This inspection took place on the 16 October and 17 October 2018 and was announced. We spent one day at the office, and made telephone calls to people.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. On the day of our inspection, there were 40 people using the service, all of which received personal care.

At the last inspection on the 20 March 2018, we rated this service as requires improvement overall. We found breaches in regulation under the Health and Social Care Act, 2008. This was because risk assessments were not always in place and people’s medicines were poorly managed. There were insufficient staff which affected the quality of care people received. People’s needs were not always assessed and care plans were not detailed. The provider did not have a robust governance processes in place to mitigate concerns about the safe running of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe, effective, caring, responsive and well led to at least good. At this inspection we found the registered provider had improved and was now good overall.

At the last inspection, the registered provider had struggled to recruit enough staff, which had affected, on the quality of care people received. At this inspection this had improved, and people told us staff arrived on time when they should have done and stayed for the agreed amount of time.

The service has 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 and associated Regulations about how the service is run.

Staff had a good understanding of how to manage medicines, and safeguarding matters. People's received their medicines in the right time and in the right way. There was enough staff available to ensure people's wellbeing, and safety. People told us staff turned up on time and stayed for the duration. A robust recruitment and selection process was in place.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff were kind and caring and had developed good relationships with people using the service. Relatives confirmed staff looked after people well. People were provided with the care and support, they needed to stay independent.

People were involved with care planning. Staff knew people well and were aware of their personal histories. People who used the service felt they were treated with kindness and said their privacy and dignity was respected. Positive relationships had developed between people and the staff that supported them. Information included guidance for staff so they could follow a structured approach when supporting people to live their day to day lives.

Surveys were carried out to seek the views of people who used the service. However, this information was not used to continuously improve the service and to make improvements. Spot checks, and care planning review meetings were carried out on a regular basis, but the audit process needed to be developed to ensure robust systems were in place, that monitored the quality of the service.

Further information is in the detailed findings below.

At the last inspection in January 2016, the service was rated Good. At this inspection, we found the service requires improvement.

MD Care Limited provides a domiciliary care service for people living in their own homes. It provides a service to older adults. The inspection took place on the 20 March 2018 and was announced. This was to ensure that someone would be at the office to meet with us. At the time of our inspection, 34 people were receiving personal care and support from the service.

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 and associated Regulations about how the service is run.

Staff did not always have the correct information to enable them to care for people in a safe way. Risk assessments were not always in place, or sufficiently detailed and people had not been involved in developing and reviewing their care plans.

The management of people’s medicines needed to improve to ensure that people received their medicines in the correct way. Staff had not always had supervision to support them in carrying out their role effectively.

The provider had struggled to recruit and retain a sufficient amount of staff, which affected the quality of care people received. People told us that staff did not always turn up on time and that they did not always know who would be coming. Staff needed training in specialist areas to make sure that they were competent to provide care to people who had specialist needs.

People’s needs were not always assessed and care plans lacked sufficient detail. There was not enough information for staff to understand about people’s preferences and choice. Care plans did not include information about how people's health condition may affect their wellbeing, nor what staff should do in the event of an emergency. Information about people’s end of life wishes lacked detail, and so staff may not have always had the guidance needed to be clear about how to support people in the best way, at the last stages of their life.

People had not always signed to show that they had consented to their care arrangements. When people had a pre-existing health condition that may have affected their capacity to make day to day decisions, this had not been recorded.

The service was not meeting the Accessible Information Standards by ensuring people’s sensory and communication needs were met. We recommend that the registered manager apply these standards.

People told us office staff did not answer telephone calls and that when they raised concerns these had not always been resolved. The provider did not regularly assess or monitor the quality of the service provided. Feedback from people, their relatives and staff was not used to make improvements to the service.

Staff were caring and people told us they were kind and respectful towards them and their property. People told us they felt safe when receiving care and support. Systems were in place to protect people from abuse and harm.

Kare Plus Ltd provides personal care to adults in their own home. It also provides a recruitment service, supplying staff to the adult social care sector. This element of the service, although provided by Kare Plus Ltd would not need to be registered with the Commission. We focussed our inspection on the people in receipt of personal care only. On the day of our inspection there were 22 people using the service.

There is a registered manager at this location. 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.

A robust recruitment process was in place which made sure people were suitably recruited and helped to protect people from the risk of unsuitable staff. Staff were supported to develop their skills and knowledge and there were enough staff to meet people’s needs and to manage risks safely.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. People were supported to consume food and drink of their choice and staff worked well with people and health care professionals, to ensure people maximised their health and wellbeing.

People and their relatives knew how to make a complaint and were listened to by the registered manager. The service had links with the local community and undertook fund raising to support local causes.

Staff were enthusiastic about working for the service and worked well as a team. Systems in place to check the quality of the service.

Most people did not require assistance to help them take their medicines. When they did they were supported by trained staff who understood their responsibilities.

Staff were trained and encouraged by the provider to continue to progress with their learning and complete further qualifications. Staff were regularly supervised and had an annual appraisal.