The inspection was carried out on 18 and 23 August 2016 and was announced.

Leabrook Lodge is a domiciliary care agency that provides personal care and support to people living in their own homes based at Meadowbrook Court. Meadowbrook Court is a complex of 60 privately owned bungalows on one site. The service operates a 24hour on call system with a minimum of two staff on duty throughout the day and night. At the time of our visit the agency was providing the regulated service of personal care to 17 people. The frequency of visits and duration across the service varied dependent on individual needs and circumstances.

There was a registered manager in post who was present during the 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.

People were supported to remain safe in their own homes. Staff were knowledgeable about the different signs of abuse and who to report concerns to. Staff were aware of the risks associated with people’s needs and how to reduce these without restricting their independence. The provider ensured that potential new staff were suitable to work with people before they started working with them. There were enough staff to meet people’s needs in a timely manner.

People received support to take their medicines as prescribed and accurate records were maintained. Only staff who had received training in the safe administration of medicine could support people to take them. Staff knew what action to take if they found people to be unwell when they visited and would arrange health care as required.

People were confident in staff knowledge and ability to meet their needs. Staff received the appropriate training and guidance to meet people’s individual needs. Staff felt valued and listened to.

Staff sought people’s consent before supporting them. Staff explained things to people in a way they could understand to allow them to make decisions for themselves.

Staff were aware of people’s dietary needs and ensured they ate and drank enough to meet their nutritional needs. Staff prepared and served meals and drinks as required.

People were supported by staff who were caring and kind. Staff had formed positive working relationships with people. Staff talked with and about people with respect. People were given choices and involved in decisions about their care. Staff treated people with dignity and promoted their independence.

People received personalised supported from staff who knew them well. Staff provided individualised care that respected people’s needs and wishes. People received a flexible service which was responsive to changes in their needs or circumstances.

People had not had cause to complain but felt able to report any concerns to the registered manager and were confident they would take appropriate action. The provider had a complaints process and were able to demonstrate they would take appropriate action in the event of a complaint.

People knew the registered manager well and found them approachable. There was a positive working culture where staff and management worked together to meet people’s needs and wishes. The registered manager sought the views of people and staff to develop the service. The registered manager had checks in place to monitor and improve the quality of care.

At our last inspection in April 2013 we raised concerns with regard to the provider’s recruitment process. Not all pre-employment checks had been carried out before someone started work. We also found that the provider did not have a system in place to regularly assess and monitor the quality of the services provided and records we examined were not accurate and well maintained. The provider wrote to us and told us they would take action to address these concerns.

At our August 2013 inspection progress had been made with regard to an improved recruitment process and the development of regular audit systems to monitor the quality of the service. Records we sampled were accurate and regular reviews of people’s care planning documentation had been undertaken.

We spoke with two people who used the service and two relatives. We also spoke with five staff and the manager.

We visited to see if the service had addressed the issues identified at the last inspection in August 2012. We found little or no progress had been made despite an action plan telling us they had been completed by December 2012.

People were satisfied with the way that care was delivered. They were very positive about the staff that cared for them. Relatives were very satisfied with the agency. One person said they were, "Absolutely delighted with the service". They said staff and the manager were, "Fantastic", and always helpful.

Care plans detailed people's needs and how staff should deliver support. Staff knew what care people needed. Care plans and risk assessments were not always updated when people's circumstances changed.

People had prompt and appropriate access to healthcare professionals when necessary.

Staff files were now kept in the office but there had been no progress in making sure that effective recruitment systems were in place. People spoke highly about the staff and they were described as a, "Very good team, who do anything for me".

The service did not have any quality assurance or audit tools in place to enable the manager to monitor and assess the quality of the service. This meant that there were no systems to evaluate the agency's records or identify measures to reduce potential risk.

We spoke with four people who used the service, two of their relatives and four members of staff. All were very satisfied with the standard of care provided. They were involved in care planning and said it was provided in a way that was respectful.

People were treated as individuals. Staff were aware of some equality and diversity issues and took them into account when planning people's care.

Detailed care plans guided staff on people's preferences, equipment and how staff should deliver support.

People had access to health and medical care whenever necessary and systems were in place to share information with other services when people had to go into hospital or care homes.

People were confident about raising any concerns with the agency. The manager and staff were clear on procedures to keep people safe. People said that they felt safe with staff, however insufficient evidence was provided to demonstrate that appropriate recruitment checks were in place before staff started work.

There were no quality assurance systems in place so that the agency could find out what people who use the service think about it. There were no audit systems in place to evaluate the agency's records or identify measures to reduce potential risks.

Some but not all records about people were kept securely in the office and people had a copy of their own plan. However, care plans and risk assessments were not always updated when circumstances changed to keep people safe and well.