We carried out an announced focused inspection of Innovations Wiltshire Limited – Pelham Court on 20 December 2018. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in July 2018 had been made. At that inspection we found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This was because the service had not notified us of incidents they were legally required to.

The team inspected the service against one of the five questions we ask about services: is the service well-led? No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. This report only covers our findings in relation to the Well-led domain. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Innovations Wiltshire Limited – Pelham Court on our website at www.cqc.org.uk.

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, people with a physical disability or learning disability, people who have dementia and mental health conditions.

Not everyone using Pelham Court 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 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.

The service had informed us of events and incidents as they are required to do. The registered manager had put into place systems to make sure the service would submit notifications appropriately and without delay.

Feedback had been sought from people who used the service. Responses were analysed and shared so improvements could be made.

Staff could attend monthly team meetings which were used to share information, discuss ideas and concerns and to facilitate learning amongst the staff.

The provider’s values were displayed at the service. Quality assurance was under review as the registered manager wanted to involve more staff in the process. The registered manager met monthly with the provider so they could monitor the service and share key information.

This inspection took place on 25 July 2018 and was announced, which meant the provider was given notice before we visited. This was because the location provides a home care service. We wanted to make sure the registered manager, or someone who could act on their behalf, would be available to support our inspection. At time of our inspection 40 people were using 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.

The service had 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.

People’s medicines were mostly managed and administered safely. We saw there had been four medicines administration and nine recording errors in the past 12 months. The registered manager investigated each error and we saw evidence that where required, appropriate health advice was sought.

The registered manager did not always notify CQC of significant events, such as where the Police were contacted or a deprivation of liberty safeguard had been authorised.

People told us they felt safe when the carers visited them in their homes.

Staff were passionate about the people they supported and the registered manager told us they supported people to go out in the community in their own time.

There were sufficient staff to meet people’s needs and staff were deployed effectively.

People were supported by staff who had supervisions (one to one meeting) with their line manager. Staff had also received their annual appraisals. Staff told us supervisions were carried out regularly and enabled them to discuss any training needs or concerns they had.

The provider regularly assessed and monitored the quality of the service provided. Feedback from people and their relatives was encouraged and was used to make improvements to the service.

Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. Staff had all received safeguarding training and we confirmed this from the training records.

New staff were supported to complete an induction programme before working on their own. Induction records were in place which showed that new staff had been supported to understand their role, complete required training and spent a period of time shadowing an experienced member of staff.

Staff had received training around the Mental Capacity Act (2005) and Deprivation of liberty safeguards. Staff explained how they supported people with making choices about their daily living. People's individual wishes were acted upon, such as how they wished to receive their personal care.

People received care and support from staff who had got to know them well. People usually had a small group of care staff visiting them, ensuring continuity in care where possible.

People or their relatives were involved in developing their care plans. Care plans were personalised and detailed daily routines specific to each person were recorded. People and their relatives spoke positively about the quality of care they received.

We found one breach of the Care Quality Commission (Registration) Regulations 2009 – Notification of other incidents. You can see what action we told the provider to take at the back of this report.

Innovations Wiltshire Limited – Pelham Court is a domiciliary care agency providing personal care and support to people living in their own homes in Marlborough and surrounding towns and villages. At time of our inspection 50 people were using the service.

This was the service’s first rated inspection since a change in their registration on 2 September 2016.

This inspection took place on 24 May 2017. This was an announced inspection which meant the provider was given notice before we visited. This was because the location provides a home care service. We wanted to make sure the registered manager, or someone who could act on their behalf, would be available to support our inspection.

There was a registered manager in post at the service. 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.

Speaking with people and relatives they told us they would recommend Innovations Wiltshire Limited – Pelham Court to others. People and their relatives were complimentary about the service received. Comments included “They are delightful. It is a very good company”, “They are an excellent bunch of people. I know them well. They are very caring and thorough” and “It’s a good service, very satisfactory”.

People told us they didn’t always know what time and which carer was due to visit. They said a weekly schedule of care would be useful.

We found systems for the administering of medicines were not always safe. Staff did not have sufficient information about people’s prescribed medicines and there were no protocols in place for medicines to be taken ‘as required’. The registered manager told us they had started to implement a safer system since our inspection.

People told us they felt safe when carers visited their homes. Staff had the knowledge and confidence to identify safeguarding concerns and act on them to protect people.

Staff had a good understanding of the principles of the Mental Capacity Act (2005). The service asked for people’s consent to care and support in their own homes, before commencing the care. Staff understood the importance of giving people choice and supporting decision making.

Staff understood the needs of the people they were providing care for. Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service and demonstrated a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. People said they had no complaints about the service they received, however they knew who to contact if they did have a complaint. People felt there was always someone in the office they could talk to and they also had the contact numbers for the out of office hours, in case of an emergency.

The provider regularly assessed and monitored the quality of the service provided. Feedback from people and their relatives was encouraged and was used to make improvements to the service.

Staff told us they felt supported by the registered manager. The registered manager was accessible and any concerns raised would be dealt with immediately.