The inspection took place on 9 and 11 October 2018. The inspection was announced.

Interserve Healthcare Liverpool is a domiciliary care agency providing nursing and personal care to adults and children in their own homes. At the time of the inspection the service was directly managing the provision of care to 12 adults and 14 children.

The service had a registered manager. A registered manager is a person who has registered with CQC 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 since our last inspection merged with another branch and now also provided care services to people in the Lancashire and Fylde area.

During the previous inspection we found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were placed at risk of receiving unsafe care as some care plans were lacking in detail.

During this inspection we found the service had made the necessary improvements. Staff had added more detail to care plans. The branch had introduced a review of care plans as a team, to ensure the information was clear to all readers. We discussed with the branch nurse and registered manager that aspects of people’s ‘as required’ medicines would benefit from a similar review to ensure clarity.

During the inspection we were given access to the electronic records relating to the service which included evidence of quality audits.

As part of our inspection we checked three people’s medication administration records (MAR). We found that staff had sent completed MAR for review by nurses. However, two people’s MAR we checked had not been reviewed until several months after completion. An audit had identified some outstanding records, but actions had not been completed when we inspected.

We have made a recommendation regarding the service’s keeping and auditing of records.

People and relatives we spoke with told us they overall had no concerns and had confidence in the staff providing care. A person and a relative we spoke to were concerned about arrangements, if their current staff should become unavailable. The registered manager was able to tell us about their contingency plans.

Staff we spoke with had no concerns about the service. Staff explained to us their role and responsibilities regarding safeguarding people who used the service. Staff were confident that any concerns they had would be dealt with by branch staff and the registered manager. The registered manager managed accidents and incidents appropriately.

The service had two dedicated care coordinators ensuring the safe recruitment of staff. Branch staff planned who would provide care to people months in advance, to help identify gaps. This identified vacancies which the provider was recruiting for when we inspected. The provider had effective recruitment, supervision and training processes in place to ensure the staff were safely able to support people using the service.

Care plans showed the service always sought people’s consent before providing support. Staff were knowledgeable about the Mental Capacity Act. The registered manager had written to social workers where a person using the service had transitioned from child to adult services, to ensure the appropriate authorisations were sought.

The service worked with other health professionals to provide effective care for people. We saw that professionals from hospitals had been involved in writing specific care plans for people.

Staff we spoke with talked about people who used the service in a caring way, showing understanding and knowledge of things important to people. People and relatives we spoke with told us about the caring, engaging nature of the regular staff teams.

Relatives told us they were invo

This inspection took place on 8 August 2017 and was announced. The registered provider was given 48 hours’ notice because we needed to be sure that someone would be available at the office.

Interserve Healthcare Liverpool is a domiciliary care agency providing nursing and personal care to adults and children in their own homes. At the time of the inspection Interserve Healthcare Liverpool was providing services to six adults and eight children.

The service was previously inspected at a different address in July 2016 and was subsequently re-registered. This was the first inspection at the current address. During the previous inspection the service was found to be in breach of regulations. The breach was in relation to the management of risk and associated care plans. During this comprehensive inspection in August 2017, we checked to see that improvements had been made and sustained.

The records that we saw relating to risk assessment were sufficiently detailed and covered risk in relation to; moving and handling, falls, use of bedrails and pressure area care, in addition to other aspects of care. Each risk assessment showed evidence of regular review and was supported by a plan of care.

The majority of care plans were well detailed especially in relation to clinical practice and contained a good level of person-centred information. However, we saw that a small number of records were lacking in sufficient detail to safely inform staff practice.

During the inspection we were given access to the electronic records relating to the service which included evidence of quality audits. Where appropriate, audits were mapped to the regulations and CQC’s key lines of enquiry. However, audit processes had failed to identify the lack of detail in some care plans which placed people at risk of receiving unsafe care.

At the last comprehensive inspection in July 2016 we identified a concern relating to the completion of medicine administration records (MAR). Some records had not been completed when medicines had been administered and some medicines were not administered without an adequate explanation. We made a recommendation regarding this.

As part of this inspection we looked at MAR sheets for four people and medicines’ audits to see if the necessary improvements had been made and sustained. Each of the MAR sheets that we saw had been completed fully and correctly.

The people that we spoke with said that their service was delivered safely. Staff were able to explain their responsibilities in relation to safeguarding and what indications of abuse and neglect to look out for. Each of the staff that we spoke with was clear about their role in reporting any concerns.

Accidents and incidents were recorded on an electronic system. Each of the records that we saw contained a good level of detail. Information was recorded under consistent headings to allow for evaluation and comparison.

Staff were safely recruited and deployed in sufficient numbers to meet people’s needs. The provider had a small number of vacancies and was actively recruiting at the time of the inspection. The people that we spoke with said that their service was generally provided by the same staff and changes due to annual leave and sickness were communicated to them in good time.

Staff were given regular training and supported through structured supervision sessions. Staff confirmed that they had regular training in relevant subjects including safeguarding, manual handling and specialist care specific to the people supported.

It was clear that staff understood the principles of the MCA and acted in accordance with requirements. The records that we saw indicated that consent was sought from each person or a nominated relative. Staff were able to explain what action they would take if they felt that a person did not have capacity to give meaningful consent.

People were supported by staff and other health care professionals to maintain their health and wellbeing. The