This announced inspection took place on 11 September 2018. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure someone would be available to speak with us. The service was last inspected on 24 February 2016 and was rated good.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It is registered to provide care and support to older people including those living with the experience of dementia, to younger adults and to people with a physical disability and/or learning disabilities. At the time of our inspection the service was providing personal care to 43 people.

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 2008 and associated Regulations about how the service is run.

There were policies and procedures for safeguarding people at risk of abuse and staff were aware of these. Risk assessments were undertaken to identify individual risks and any environmental risks so these could be addressed. People and relatives said they felt safe when staff provided care and support.

Recruitment checks were undertaken prior to staff being employed by the service to confirm they were suitable to work with people. There were enough staff to meet people’s needs and regular staff were allocated to people to ensure continuity of care.

The provider had policies and procedures for medicines management and staff received appropriate training prior to supporting people with medicines. Staff were trained in infection control and followed procedures to protect people from the risk of infection.

People were assessed prior to receiving care to help ensure their needs and wishes were met in a person-centred way. People received care and support from staff who were trained and supported.

People were supported with simple meal preparation if required and had received training in food hygiene. Staff knew what to do if someone became unwell such as calling the GP or the emergency services if necessary.

Staff received training about mental capacity and knew to report any concerns if they thought a person’s mental ability to make decisions for themselves was deteriorating. Where people using the service could make decisions for themselves, they confirmed staff respected their right to do so.

People and relatives said the staff were kind and caring, maintained people’s dignity and treated them with respect. Staff supported people’s right to make choices about their lives and supported them to maintain as much independence as they could.

Care records included the care and support people required and, where relevant, information about their lifestyles and interests and hobbies, so staff could speak with people about their interests.

There was a complaints procedure in place and people and relatives said they were confident to raise any concerns with the provider and that any issues they had raised had been addressed promptly.

People and relatives had confidence in the provider and were happy with the care and support people received and the way the service was being run. Staff felt well supported by the provider and enjoyed working for the service.

There were quality assurance processes in place for monitoring aspects of the service and these were effective. People’s care and support was regularly reviewed and people were asked their opinions about the service they received and given the opportunity to provide feedback.

The provider recognised the importance of working in collaboration with health and social care professionals to ensure all people’s needs were being met.

The managing director was involved with the community a

This inspection took place on 24 February 2016 and was announced. We gave the provider 48 hours’ notice because the location provides a home care service and we wanted to make sure someone would be available to speak with us.

The agency was registered with CQC since 13 May 2011. The last inspection took place on 21 January 2014 and the provider was compliant with the regulations we checked.

Lifestyle Care Services Limited t/a Home Instead Senior Care is a care agency that provides personal care and support to people living with dementia, learning disabilities and autistic spectrum disorder, as well as older people, people who misuse drugs and alcohol and people with an eating disorder, physical disabilities or sensory impairments.

On the day of our inspection, the agency provided support for 61 people out of which 38 were receiving personal care.

There was a registered manager in post, who had been managing the service since June 2011. A registered manager is a person who has registered with the CQC 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 registered manager was supported by a director who was the owner of the company and a deputy care manager as well as an administration team that consisted of a care workers’ coordinator, an in-house trainer and a community developer. At the time of our visit, the agency employed 47 care workers.

All people using the service and family members we spoke with told us they were happy with the agency and they described it as caring and responsive.

The agency had effective safeguarding procedures and people using the service were protected from harm and abuse. The agency assessed risks to people’s health and safety. Care workers had access to risk management plans that gave them guidance on how to mitigate/manage these risks.

The agency managed people’s medicine in a safe way and ensured any changes to people’s medicine were promptly noted and addressed. Any medicine errors were reported and investigated.

The agency had a rota system to ensure all care workers knew who they were assigned to visit that week and that all care workers’ planned absences were covered. People said they received regular support from the same care workers and the agency informed them if a different care worker was to attend instead.

The service had robust recruitment procedures to ensure only suitable care workers were appointed to work with people who used the service.

Care workers had sufficient skills and knowledge to provide effective support for people they cared for. Newly appointed workers received induction training before they started working unsupervised. All care workers were required to repeat trainings that the agency considered mandatory on a yearly basis.

Care workers received effective support in the form of regular one to one meetings, yearly appraisals, spot checks of their work and by attending team meetings.

The agency followed the principles of the MCA 2005. The agency discussed people’s mental capacity and encouraged people to make their choices where possible.

The agency carried out initial assessments in which they gathered all information on peoples care needs, health and wellbeing and personal likes and dislikes.

The agency had introduced a variety of systems to ensure that people were involved in planning of their care, they were encouraged to give feedback on the service they received and to take part in the activities organised by the agency.

People told us that care workers, who supported them, treated them with dignity and respect while providing personal care.

The management team introduced a matching service, which enabled them to match a care worker to a person, based on certain attributes. By doing so, the agency encouraged development of las

At our inspection on 30 October 2013 we found that systems for the safe management of people's medicines were not effective and did not ensure that people were protected from the risks associated with medicine errors. For example, staff lacked understanding of the procedures and the differences between prompting people to take their medicines and administering them. In addition to this we found that not all care records contained a signed medicines agreement and not all of the records contained details of the medicines people were taking. We found that there was limited information in people's care records about the assistance they required with their medicines or the risks associated with this. Therefore staff did not have full information about the support people needed or the action they should take to minimise any risks in relation to medicines to ensure people were protected from unsafe care. We also found that the daily log sheets and medicine administration record sheets and were not clear in relation to what medicines were being administered or when they were being given.

Following our inspection the manager submitted an action plan telling us what action would be taken to ensure these issues were addressed. The manager told us that the service would be fully compliant by 19 December 2013.

During this inspection we found that systems had been improved to ensure staff understanding and found more detailed recording in relation to the support people required and received in relation to their medicines.

We spoke with the provider, the manager, five care staff, four people who were using the service and two relatives. We found that people and/or their representatives were asked for their consent for any proposed care or support. People told us that they were able to make decisions about their care and said that staff listened to them.

People's needs were assessed and a personalised care plan developed that detailed their individual preferences, likes and dislikes. People told us that staff were polite and respectful when providing care for them. For example, one person said, "they [staff] are very respectful." Another person told us staff were, "perfectly adequate and very caring." All of the people spoken with told us that they had named staff who visited regularly and knew their needs.

There were effective recruitment systems in place to ensure that staff were suitable to work with vulnerable people and the service had quality monitoring systems in place to identify and address any areas for improvement based on the views and experiences of staff, people using the service and their relatives.

People were not protected from the risks associated with the unsafe management of medicines as instructions for staff in relation to the support people required with their medicines were unclear and medicine recording systems were ineffective.

We visited the service because we had received information that the service might not be complying with essential standards of quality and safety. In particular concerns were raised about staff training especially in relation to moving and handling, poor communication leading to neglect of the people using the service, inadequate recruitment checks and poor support for staff.

We spoke with the provider, three members of staff and two people who use the service. People's needs had been assessed and a care plan developed detailing what action staff should take to meet them. Care plans included information about people's individual preferences, likes and dislikes. The care records had been reviewed at regular intervals and updated to reflect people's changing needs.

Systems were in place to ensure that people were supported with medicines safely and any risks associated with the storage and administration of medicines were being managed to ensure these risks were minimised.

Recruitment checks were undertaken before staff commenced employment to ensure that they were suitable to work for the service.

Staff received support and training to enable them to meet people's needs effectively.

We carried out a themed inspection looking at domiciliary care services. We spoke with nine people who received a service from this agency or their relatives over the telephone and visited three people in their own home and spoke with them and their relatives about their experiences of the support they have received. We spoke with senior staff and five care workers to get their views about the way the agency operated.

All people who use the service and relatives who spoke with us reported that they were involved in drawing up and reviewing care plans and in making decisions about the care and support people received. People said their care workers showed respect when engaging with them and maintained their privacy and dignity. One family member said “they look after my relative well and cheer them up”. A person using the service said “staff promote my independence and show respect to me in every way”.

Most people and relatives said they could report things to the agency and these would be taken seriously and addressed. One relative said on the occasion when they had a small problem the agency listened to them and things were changed. Another said the agency acted promptly when they reported that a care worker was not turning up and the matter was immediately resolved.

The provider had some governance arrangements to ensure that the agency provides a quality service. For example there were satisfaction surveys and annual audits. We however found that the monitoring of accidents and incidents and the agency’s complaints management system was not that effective to ensure that learning took place to improve the quality of the service provision.