About the service:

Kareplus Worcestershire is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing care to 68 people.

People's experience of using this service:

People continued to receive care that was safe. People were protected from abuse and avoidable harm. Staff understood their role and responsibilities in keeping people safe, they had received safeguarding training and had a safeguarding policy and procedure to inform their practice. Staff were safely recruited and deployed to provide people's care. Risks to people's health, associated with their care and related safety needs, were effectively monitored and managed. Staff supported people to take their medicines safely when required.

People continued to receive care that was effective. People's care needs were effectively assessed, carried out and regularly reviewed, in agreement with them or their representative. Records relating to consent for care were accurately completed and people told us they were always offered choice and control over the care they received.

Staff spoke of their commitment to deliver care in a person-centred way based on people's preferences and likes. Staff treated people with kindness, compassion and respect and ensured that people's dignity was maintained at all times. People spoke positively about the care and support they received. Most people told us they received support from regular staff who stayed the right amount of time and knew them well. People were informed and involved to make ongoing decisions about their care; or to access relevant advocacy services, if needed.

People continued to receive care that was timely and responsive to their individual needs and wishes. People were confident and knew how to raise a concern or make a complaint if they needed to. People's views, feedback and any complaints received were monitored by the provider and used to help inform any service improvements needed. Staff were trained and supported to follow nationally recognised best practice standards, concerned with people's care at the end of life.

The provider operated effective governance and quality assurance systems for service improvement. Staff understood their role and responsibilities for people's care. The manager and staff worked in partnership with people, their representatives and relevant health or social care agencies when needed.

More information is in the full report.

Rating at last inspection: Good (published 16 March 2016).

Why we inspected:

This was a scheduled inspection based on the previous ratings.

Follow up:

We will continue to monitor the service through the information we receive.

This announced inspection took place on 3 and 8 February 2016. We gave the manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in either their own home or a family member’s home as we needed to be sure someone would be available at the office.

Kareplus Worcestershire is registered to provide personal care to people. At the time of our inspection 73 people received care and support.

There was no registered manager in place for this service. A manager was in place and had applied to register with the Care Quality Commission. 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 carried out a comprehensive inspection at this service on 27 and 29 May and 8 June 2015. A breach of a legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was due to shortfalls in good governance.

In addition to the breach in Regulation we also found areas where improvement was needed to ensure the service provided support to people to ensure it was safe and met their identified care needs.

At this inspection we found action had been taken to ensure people received a service which met their identified care needs. The provider had taken appropriate steps to improve systems to ensure good governance. Systems were in place to monitor the quality of the service provided and staff were supported in their work.

People and their family members were confident in the service provided. Staff were knowledgeable about how to protect people from the risk of abuse. Care plans and risk assessments had been reviewed and updated to provide staff with the information and guidance needed to care and support people safely.

People told us staff treated them with respect and their privacy and dignity was maintained while care was provided. Staff had knowledge about people’s care needs and how these were to be met. People received their medicines as prescribed and staff supported people to have their healthcare needs meet.

Before new staff started working for the provider checks were carried out. Induction training was in place to support new staff members. Induction training including spending time with experienced members of staff and getting to know people who used the service was in place.

People’s consent was obtained before care and support was provided. People and their family members were aware of how to raise concerns about the service provided with the manager.

Staff felt well supported and were complimentary about the management. Staff had received training to provide them with the knowledge they needed to support people safely. Meetings were held for staff to discuss the service. Staff attended regular one to one meetings and had their practice checked while they were providing care and support to people.

When we inspected the agency provided care for 61 people. We visited the agency office and spoke on the telephone with six people who used the agency. We also spoke with relatives of six other people who used the agency. We spoke with the registered manager, a team leader and three care staff. We looked at seven care plans and four staff files.

People we spoke with were complimentary about the care and support that they received. One person said: “They are prompt and they do their job fine.” Another person said: “They are very good.”

We found consent had been obtained from people before care had been provided. We also found that steps had been taken to ensure that people received individualised care. Care had been planned and delivered in a way that was intended to ensure people's safety and welfare.

People had been protected from the risk of harm and abuse because staff had received training. We found staff had a clear understanding of their roles and responsibilities with regard to safeguarding.

Staff had been recruited in an appropriate way and checks had been undertaken that ensured they were suitable to care for vulnerable people.

The provider had systems of audit in place to enable them to monitor the quality of the service provided to ensure that people received appropriate care and treatment.

As part of this inspection we visited the agency office. The registered manager started employment at the agency in April 2012. The registered manager told us that they were aware of the need to make some improvements to the quality of the service and they had a plan in place to do this. We saw that the agency had already begun making arrangements which would enable them to monitor the quality of the service.

We spoke on the telephone with two people who used the service and one relative. In addition to this we spoke with five members of staff who provided care and support to people who used the service.

We found that people had been involved in making decisions about their care and were satisfied with the care they received from staff. People we spoke with told us they felt safe when receiving care.

Care plans had been recorded for each person. This provided information for staff who visited them and ensured their individual needs would be met. When we spoke with staff they told us about the care people received and this matched the information in their care plans.

There were effective recruitment and selection processes in place. This ensured that people who used the service were cared for by staff that were suitably capable and competent.

This inspection took place on 27 and 29 May and 8 June 2015. The first two days were announced. We gave the registered manager 48 hours’ notice of the inspection. This was because the organisation provides a domiciliary care service to people who live in their home or a family members home and we needed to be sure someone would be available at the office. At the time of this inspection the agency was providing personal care to about 80 people.

At our last inspection in November 2013 we found the provider to be meeting the regulations we assessed.

There was a registered manager for this service who was available for the first two days of our inspection. 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 found a range of shortfalls which needed to be improved to ensure people received appropriate care and support. Systems to assess and monitor the service or to identify where improvements were needed were not always consistent. In some aspects they were inadequate and failed to ensure that people were protected from potential risks related to care being provided.

People told us they felt safe and had no concerns about the care provided by care workers at the agency. Care workers and office based staff had an awareness of different types of abuse and the actions they should take in reporting concerns about people’s care.

People who used the service were involved in planning their own care and support and agreed how they wanted their care to be provided. People were supported in aspects of their care such as the management of medicines to maintain their well-being. Care workers had a good awareness about the need to seek people’s consent prior to providing care and support. Care workers were aware of actions they needed to take if they identified concerns with people's healthcare or identified risks to their safety in their own homes.

People told us the care and support they received was from a consistent team of care workers and they usually visited at the agreed time. Care workers were recruited after checks were made about their suitability and training was provided. Some training needed to be improved to ensure care workers had suitable knowledge about people’s medical conditions to ensure their needs were fully met. In addition we found staff had not always brought to the attention of management particular training needs so that they were trained in the use of specific pieces of equipment.

People were complimentary about the management of the agency and felt their concerns would be listened to. They could make contact with the office if needed and were aware of how they could raise concerns about the service provided.

You can see what action we told the provider to take at the back of the full version of the report.