprons.

The provider was active in partnership working to improve the social care sector as a whole and had implemented healthy living initiatives for staff and people using the service, developed partnerships to improve recruitment and retention and was part of a cadet pilot programme that would encourage staff to choose social care as a career.

The service had policies and procedures in place in relation to the Mental Capacity Act 2005 and staff had received basic training. The registered manager and director were fully aware of their responsibilities concerning mental capacity and people we spoke with told us staff always asked for consent before carrying out

The inspection was announced and took place on the 6, 7 and 10 October 2016.

Homecarers Liverpool Ltd provides a domiciliary care service to people living in their own home. The service operates throughout Liverpool. At the time of the inspection there were 649 people using the service.

There was a manager in post who had been registered with the CQC since December 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 was carried out in December 2013, during which the registered provider was found to be meeting the standards inspected against.

During the inspection we found examples which demonstrated that good care was being provided to people. However we also found several areas where improvement was needed.

Information within people’s care records was not personalised. Information was task-led and did not contain details around their strengths, likes, dislikes or preferred daily routines. Where information was provided, this did not go into sufficient detail. For example one person’s record stated that they had a diagnosis of Schizophrenia and were alcohol dependent, however there was no detail regarding the severity of this or what impact these conditions had upon them. We raised this with the registered manager who was already in the process of re-writing people’s care records to address this issue.

There were audit systems in place; however these were not always robust or effective. Medication audits had failed to identify and address where medication administration records (MARs) had not been appropriately signed by staff. Audits of care records had failed to identify poor risk assessing, the lack of sufficient depth and personalised detail to the information provided. There was no audit of accidents and incidents for people using the service, which meant that trends could not always be identified and would impact upon the ability of the organisation to take appropriate action. We raised these issues with the registered manager who started to rectify these areas immediately during the inspection.

You can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation around risk assessments. People’s care records contained generic risk assessments which looked at the risk to people and staff regarding moving and handling tasks, and the environment. These were not personalised, and did not consider all the risks associated with people’s needs. Other factors, for example the risk of developing pressure sores, or supporting people to manage their diabetes had not been assessed.

Staff had received training in the safe administration of medicines, and had been assessed as competent in this subject. People confirmed that they received they received appropriate support with taking their medicines. However medication administration records (MARs) were not always being appropriately signed by staff to show that medicines had been given to people. We raised these issues with the registered manager who told us she would raise this issue with staff.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and were aware of how and when to report their concerns. There was a whistleblowing policy in place which staff were aware of.

There were sufficient numbers of staff in place to meet people’s needs, and recruitment processes were robust enough to ensure that they were of suitable character. Staff had been required to provide two references including one from their most recent employer, and had also been subject to a check by the disclosure and barring service (DBS).

Staff had received the training needed to c

Homecarers Liverpool Limited had a contract with Liverpool City Council to provide domiciliary care to people in designated parts of Liverpool. Under the terms of their contact they had to accept all referrals.

When the provider was given a contract a care plan and risk assessment had already been completed. We saw evidence that where people’s needs had changed the provider’s review team had put new plans in place and notified the council appropriately. There were systems in place to notify the relevant body if a person required more care than the contract detailed or if their capacity to consent to care or support was in question.

Equipment related to people’s care was provided by the council. There was a system in place to report faulty equipment.

The provider had an effective recruitment system in place to make sure staff had the relevant experience and qualifications and were of good character.

There were systems in place to monitor the quality of the service that was provided.

The people we spoke with were positive about the service they received. Their comments included “You can’t go wrong with Homecarers. They all know what they’re doing”, “The carers are very good. All of them know what to do and I need a lot of help” and “They always ask what I want and I get it”.

Prior to our visit we were told that people who used the service had not been treated with respect. People we spoke with during our inspection raised no concerns about the way they had been treated.

We found that action had been taken in response to a recent concern about the care and welfare of people who used the service. People told us that care staff had always provided them with the care they needed.

We found that action had been taken in response to a recent concern about staffing levels. People told us that the right amount of care staff had provided their care and support.

Prior to our visit we were told that people who used the service had been cared for by care staff who were not suitably qualified. People we spoke with during our inspection told us they had confidence in the ability of care staff and that in their opinion care staff were suitably trained in all areas of their work.

Prior to our visit we were told complaints made about the service had not been appropriately dealt with. People we spoke with during our inspection said they had been given information about how to complain. People who had complained told us that their complaint had been dealt with quickly and to their satisfaction.

We found that action had been taken in response to a recent concern about record keeping. People told us care staff had kept their records up to date.

We spoke to nine people who were provided with support from the service and three relatives. Most people were very positive about the service. They made positive comments such as;” Quite happy with the service”; “This agency is marvellous”; “I can’t praise them enough….they have all kept my dignity….”; “I’m very happy”; “we’ve had no problems”; “they are brilliant they help me get a bath” and “more than happy no problems.”

Most people told us they see the same staff which they liked and appreciated as it gave them greater stability. They advised that during holiday periods they sometimes had to have different staff which they understood was inevitable at times to provide cover for their usual team members.

Throughout the inspection we were shown lots of ways the service were monitoring and managing the support provided. We were also told of future initiatives and developments that they were constantly striving to do to ensure the service continued in promoting good practice and good levels of service to people in the community.