About the service: InTouch Care Services Limited is a domiciliary care agency. They provide personal care and support to children and younger adults with disabilities and older people living in their own homes in the Walsall area. At the time of our visit there were six people receiving the service.

People’s experience of using this service: At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person-centred care, safe care and treatment and governance.

The service did not consistently mitigate risks. People's risk assessments did not consistently cover all potential areas of risk, such as bed rails, and managing behaviour. We looked at the systems in place for medicines management and found they were not always effective.

People felt safe in the care of staff members and were happy with staffing levels. However, they told us staff did not always arrive on time and staffing was not always consistent. We asked the manager to explore this issue and to look at systems to improve staffing.

Care plans did not reflect people's preferences or routines in all cases.

Systems were in place to ensure that staff received appropriate supervision to support them in their roles. However, training records were not up to date and some specialist training could not be verified. Checks made on the ongoing competency of staff had lapsed from May 2018. We received feedback that some relatives had concerns over the competency of staff to support people effectively.

The provider’s systems and processes in place to monitor and audit had not identified the areas for improvement found. Records management needed improvements regarding medicines, risk assessments, care plans, staff records and quality monitoring of the service. People and staff members were asked their views via regular surveys.

The provider had appropriate systems in place to support staff to raise any safeguarding concerns. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection.

People were supported to eat meals of their choosing and were supported to access healthcare professionals when necessary.

People told us care staff were caring and kind. Some people told us that timekeeping was an issue and also the consistency of staff that arrived to support people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: At the last inspection the service was rated good (report published July 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

More information is in the detailed findings below.

This inspection took place on 9 June 2016 and was announced.

Intouch Care Services Limited provides personal care for adults and children in their own home. There were 18 people using the service when we inspected and 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 and associated Regulations about how the service is run.

People told us they felt safe and free from the risk of potential abuse and felt safer when the staff visited. People’s individual risks had been identified and reviewed when looking at the care they needed. Care plans recorded these risks and provided people and staff with advice and guidance about how these could be managed. There were enough staff deployed by the agency to ensure that people had their calls times met and staff were flexible if the call times were changed by a person. People looked after their own medicines or were supported by staff to manage their medicines when needed.

People said the staff knew how to care for them and understood what help and support they needed. Staff told us they received training and were knowledgeable about their roles and responsibilities. The registered manager had looked at the staff teams skills to ensure people received care from staff that understood their needs.

People’s consent was appropriately obtained by staff when caring for them and people who could not make decisions for themselves were supported by representatives or family members.

Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People’s meals were prepared where needed and they got the meals they enjoyed or chose. People told us they made their own healthcare appointments as required and that staff were happy to support them if they requested it.

People told us the staff knew them and they were supported to receive care in a personalised way. People received care from staff that spent time chatting whilst providing care and getting to know them. People felt the care they had received met their needs. They were also supported in maintaining their dignity and encouraged to be involved in their care needs where able to retain independence.

People had been involved in the planning of their care and relatives felt they were involved in their family members care and were asked for their opinions and input. People were confident to approach the management team if they were not happy with their care. The registered manager had reviewed any minor concerns or questions that had been raised to ensure they had been resolved.

People, their family members and staff felt able to speak with the management team and provide feedback on the service. The management team led by example and ensured regular checks were completed to monitor the quality of the care that people received and looked at where improvements may be needed.

We inspected Intouch Care Services Limited as part of our scheduled inspection plan. We told the provider we were visiting them before the inspection to ensure they would be available.

In the office we met and spoke with the providers, one of whom is the registered manager and four care staff who were employed by the agency. We also met one person who used the services of the agency. This person had called into the office with a member of staff for a chat and a drink. We contacted one person that used the service by telephone and spoke with them about their experiences. We also spoke with four relatives. People were generally happy with the service they received and all praised the staff that provided care.

During the inspection we looked at three people's care plans and risk assessments. We saw that the care records were in order and updated to ensure that care was delivered correctly.

We spoke with care staff about how they were supervised and trained to meet people's needs. We reviewed the training and support mechanisms in place for staff. We saw that the agency provided some training to ensure that staff were competent to fulfil their role; other training had been booked for early 2014. One person we spoke with told us: "The staff are lovely, very polite and friendly". We looked at how medication administration was supported by the staff and how staff competencies in this area were checked. We saw that this process was well managed by the agency.

During our inspection we spoke with the registered manager and three members of staff.

After the inspection we contacted people who used the service and their relatives.

People we spoke with told us that they were happy with the standard of care they received and were involved in giving feedback to the service.

One person told us, “I think the staff are brilliant. They help me to be independent and give me choices. I think they give the best standards of care and I can have a laugh with them too”.

We spoke with a relative who told us, “The staff are very good. I am able to talk to the agency if I have any issues and things have been sorted out”.

Staff we spoke with told us they had appropriate training to undertake their work competently and to keep people safe.

We found that appropriate recruitment and selection procedures had been undertaken by the service.

We found that there was a system for ensuring the ongoing quality assurance within the service.

We found that Intouch Care Services Limited was compliant in the five outcome areas.

We carried out this review to check on the care and welfare of people using this service. We talked with one person who used the service, five relatives and three staff employed by the service about the quality of care. They all told us the service was very good. One person we talked with said, "They are a fantastic service”. A relative we talked with said, "They are very good, the best ever”.

We saw that everyone had a written care plan. People told us they or their relatives had been involved in agreeing what to include in their care plans. One person said to us, “There is a written plan and staff write down everything they do every time they come”. Staff we talked with were knowledgeable about people's individual care needs. This meant that people were involved in agreeing the care they received.

We saw that care plans were detailed and risks to people's health and wellbeing had been considered and were regularly reviewed. Relatives we talked with told us that they could talk to the staff and the manager about anything they needed to change. One relative said, “I know I can just ask and they will review G’s needs”. This meant that people’s needs were monitored and care plans adapted to meet new needs.

We found that staff were effectively trained and supported to meet people’s needs. We found that staff met regularly with their line manager to discuss their practice and development of their skills. Staff we talked with told us they were observed in practice and had regular staff meetings. Staff explained how they ensured people’s dignity, privacy and safety while carrying out care tasks. Relatives we talked with said that staff were thoughtful and courteous with their relatives.

We found that the quality of care was regularly reviewed by the registered manager. We saw that the registered manager monitored the daily care records and undertook annual satisfaction surveys of people who used the service. The provider regularly worked alongside staff to deliver care which also allowed her to observe staff. This meant that the provider met regularly with people who received services to ensure that the quality of service was maintained.