This inspection took place inspection on 23 and 27 February and 15 March 2018. The first day of the inspection was unannounced.

Knowsley Homecare Associates provides care and support to people living in their own homes and assists people to access the local community. At the time of this inspection the service were supporting approximately 200 people. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to adults of all ages and young people.

Not everyone using Knowsley Home Care Associates receives a 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 personal care is undertaken we also take into account any wider social care provided.

A registered manager was 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 last inspection of the service was carried out in March 2015 and at that time the service was rated as good overall. During that inspection a breach of Regulation 12 of the Health and Social Care Act 2008 was identified as systems were not in place to ensure that people received their medicines safely. During this inspection we found that improvements had been made and the service was no longer in breach of this regulation.

We have recommended that a regular review of people’s care planning documents takes place to ensure that up to date consistent information is recorded. This recommendation was made as not all of the information in people’s care plans was consistent.

We have recommended that the monitoring systems in place are kept under review to ensure they remain effective. This recommendation was made as the current quality monitoring systems had not always identified areas of improvement.

People were supported to have choice in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We saw that policies and guidance were available to staff in relation to the MCA.

People told us that the staff were very caring. They told us that staff met their needs and had sufficient training to enable them to carry out their job. Staff received regular support and supervision from a senior member of staff.

People, a family member and carer told us that they were listened to by the staff.

People felt safe using the service. Policies and procedures were in place in relation to safeguarding people from abuse. People’s care planning considered risks to people and in most situations, plans were in place to minimise these risks.

Procedures were in place for the effective management of infection control. Staff had access to supplies of protective aprons and disposable gloves to promote safe hygiene practices.

Recruitment practices helped ensure that only people suitable to work with vulnerable people were employed by the service.

Sufficient numbers of staff were employed to meet the needs of people supported. All staff received an induction and had the opportunity to ‘shadow’ an experienced member of staff prior to lone working with people.

People had access to and were aware of the services complaints procedure. A system was in place to manage and monitor complaints and compliments about the service.

People told us that staff always asked if they were ok and happy with the service. In addition, regular reviews and ‘spot checks’ were carried out by a member of the supervising team to help ensure that people received the care and support they required.

People were supported with their eating and d

We spoke with four people who were receiving support from Knowsley Home Care Associates and invited them to share with us their experience of the service. As part of our inspection, we also had the opportunity to speak with two relatives. All were positive about the service they received. One person told us, “The carers are marvellous and they are always on time.” Another person said, “I am happy with the help I get and feel safe.”

The relatives we spoke with expressed a satisfaction with the service. One relative told us, “The carers are reliable and get on with my mum very well.” Relatives said both the office and care staff communicated well and kept them informed of any changes.

Effective recruitment procedures were in place and sufficient numbers of staff were available to provide the support people needed.

A complaints procedure was provided to people receiving a service and/or their relatives. Complaints were managed effectively.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they could make choices about their care. The inspection team was led by a CQC inspector and joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We carried out 18 telephone interviews, four home visits to people who used the service and to their main carers (a relative or friends) to gain views about the service. We also spoke with the manager and ten of the staff members who work for the agency.

People told us that CASA Knowsley provided good quality care and offered a reliable service. People spoke positively about their care workers and that they fully supported their care needs. People also said that their care workers spoke with them in a calm and respectful way which respected their dignity.

People we spoke with told us they were given choices as to what they needed care staff to do for them. They said that they were involved in making decisions about their care and support package and they understood the choices available to them. Comments included; ‘They always ask me for consent, they are lovely’, ‘Staff are sensitive and I feel comfortable with them.’

People told us that an assessment of their needs had been carried out when they started receiving support from the agency. This had then been used by the staff and with the person to produce a care plan and risk assessments for them to work to. Everyone we spoke with said they had a care folder with all the details of their assessments and plans. Comments included, ‘I have no worries or concerns about the girls [carers], they don’t rush me and always treat me with respect and dignity’, ‘[I am] Regularly asked if I need anything else.’

People confirmed that they felt safe with the carers who were visiting them and did not feel in any way threatened or concerned when the care workers were around. During the home visits and telephone calls they told us they were respected and listened to. They knew they could speak with a senior or the manager and would have no problem doing so if they had any concerns.

All of the people we spoke with made positive comments about the staff members who supported them. They felt that the staff possessed the knowledge and skills to care for them effectively, which was allied to a positive attitude towards their role. People were complimentary about the level of understanding of the staff concerning their care needs and the quality of the care/support provided by them. Comments included, ‘They know what they are doing’, ‘They do things the way I want it.’

People told us they were regularly asked if they were happy with the care and the service provided. They thought the agency was open to suggestions and actively sought views to help and improve the service provided. Some people had completed feedback forms about their care and support and had also had reviews where their views about the service had been obtained. One of the people we contacted by telephone said, ‘If I had a problem I would ring the office, they have phoned to check if all is ok, a senior has visited too.’

This was an announced inspection carried out on 7 January and 3 March 2015.

Knowsley Home Care Associates known also as CASA Knowsley is a domiciliary care agency providing personal care and support services to people living in their own homes. The agency operates from an office in the Huyton area of Liverpool and provides a service in the local area and other areas in Merseyside. At the time of this inspection the service was supporting approximately 136 people within their home and the local community with personal care.

During our previous inspection of the service in November 2013 we found that the service was meeting the regulations we assessed.

The service had a registered manager who has in post since May 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.

During this inspection we found that improvements were needed as to how the service managed people’s medicines. This was because the current systems in place did not always protect people from the risk of not receiving their medicines appropriately.

People told us that the staff were very caring. They told us that they had a core team of staff going into their homes which was good because they got to know them as friends as well as carers. They told us that staff met their needs and had sufficient training to enable them to carry out their job.

People and their relatives told us that they were listened to by the staff and that they felt that staff were like family and that they could speak with them.

Policies and procedures were in place in relation to safeguarding people. Staff spoken with demonstrated a good understanding of what action they needed to taken in the event of a person being at risk from harm.

Recruitment practices helped ensure that only people suitable to work with vulnerable people were employed by the service.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw that policies and guidance were available to staff in relation to the MCA. However, we saw that improvements were needed to ensure that the MCA was fully implemented to support people in their decision making if needed.

People had access to the services complaints procedure. A system was in place to manage and monitor complaints and compliments about the service.

Systems were in place for the service to monitor the quality of the service that people received.