This inspection took place over three days on 5,6 and 12 March 2018. At our previous inspection in September 2016 we found that improvements were required in the safe handling of medicines and the provider was not always notifying us of significant events. At this inspection we found that improvements had been made to the management of medicines, however further improvements were required in the systems in place to monitor and improve the service.

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 and younger disabled adults. At the time of the inspection 149 people were using the service.

Not everyone using Homestay Care Limited receives regulated activity; 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 receive this support we also take into account any wider social care provided.

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.

Improvements were required to the quality assurance systems in place to ensure people's care was reviewed. Analysis of quality questionnaires had not taken place. There was no staff training development plan. The provider told us they would take action to make improvements in these areas.

People were protected from the risk of abuse as staff knew what to do if they suspected potential abuse and risks to people were minimised through the effective use of risk assessments. Incidents that could have resulted in harm were analysed and action taken to minimise the risk of them occurring again.

There were sufficient numbers of staff to meet people's needs. New staff had been employed through safe recruitment procedures.

People were supported to take their medicines safely and staff followed safe infection control procedures to prevent the spread of infection.

People's needs were assessed with them and their relatives and staff knew people's needs. People were supported to access other health care agencies if they became unwell and staff worked alongside other professionals to provide holistic care.

Staff received support and training to be effective in their roles.

People were supported to eat and drink sufficient amounts of food and drink of their choice.

The principles of the Mental Capacity Act 2005 were followed to ensure people who lacked mental capacity were consenting to their care and support. 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.

People and their relatives were treated with dignity and respect and they were involved in and able to make choices about their care. People's right to privacy was promoted.

People received care that was personalised and met their individual needs and preferences. People and their relatives were able to raise concerns and complaints and they would be acted upon.

The provider worked with other agencies to meet people's needs at the end of their life.

There were systems in place to monitor and improve the quality of service. People were routinely asked their views on the service they received and there was a kind and caring culture within the service. The provider worked with other agencies to ensure a holistic approach to people's care.

People, their relatives and staff liked and respected the management.

This inspection visit took place on 20 September 2016 and was announced. The provider was given four days’ notice of our inspection visit to ensure the manager and care staff were available when we visited the agency’s office.

The service was last inspected in September 2013 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Homestay Care provides domiciliary support for people of all ages and abilities who live in their own homes. Most people received support and care with several visits each day. On the day of our inspection visit the service was providing support to 112 people.

The service had a registered manager. 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 refer to the registered manager as the manager in the body of this report.

We found the provider had not notified us of all the important events that occurred at the service. For example, the deaths of people who used the service and allegations of abuse.

Medicine procedures required improvement to ensure care staff recorded the administration of all prescribed medicines. Medicine auditing procedures were not always sufficiently detailed to ensure issues for improvement were identified. For example, audits had not identified where staff were not following the provider’s policies and procedures for the recording of medicines.

The manager understood the principles of the Mental Capacity Act (MCA), and staff respected people’s decisions and gained people’s consent before they provided personal care. However, mental capacity assessments were not always clearly documented, where people lacked the capacity to make all of their own decisions. A new format for recording mental capacity assessments and best interest decisions was being implemented at the time of our inspection visit.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care. Staff understood how to protect people from abuse and keep people safe. The character and suitability of staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

There was enough staff to deliver the care and support people required. People told us staff were kind and knew how people liked to receive their care. Staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. Although the manager did not keep a current record of staff’s training this was being developed. People told us staff had the right skills to provide the care and support they required.

Care records were detailed and provided staff with accurate information on how they should support people, according to their preferences. Care reviews were undertaken each year, or when people’s needs changed to ensure support continued to meet people’s needs.

People told us the manager was approachable. Staff were supported by managers through regular meetings. There was an ‘out of hours’ on call system in operation which ensured management support and advice was always available for staff.

Quality assurance systems were in place to assess and monitor the quality of the service. There was regular communication with people and staff whose views were gained in relation to how the service was run; their views were used to make improvements.

People knew how to complain and information about making a complaint was available for people. The provider monitored complaints to identify any trends an

At the time of our inspection Homestay Care were providing personal care services to 53 people. In order to make our judgement about the service we spoke with five members of staff including the registered manager and we spoke with five people who used the service or their families.

We saw records which showed that people had consented to their care and support. People who used the service told us that staff always asked permission before providing services. One person said, “They always ask. I don’t always need things so they check first”.

The provider had systems in place which enabled them to liaise closely with other services in the wider health community.

Policies and practices ensured that people who used the service and staff who provided services were protected from the risk of infection.

There were sufficient suitably qualified and skilled staff to provide the service.

The provider had a complaints system. Issues were recorded and responded to. People told us they knew how to complain if they needed to. A person who used the service said, “I would telephone the office and speak to the manager”.

People were involved in planning and reviewing their care. They told us that staff treated them with respect and they felt safe when supported by staff from the agency. One person told us they were "very happy with the service". One family member described their relative's care staff as "very helpful and caring".

We saw that the care plans called ‘my support plan’ included evidence of input from the people supported and their representatives. All documents seen had been signed to confirm involvement and agreement. The care plans included references to people’s preferences and choices and also included details of how the identified support should be provided.

The agency had appropriate procedures to safeguard people from abuse. The people supported were informed about the procedure and staff received training and written information on safeguarding.

Staff confirmed that they received an induction, relevant training and supervision to support them in their role. Some staff were due updates to some of their training.

The agency had regularly gathered the views of the people it supported and had systems in place to monitor its ongoing performance.