This inspection took place on 16 and 23 January 2018 and was announced. The provider was given 48 hours' notice because the location provided a domiciliary care service and we needed to be sure that someone would be in.

I and S Care is a small domiciliary care agency, providing personal care and support to people in their own homes around the Essex area. At the time of our inspection the service was supporting 14 people.

At our last inspection in September 2016 we found the service to be in breach of Regulations 12, 17 & 19 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. This was because the service failed to have systems in place to ensure the safe management of medicines and safe recruitment of staff. The registered manager did not have systems to monitor gaps in staff training. All breaches in regulation had been met at this inspection.

The service has 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 a 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 not consistently safe. Medication practice required improvement to ensure that people received their medicines as prescribed. The service had a quality assurance system in place and except for one minor error in regards to medication management which was addressed at the time of inspection, was being effectively operated. The service had sufficient numbers of staff met people’s needs.

The service was effective. People were cared for and supported by staff who had received training to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff supported people to eat and drink enough to ensure they maintained a balanced diet. Referrals to health and social care services were made when required.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. The service reviewed care plans on a regular basis and when there was a change in care needs. Staff supported people to follow their interests and participate in social activities. The service responded to complaints received in a timely manner.

The inspection took place on 23rd September and was announced. The provider was given 48 hours' notice because the location provided a domiciliary care service and we needed to be sure that someone would be in. I&S Care is a domiciliary care agency that provides personal care and domestic support to people in their own homes. At the time of inspection there were nineteen people using the service.

The service has 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.

At this inspection we found the service to be in breach of Regulations 12, 17 & 19 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were required in the safe management of medicines to ensure people received their medicines as prescribed and any errors were identified and addressed.

There was a system in place for the safe recruitment of staff but this was not always adhered to. This meant that the necessary checks were not always completed for all staff.

The provision of formal training was patchy and inconsistent with no structured training programme in place. The registered manager did not have systems to monitor gaps in staff training.

Staff received informal supervision and appraisals on an ad hoc basis. There was no formal systems and processes in place to ensure that staff were supported with their professional development and monitored to ensure their competency so that they could meet people’s needs safely and effectively.

There was a lack of quality assurance mechanisms in place to monitor the safety and quality of the service and to drive improvements.

People were protected from abuse as staff knew what constituted abuse and who to report it to if they suspected it had taken place.

There were sufficient numbers of staff to meet peoples care and support needs and keep them safe.

The service understood how to manage risk in a way that kept people safe whilst respecting people’s rights and freedom to exercise choice and control.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The provider followed the principles of the MCA by ensuring that people consented to their care or were supported by representatives to make decisions.

People were supported to have enough to eat and drink and to access health care services to maintain their health and wellbeing. When people became unwell staff responded quickly and sought the appropriate support.

Care workers had very positive relationships with people who used the services and were valued and held in high regard by people and the families they supported. The care delivered was personalised and met people's individual needs and preferences.

People, or their representatives, where appropriate, were involved in how their care and support was delivered so felt listened to and included. Care workers treated people with dignity and respect and promoted people’s independence.

The provider had a complaints procedure in place and people who used the service knew how to use it.

Staff told us that they were well supported by the management team and felt confident that any concerns they raised would be listened to and dealt with fairly.

People told us that the staff team supporting them were very efficient and always respectful and polite, they also told us that they had known them for a very long time and understood their care and support needs very well.

People told us that they felt safe being supported by I & S Care and were confident that if they had any concerns they would be listened to and any issues addressed.

We looked at the care records of both people using the service. They detailed the needs of people and contained risk assessments to minimise any risks present during day-to-day activities.

We saw that staff received appropriate training which was specific to the needs of people who used the service.

The provider had effective systems in place to monitor the quality and safety of the service that people received.

People told us that the staff team supporting them had known them for a very long time and understood their care and support needs very well.

They also told us that staff were always polite and respectful when supporting them and always involved them in all aspects of their day-to-day care.

People told us that they felt safe being supported by I & S Care and were confident that if they had any concerns they would be listened to and any issues addressed.