About the service: Managed Care Limited is a domiciliary care agency providing personal to people in their own homes. At the time of the inspection eight people were being supported by the service.

People’s experience of using this service: People and relatives praised the service they received from Managed Care Limited and said they were treated with kindness, compassion and respect. One person told us, “They are kindness itself.” A relative commented, “They [staff] are really quite special.”

We received positive feedback on how staff went over and beyond what they were expected to in order to provide a truly person-centred service.

People told us they felt safe and supported by staff who visited them. Staff knew how to recognise and report abuse and were confident any concerns raised would be responded to by the provider. Risk assessments were in place to ensure people’s safety. Recruitment procedures were in place to ensure the service employed suitable staff.

Staff were punctual and consistent at carrying out visits with people in a person-centred manner. One person told us, “They are pretty good with timings, they really are.” People were supported to continue living at home in a way that enabled them to be as independent as possible.

Risks to people were assessed and staff had a good understanding of how to mitigate any risks.

People’s medicines were administered by staff who had received training and competency checks to ensure they were competent to carry out the task. One person’s medicine had not been consistently administered in line with the prescribers instructions and dated when it was opened. We discussed this with the provider who told us they would address this.

Staff were trained and supported to be effective carers in a collaborative team. Staff supervision was not always recorded formally. The provider told us they would record this in the future.

Where needed, staff were quick to support people to have access to health care professionals such as GPs, district nurses and emergency services if required.

Care plans were created with people and relatives to ensure they were person centred and tailored to peoples’ needs and routines. Some of the care plans required additional information to enable an unfamiliar staff member to support them. Staff working for the service knew people, their needs and preferences very well.

People and relatives told us the service was responsive to their needs. One person told us, “I can’t rate them highly enough. All along they have been pushing me forwards and seeing things in advance, they are very positive.”

People, their relatives and staff were complimentary of the provider and their management of the service. The provider worked closely with people, relatives and staff and continually monitored the service.

More information can be seen in the main body of the report for each Key Question below.

Rating at last inspection: Good (report published October 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that the quality of service good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection was announced and took place on 6 September 2016. We gave the provider short notice of the inspection as we needed to make sure we were able to access records and gain permission from people who used the agency to telephone them or visit them in their own homes.

The last inspection of the service was carried out 9 May 2014. No concerns were identified with the care being provided to people at that inspection.

Managed Care Ltd provides is a small domiciliary care agency that provides personal care and support to people in their own homes. At the time of this inspection the service was providing support to six people. The agency offered people a range of hours of their choice. Support ranged from half hour drop in visits to assist people with meals to visits that supported people with personal care to accessing the community.

During our inspection the registered manager was present. The director was the registered manager of the agency. 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 and their relatives were very complimentary about the quality of the service provided and of the registered manager and staff team. They felt the care was exceptionally good. One person said, “Excellent service first class, we have received support for many years and it has always been the same”. The registered manager informed us they were proud of the standards of care it provided. The service worked in partnership with its clients, their representatives and allied professionals to deliver good quality services to people in their own homes. Staff monitored people's health and referred them to other healthcare professionals when needed

People and their relatives told us they appreciated the agency being small. It meant they always knew the people who were coming to support them in their homes. The registered manager also worked as part of the team. This meant people using the service felt that their care was monitored closely by people they knew and who know them well.

Staff had an excellent knowledge of the needs and preferences of people they cared for. All Staff spoken with were able to describe how they supported the people they visited. Staff were enthusiastic when they described how they tried to make their visits the highlight of a person’s day.

Staff had received training in safeguarding vulnerable adults from abuse. Staff told us they were aware of the risks of financial abuse. However the service required improvement to ensure records were in place to protect people and staff. Although independent audits had been recently carried out for one person, financial records had not been maintained at the time of the inspection for this person. Following the inspection the registered manager immediately implemented changes to financial recordings people using the service. They also stated all records would be audited on a monthly basis.

People who required support to take their medicines received support from staff who had received training in this area. However systems were not in place to ensure the administration of medicines were recorded. Although records needed to be improved for one person, the person said they had received all their medicines at the appropriate times. The registered manager told us future records would be kept of collection, storage and administration of medicines handled by all staff on behalf of people they were supporting. Whilst the registered manager took immediate and positive action it was reactive and not proactive.

Staff told us, and records seen confirmed that all staff received training in how to recognise and report abuse. Staff spoken with had a clear understanding of what may constitute

Managed Care Ltd, provides personal care and support to people living in their own homes. During our inspection we visited two people using the service. We spoke to two relatives, a district nurse and two members of staff.

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

People told us they felt safe receiving the service in their own homes. Safeguarding procedures are robust and staff understood how to safeguard people they supported.

People receiving the service spoke very positively about the services. One person told us they felt the service was “excellent, couldn’t be better” People using the service felt the small size of the service was a great benefit, they were always cared for people “they knew well and trusted implicitly”

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The registered manager worked closely with staff, people using the service, relatives and other professionals ensuring peoples needs were taken into account. This ensured that people’s needs were always met.

We spoke to a District Nurse who told us they had worked with the service for several years and found “Communications were very good, any problems were dealt with immediately”

We saw how staff received training, which reduced the risk of vulnerable people being abused and observed safe working practises during our visit.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in writing their plans of care. We were told that care needs were constantly monitored and kept up to date, with changing care needs taken note of.

We were told “Care is available at all times; all I have to do is contact the manager for any extra requirement”

Is the service caring?

People told us that they greatly appreciated the service being small, they felt the carers really knew them as individuals and this was reflected in how they went “that extra mile” to ensure people were receiving quality care.

We observed how the care given was person centred at all times.

We observed the staff were held in high regard by the people they cared for and their relatives. We were told “I know that even when I cannot visit my relative they are in the best hands possible” and “Their care enables me to have time for myself, so I can continue with activities I enjoy”

Is the service responsive?

People knew how to make complaints if they were unhappy with any part of the service.

We were told the manager was very easy to contact and a response was received very quickly without fail. One person told us they unexpectedly needed extra help for their relative and it was given straight away, “even though it was late on Christmas Eve.”

Is the service well led?

The service had a quality assurance system.

The manager and staff worked together to identify any problems and improve the service provided. People told us they were always listened to and consulted in any changes and felt totally confident in both the staff and management .

Managed care was a small domiciliary agency which provided personal care to five people living in their own homes. We visited one person in their home and spoke with another on the telephone. We also spoke with a relative of a person who used the service.

People we spoke with were very complimentary about the care that they received from the agency. One person said “It’s all pretty good and I know I get the care I need.” Another person said “There is nothing they could do better. I think I get the very best care.”

Everyone we asked said that carers always arrived on time but were flexible if required. One person said “If we need to go out to an appointment the carers adjust the times of visits to fit in with us.” This showed that the agency was responsive to the needs and wishes of people who used the service.

Each member of staff had a personal file which contained evidence of on-going learning and development. We looked at two staff files. We saw that staff had received training which included; health and safety, infection control, nutrition, first aid and safeguarding vulnerable adults. This ensured that staff were aware of up to date good practice and how to support people safely.

The systems in place to monitor quality were appropriate to the size of the agency. The systems monitored the quality of the service offered to people and ensured that practices were safe.

We visited three people in their own homes and spoke with one of the four members of staff. We then arranged to speak with the provider and view records at agency’s office on a separate day.

People who used the service said staff were always polite and respectful when assisting them. One person told us “They are all very respectful and protect your privacy.” Another person said “I always feel very comfortable when they are helping me with washing and dressing. They do everything they can to make sure that your modesty is protected.”

People told us they had been fully involved in deciding how their needs should be met. One relative said “We did the care plan together and have changed it over the years to fit in with our preferences.” Another person commented that there was a continuous dialogue between themselves and the carers to make sure that they had the care that suited them at the time.”

People spoken with were very happy with the care they received from the agency. One person told us “The carers and the service we get is excellent” another person commented “They do a really good job and have helped me to stay independent.”

People who used the service said that they always knew who was arriving to support them before they arrived. The agency only employed four members of staff and people said they received care from all staff. One person said “It’s such a small agency that I know them all well and they all know the help I need.”

People said they felt safe and relaxed with the staff who provided their care. We were told that all staff were “Polite and kind.” One person said “They are all very nice and I feel very safe with them.”

People told us staff always arrived on time and stayed for the allotted amount of time. One relative said “You can set your watch by them.” They also told us that the service could be flexible to meet changing needs or deal with emergencies.

The people we spoke with said that the manager regularly visited them to check they were satisfied with the care they received. One person said “I see the manager often and she always checks that I am happy with everything.” Another person told us “The manager does hands on care sometimes to make sure that the care plan is still right for us. She always asks for our views about everything.”