About the service: Jane Care is a domiciliary care service that was providing personal care to 33 people at the time of the inspection. The service operates in Ellesmere Port and surrounding areas of Cheshire.

People’s experience of using this service:

Since the last inspection checks carried out on the quality and safety of the service had been improved and were now effective. Recruitment processes had improved in ensuring staff were suitable for the role.

People told us the staff team treated them with respect and ensured their dignity was promoted at all times. People received a consistent service, they told us staff always turned up when required and as much as possible the same staff team visited them. People felt safe with the staff team.

People experienced support which was effective, caring and responsive to their needs.

Staff told us they felt very much supported by the organisation and they were valued as employees. Staff also told us they were encouraged to develop their careers as carers through qualifications offered to them. Staff received appropriate training in topics appropriate to the needs of people they supported.

People had their independence promoted and were supported in a dignified manner. Care was provided in a person-centred manner.

People who were reaching the end of their life were supported in an appropriate manner. The registered provider worked closely with other agencies and family members at these times.

A complaints procedure was in place for people to follow. Although no complaints had been received there was a system in place for complaints to be recorded and responded to.

The service met characteristics of Good in all areas more information is in the full report.

Rating at last inspection: The service was rated as requires improvement at our last inspection in November 2017. This was because the process for recruiting new staff was not always robust.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved on the quality of care provided and has been rated good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection was announced and carried out on the 17, 21 and 24 November 2017.

The service was previously inspected in June 2016 during which we identified two breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care records did not contain contemporaneous information, and audit systems were not always robust. At this inspection we found that improvements had been made in these areas; however we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger adults, and provides a lot of support for people who are at the end stages of their lives.

The service has a registered manager in post who had been registered with the CQC since July 2011. 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 the last inspection in May 2016 we had made a recommendation to the registered provider around the safe recruitment of staff. However, we found at this inspection, that some of the issues we had identified had not been addressed. Recruitment processes were not robust enough to ensure the safe recruitment of suitable staff. We identified that risk assessments had not been completed for those staff who had previously committed criminal offences. Interview processes had not taken this information into account, and disciplinary processes had not been considered in an example where a member of staff had not disclosed criminal offences. In one example we identified that action had not been taken to verify a reference, sent from a personal email address, despite this member of staff having a previous criminal history.

At the last inspection we identified that care records did not always contain up-to-date information about people’s needs and risk assessments were not being completed in relation to people’s needs. At this inspection we identified that people care records contained accurate and up-to-date information about people’s needs. Risk assessments were in place and provided information to staff around how to manage those risks presented to people. This helped ensure that staff had access to information about supporting people and how to keep them safe.

At our previous inspection we found that audit systems were not robust. At this inspection we identified that improvements had been made in relation to these. Spot checks on staff had been completed by the registered manager and the care record audits were also being completed. However; the registered manager and registered provider had failed to identify issues relating to the recruitment processes.

There were sufficient numbers of staff in post. People commented that staff usually arrived on time, or within an acceptable time frame. People confirmed that staff always turned up for their care call. Staff told us they had enough time to spend with people and did not feel stretched.

Supervisions were carried out with staff. A tick box format was used to rate staff based on their performance. In some examples we found no written commentary had been added to this to demonstrate the rating given to staff, or any discussions around development and progression. We have made a recommendation to the registered manager in relation to this.

Staff had received the training they needed to carry out their role effectively. People and their family members told us staff were good at their jobs and that they used the correct equipment to support them during moving and handling tasks. The service provided end of life support to

This was an announced inspection, carried out on the 28 June 2016.

Jane Care is a domiciliary care agency registered to provide personal care and support to adults who live in their own homes. The agency is based in Ellesmere Port and currently provides support to fifteen people who have a range of complex health and support needs.

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.

We last inspected this location in July 2013 and we found that the registered provider met all the regulations we reviewed. During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

Staff had a good awareness of the support and help that people required. Records showed that people’s needs were not always robustly assessed and only basic information was available for staff. Risk assessments were in place for people which identified potential areas of risk, however support plans and assessments did not clearly describe the support people required and how best to support people at times of increased risk.

Support plans did not always record people’s needs accurately. Records were not always personalised to reflect people’s individual preferences about how they would like their care and support to be provided. Food and fluid charts were always completed in detail to reflect what people had consumed on a daily basis.

The registered manager completed a range of checks to assess the quality of the service provided to people. Quality assurance systems in place were not always effective. Issues we raised during our inspection relating to support planning, risk assessments and documentation had not been identified or fully addressed through the registered provider’s quality assurance processes.

There were sufficient levels of suitably trained staff to support people. When new staff were appointed, recruitment checks were carried out to make sure they were suitable to work with vulnerable people. We have made a recommendation about accessing suitable employer references.

Staff understood the importance of seeking consent from people prior to delivering care and support. People and family members confirmed that support was always given in line with people’s own wishes. We have made a recommendation about accessing training and a policy and procedure in relation to the Mental Capacity Act (2005).

Staff understood what was meant by abuse and they were aware of the process for reporting any concerns they had and for ensuring people were protected from abuse. Family members told us that they felt reassured by staff and that their loved ones were safe using at the service.

Discussions were held with family members and people were referred onto the appropriate services when concerns about their health or wellbeing were noted. Staff worked well with external health and social care professionals to make sure people received the care and support they needed.

The service ensured that where possible, staff supported the same people. This enabled people, their family members and staff to build good working relationships and develop confidence in the support provided.

Staff were caring and treated people with kindness and respect. Most people and relatives were happy with the overall care that they had received. Feedback we received and discussions with staff confirmed they were mindful of people’s privacy and dignity and encouraged people to maintain their independence.

We looked at three care records and all had an assessment of each person's health and social needs completed. However some of the records were not up to date and moving and handling risk assessments had not been completed.

We spoke with four people who used Jane Care and two staff. We also spoke with a range of professionals who worked with the staff at Jane Care. Comments included “The staff are lovely”, “I have no concerns”, “The carers usually turn up on time” and “I was involved in my care plan.” All people spoken with said they would recommend this service and that they didn’t have any concerns or complaints. Staff commented “The staff team are friendly and helpful and the managers are supportive and really good” and “The best part of my job is helping the clients to be happy.”

We looked at staffing levels at the service. We saw the rota and discussed staffing issues with the manager. The manager stated they were currently interviewing for two new staff. She said they recruit in line with the needs of the popple who used the service.

We saw that the agency had not received any formal complaints in the last year and the Commission had not received any complaints about Jane Care.

We did not speak to people who used the service as part of this review.

We looked at five staff records to check on the improvements made with regard to recruitment, training, supervision and appraisals.

We spoke with the provider, manager and deputy manager during this visit.

We spoke with some of the people who use the agency and some family members and they all agreed that the staff were very nice and polite.

People using the service and their families told us that they felt well cared for and safe and they were satisfied with the support they received.

We received positive feedback about the staff team and comments included “The support my relative receives is very good. The staff provide support very well”, “The staff team are very caring” and “The staff team work well together.”

On discussions with the staff team it was evident that they were aware of the peoples needs and that they had taken time to get to know them.