We inspected Live-in Comfort on the 17 December 2015 and this was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to be sure that people would be in the office that we needed to speak with. Live-in comfort supports people in their own home, including those with dementia type illness, physical disabilities, sensory impairment and / or medical (including terminal) illness. They provide staff who live with people to provide regular and consistent care and support to people who wish to retain their independence

and continue living in their own home. On the day of our inspection there were four people receiving support from Live-in Comfort.

The service had a registered manager. 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 service considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care

tasks before they proceeded. However there was no formal specific recording where someone may lack capacity to make day to day decisions regarding their care and support. This is an area that needs improvement.

Staff felt supported to carry out their roles and were in regular contact with the registered manager. Staff had received training relevant to the care and support they provided but some of this was not current and needed to be updated. We identified this as an area that needs improvement.

People were supported to have their nutritional needs met and there was detailed guidance in care records as to how to meet these. People were supported to access support from the appropriate health professionals.

Risks to people were assessed and monitored to ensure action was taken to avoid accidents and the deterioration of people’s health. The service had recruited a sufficient number of suitably qualified staff to meet people’s needs. Recruitment practice was robust and protected people

from the risk of receiving support from staff who were unsuitable.

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access to health care services when needed.

Staff had a very good understanding of respecting people within their own home and providing them with choice and control. The service had identified people’s needs and preferences in order to plan and deliver their care. People told us staff were kind and caring. One person said I’m very well looked after”.

There were clear lines of accountability. The agency had good leadership and direction from the registered manager. Feedback was sought by the provider. Survey results were positive and any issues identified acted upon. People and relatives we spoke with were aware of how to make a

complaint and felt they would have no problem raising any issues. In respect to the registered manager one relative told us they were “On the ball and has been a great help and guide”.

During our inspection we spoke with two people who used the service, two relatives of people who used the service, three care workers and the registered manager.

People told us that they received the care and support they required to meet their needs. They said that they were aware of what care was to be provided and were in agreement to it being provided. People told us that their care and support needs had been discussed with them and the care they received reflected this.

They also told us that the care they received was consistent and met their individual needs. One person said, "I'm very happy with the care and support I get. The carers are like family to me.” A relative commented, "The carers are all very good and very professional."

We looked at the systems and processes the service had in place to protect people from abuse. Staff knew what constituted abuse and what to do if it was suspected.

We reviewed the recruitment procedures that were in place and found that processes were thorough and well documented. Staff received regular training and supervision and felt valued and supported.

The service had effective systems in place to deal with people's comments and complaints.

People receiving support from Live-in-comfort benefitted from an experienced and dedicated management structure and care workers who were clearly committed to providing consistent and good quality care.

We found that comprehensive and well maintained care plans enabled care workers to meet people's assessed support needs in a structured and consistent manner.

Positive comments received from people receiving a service, or their relatives, indicated satisfaction with the care workers and the support services provided:

“I’m totally satisfied and have absolutely no complaints at all. The first class care and support that mum receives has transformed her life – she has been revitalised and seems to be getting younger”.

“I sleep easy in my bed at night with the peace of mind of knowing that she is being so well cared for. They are all very professional, I just can’t speak highly enough of them and I would recommend them to anyone”.

People using the service were protected, through robust policies and procedures and effective staff training relating to safeguarding vulnerable adults.

People had been supported by, suitably qualified, skilled and experienced staff. Appropriate checks were undertaken before staff began work.

The agency had systems in place to identify gaps in service delivery, draw up action plans to address the shortfalls and monitor the improvements.