We carried out an announced inspection of Immaculate Healthcare Limited on 14 August 2018. Immaculate Healthcare Limited is registered to provide personal care to people in their own homes. The 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. At the time of our inspection, the service provided personal care to 40 people in their homes.

At the last inspection on 11 February 2016 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run. The registered manager was away at the time of the inspection. The care manager supported us with the inspection.

Risks had been identified and assessed, which provided information to staff on how to reduce these risks to keep people safe. Medicines were being managed safely. There were sufficient staffing levels to support people. Staff had been trained in safeguarding vulnerable adults and knew how to keep people safe. There was a safe recruitment process in place to ensure staff were suitable to support people.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles. People had choices during meal times and were supported with meals when required. Staff knew what to do if people were not feeling well. People’s needs and choices were being assessed regularly through review meetings to achieve effective outcomes.

People and relatives told us that staff were friendly and caring. People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights. People had been involved with making decisions about their care.

Care plans were person centred and included clear information on how to support people. People and relatives were aware of how to make complaints if they wanted to and staff knew how to manage complaints.

Staff felt well supported by the management team. Some quality assurance and monitoring systems were in place to make continuous improvements. However, there was not an effective audit system in place to ensure medicines were managed safely. We made a recommendation in this area.

This inspection took place on 11 February 2016 and was announced. The registered manager was given 48 hours’ notice because the location provides a domiciliary care service. This was to ensure that members of the management team and staff were available to talk to. At our last inspection in August 2013 we found the provider was meeting the regulations we inspected. The inspection was carried out by one inspector.

Immaculate Healthcare Services Limited provides support with personal care to people living in their own homes. At the time of this inspection there were 85 people using the service.

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.

Most people told us that they were happy with the care they received and there were enough staff to meet their needs. Records we saw indicated staff had received appropriate training to keep people safe including moving and handling, health and safety, safeguarding and food safety training. Staff received on-going support through staff meetings and supervisions.

We saw safeguarding procedures were robust and staff understood how to safeguard the people they supported. People were cared for by staff who had completed the necessary pre-employment checks to ensure it was safe for them to work for the service.

People where appropriate, were supported to take their medicines and their nutritional needs were being met by the service. The registered manager worked well with external health and social care professionals to make sure people received the care and support they needed. People were referred onto the appropriate service when concerns about their health or wellbeing were noted.

People told us staff always treated them with kindness and respect and they encouraged people to maintain their independence and were mindful of their privacy and dignity.

People care records and risk assessments had information for staff to help them provide the personalised care to people using the service. People were involved in planning and agreeing their care and support arrangements. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) and how to put these into practice.

There were quality checks undertaken to ensure people received care and support in accordance with their needs and preferences. People said they knew how to make a complaint if they were unhappy about the support they received.

People were asked for their opinions of the service through telephone calls, care plan reviews and quality monitoring surveys. The management team welcomed suggestions on how they can develop the services and make improvements. Where shortfalls or concerns were raised these were addressed.

People told us that they were treated with dignity and respect, and that staff helped to promote their independence. One person said "my carer is a real gem, she does anything I ask her to help me." People told us that when regular staff were provided, they knew how to support them. A relative said “X had a succession of six to seven care workers initially, sometimes calls were missed, but things have stabilised now and I am pleased with the care.” Risk assessments and care plans were in place which set out how to meet people’s individual needs.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and reduce the risk from happening. We found that people’s health needs were met because the service had effective recruitment procedures in place and carried out relevant checks before they employed staff. People told us that they were asked for their views on the service provided by the care agency and we found that systems were in place to monitor and assess the quality of care provided.

People told us that they were treated with dignity and respect, and that staff helped to promote their independence. One person said "they let me do what I can for myself." People told us that when regular care workers were provided, they knew how to support them, but new carers did not. One person told us "last Sunday we had two carers who were both new, they did not know the routine." We found that care plans did not contain all necessary information to inform staff how to meet people's needs. We found that staff did not have a understanding of how to safeguard vulnerable adults, but people did tell us that they felt safe, and that they trusted their carers. Some people told us that they were asked for their views on the service provided by the care agency, others told us this was not the case. We found that the service had systems in place to monitor and assess the quality of care provided.