About the service: Manorcourt Homecare is a domiciliary care provider based in the town of Swaffham in Norfolk. At the time of this inspection approximately 140 people received personal care support from the service.

People’s experience of using this service: At our last inspection of this service in October 2017 we found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because some people had experienced either missed late or inconsistent call visits and did not see regular staff. Also, risks to people’s safety had not always been thoroughly assessed and systems in place to monitor people’s medicines had not always been robust. The provider sent us an action plan telling us what they were going to do to meet this regulation.

At this inspection we found that some improvements had been made and the provider was no longer in breach of this regulation. However, further improvements are required. The quality of care that people received from this service at the time of the inspection was mixed. The main areas that required improvement were as follows:

People did not always receive care that consistently met their needs and preferences. This was particularly in relation to the times they received their care visits. The provider was aware of this and therefore, more staff had been recruited to work for the service and the way people received their care visits was being reviewed. People’s feedback was mixed as to whether or not they could get hold of someone in the office when they wanted to.

The provider had systems in place to monitor quality such as regular audits but these had not always taken place as often as they should have done. This meant potential errors that had been made had not been identified and acted upon in a timely way to prevent people from the risk of receiving poor care. The registered manager was aware of this and had taken steps to improve the provider’s current monitoring systems.

Most people had received their care visits when they needed them. However, some had experienced missed visits which had resulted in an impact on them. We had been advised at our last inspection in October 2017 that the provider had recognised they needed to improve the way they monitored for missed and late care visits and were trialling new technology using electronic monitoring. However, this had still not been implemented some 16 months later for the benefit of people using the service.

Aspects of the service that were good were as follows:

People told us that they felt safe when the staff were in their home with them and the provider had ensured that systems were in place to protect people from the risk of abuse. Staff used good infection prevention techniques to protect people from the risk of the spread of infection.

The staff were well trained and their practice had been regularly assessed to ensure it was safe and appropriate. The provider had made sure that staff had been checked as having good character before they started working with people in their own homes.

Where the staff supported people to eat and drink and with their healthcare needs, this had been done to people’s satisfaction. The staff worked well with other health and social care professionals and organisations to ensure people received the care they required.

People received care from staff who were polite, kind and caring and who treated them with dignity and respect. Staff asked people for their consent before they provided care and where people were unable to provide their consent, staff acted in line with relevant legislation to up hold people’s rights.

Most people saw regular staff so they could build caring and trusting relationships with them. People had been involved in the planning of their care and could make choices about this. People received information about how to contact the service if they needed to.

There was an open culture where people and staff could raise questions o

The inspection took place on 25 September, the 9, 16 and 20 October 2017 and part of the inspection was announced. This was the first inspection on the agency since a change in its registration.

The service provides domiciliary support to people in their own homes. Most people are elderly but the agency are able to meet the needs of people over the age of eighteen. Support ranges from providing domestic help, personal care, social visits, sitting service and night sitting as appropriate.

At the time of our inspection 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.

The feedback we were given from people receiving a service was very positive. People generally felt they got a good service and said staff were well trained and kind. People reported some concerns with late running of calls and said they did not have regular carers but lots of different carers. People told us they got to know all the staff. The service had four recorded missed calls in six months. which had meant people did not always get the support they needed. We were informed prior to our visit that one person had not been given their medication as a result of a missed call.

There were systems in place to help ensure people always received their medicines as intended. The service had medication officers who supported people who required support to take their medicines. Their role involved collecting and returning medications. Auditing medication and dealing with any potential medication errors. They also supported staff in administering medication and assessing their competencies. We noted from the audits that missed signatures of the persons medication records had been identified on numerous occasions. We were made aware of several medication errors which had been reported to the local authority safeguarding team and an internal investigation completed so lessons could be learnt. For one person missed medication may have resulted in a decline in their health although there were other mitigating factors. However systems and processes in place at the time had not been sufficiently robust to identify the error sooner which could of resulted in avoidable harm.

Care plans instructed staff on how to care for the person and what support to provide. These were up to date taking into account any changes to people’s needs. However they could be more detailed which would help ensure a more consistent approach to care. For example it might identify that the person did not have smoke detectors but then did not go on to say how this was to be addressed or how this put the person at an increased risk due to other mitigating factors such as whether the person smoked in the property. Documentation could be in more detail to help the reader respond adequately to people’s needs.

We had a concern about people’s security. Personal data was not sufficiently protected particularly in relation to door entry systems. This was rectified immediately. When visiting people we were concerned about the security arrangements some of which had not been identified or documented as a risk. This was fed back to the registered manager for their consideration.

There were systems in place to protect people from actual harm and abuse and staff were familiar with actions they should take if they suspected a person to be at risk of harm or abuse. People’s safety was promoted within their homes because risks were assessed and steps taken to reduce the level of risk to people. Care plans included detailed of how to support people safely particularly with their manual handling requirements. Staff received training in all areas of practice before supporting people. This he