This inspection visit took place on 7th November 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection around 100 people were using the service.

There was no registered manager working at the service. They had recently resigned from their 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 service was being managed by the care manager who had been working for the service for several years. Their intention is to put in an application to register as the manager soon.

At the last inspection of Manorcourt Care Watton, we rated the service overall as good. We did however ask the provider to make improvements in some areas. These were in relation to being more responsive to people’s preferences regarding the times of their care calls and to ensure that all appropriate guidance was in place for staff to follow in relation to meeting people’s needs. At this inspection we found the required improvements within these areas had not been made. Therefore, the overall rating for the service had now been changed to requires improvement.

Systems were in place to protect people from the risk of abuse and there were enough staff to cover people’s care visits. No care visits had been missed within the last three months. Improvements had been made to staffing levels and the manager was actively looking to improve the scheduling of calls to meet people’s preferences with regards to the times they received them.

People were supported by staff who were kind and caring. They treated people with dignity and respect. Where supported with eating and drinking, the staff made sure people received enough to meet their needs.

The staff took good precautions to protect people from the risk of infection and people received their medicines when they needed them. The auditing of this area had recently improved.

Consent had been obtained from people in line with the relevant legislations and when required, they had been supported with their healthcare needs.

People had been involved in making decisions about their care and had access to information on how to complain. People gave us mixed views as to whether they felt listened to and their complaints dealt with to their satisfaction.

Staff had received enough training and supervision to provide people with effective care. They were happy working at the service and felt supported. There was an open culture where they and people could raise concerns without fear.

Although people were happy with most aspects of the support they received, some again told us their care calls were made at inconsistent times which had an impact on their lifestyle and wellbeing. People’s care needs had been assessed and in most areas, there was clear guidance for staff to follow so they could provide support that people needed. However, there was a lack of information in relation to how staff should deal with catheter, stoma and diabetic care which increased the risk of people receiving inappropriate care.

The provider’s governance systems had not been effective at ensuring that these areas had been improved adequately since our last inspection. Also, they had not identified that some incidents had not been reported or investigated appropriately. This was a lost opportunity to learn from incidents. There was a new manager in post. They had recently made some changes to the current systems used to monitor the quality of care people received which demonstrated some improvements. These now need to be consistently applied across the service.

This was an announced inspection that took place on 25 February 2016 and 03 March 2016. On 25 February 2016 we visited the central office of the service and on 03 March 2016 we made phone calls to people who used the service to obtain their feedback on the care that was being provided.

Manorcourt Homecare is a service that provides personal care to people in their own homes. At the time of the inspection, 150 people were receiving care from the service.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

People received care from staff who were kind and caring and who treated people with dignity and respect. The staff were well trained and the provider had systems in place to protect people from the risk of abuse. There were enough staff to meet people’s needs.

People received their medicines when they needed them and staff asked them for their consent before providing them with care. The staff acted within the requirements of the Mental Capacity Act 2005 when providing care to people who were unable to consent to it themselves.

People’s care needs had been assessed and were being met. However, staff sometimes did not provide care at people’s preferred times. Information was not always in place to guide staff on what care they needed to provide to meet some people’s specific needs.

The systems in place to monitor the quality of service being provided were effective. Audits had been conducted that had identified improvements that were required to the service and these were being worked on.

The staff were happy working for the provider and felt supported in their role. The provider had promoted an open culture where both staff and people using the service could raise concerns without any hesitation. People knew how to complain and any complaints were investigated and responded to.

We spoke with people using the service and their relatives who told us that staff consulted them and respected and acted on the decisions they had made about the care and support they agreed to.

We found that improvements had been made to the plans of care held in the office and a person’s home and that they now contained the same information. We saw that they contained the information staff members needed to ensure that the health and safety of people was promoted.

People using the service told us that they had received the care and support they needed and that staff were excellent.

We saw that the people’s individual medication was available and monitored and found that it was administered and recorded accurately and safely.

People using the service told us that staff members were kind and respectful towards them. They said that sometimes the time of their visit could change and that staff were occasionally in a hurry and under stress due to the number of additional people that they had to visit. We saw that additional staff members were in the process of being employed.

People using the service and their relatives told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people using the service.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care.

We used postal surveys, telephone interviews and home visits to people who use the service and to their main carers (a relative or friends) to gain views about the service.

We visited five people in their own home as part of this review and spoke with them and one relative about their experiences of the support they had received. We spoke with senior staff at the time of our visit, one care worker out in the community and three care workers who were meeting their training assessor in the office.

We spoke over the telephone with 22 people who received a service from this agency. The majority spoke positively about their care workers and felt that nearly every staff member fully supported their care needs. They told us that all their care workers spoke with them in a pleasant, calm and respectful way.

Most of the people we spoke with told us that their care was personalised to their needs. They told us the care workers would use their preferred names. In most cases, people were happy that their care workers. However, a minority of people felt some less experienced staff only did a “fair job” and that some of the visits were not always carried out in a timely manner when one visit may be late and then the next too early.

The people we visited told us about their care plan and although they were not wishing to be involved in the content were happy with the care provided. They told us that they received calls from the office about their care to ensure they were receiving what was expected and that a senior care worker visited on occasions to update the paperwork. One person told us “I can call the office at any time if I need my care changing.”

Most of the people felt that staff were well trained and understood their needs. However, we did receive a comment from a relative which suggested that staff could do with some additional training as some were not so good at clearing up and wiping down surfaces.

People told us that they felt safe, and if they had any concerns they would speak with a family member, friend or somebody from the office.