About the service: Mears Care Kings Lynn is a domiciliary care agency that was providing personal care to 254 people at the time of the inspection.

People’s experience of using this service:

People felt safe with care staff and care staff understood how to safeguard people from harm.

There was guidance for staff on how to manage risks associated with people’s care and support.

There were enough staff to meet people’s needs. Care visits were occasionally late if they had to be covered because of staff absence. Any issues with staff attending visits late were addressed to improve attendance for the future.

Medicines systems were organised, and people were receiving their medicines when they should.

Staff were provided with equipment such as gloves and aprons and understood how to prevent and control the spread of infection.

Accidents and incidents were monitored and reviewed so that action could be taken to make improvements for the future.

People’s care needs were holistically assessed and included information about health needs, eating and drinking and mobility.

Staff received the training they needed to carry out their role.

The service worked well with other professionals to improve the health and wellbeing of people using the service.

People were 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 supported this practice.

People told us that staff were kind and caring and respected their privacy and dignity.

The service responded to people’s needs and supported people to maintain their independence.

There was a robust complaints procedure in place.

The service was well run, managers were respected and there were systems in place to monitor the quality of care.

There was an open and honest culture where people felt listened to. Feedback from people and staff was used to improve the service for the future.

Rating at last inspection: At the last inspection this service was rated good. (Report published 19 October 2016)

Why we inspected: This was a scheduled planned inspection based on the previous rating.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rating requires improvement.

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

This announced inspection was carried out on 14 September 2016. Mears Care - King's Lynn provides support and personal care to people living in their own homes in west Norfolk. The provider informed us prior to the inspection there were 309 people using the service who received personal care.

The service had a registered manager in place at the time of our inspection. 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.

At our last inspection on 3 April 2014 we asked the provider to take action to ensure people’s risk assessments and care plans included information to reduce the risk of people receiving care that was inappropriate or unsafe. During this inspection, we found that the provider had taken appropriate action and improvements had been made.

People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent and risks were mitigated in the least restrictive way possible.

People may not receive their care appointment at the time or for the duration they expected. People could not be assured they would receive the support they required to take their medicines safely.

People were provided with the care and support they required by staff who were trained and supported to do so. People provided consent to their care when needed but they may not receive the support required by the Mental Capacity Act 2005 if they were unable to make a decision for themselves.

People were supported to consume a sufficient amount of food and fluids that promoted their wellbeing. People received support from staff who understood their health needs.

People were treated with respect by staff who demonstrated kindness and understanding. People were involved in determining their care and support. They were shown respect and treated with dignity in the way they wished to be.

People were able to influence the way their care and support was delivered and they could rely on this being provided as they wished. People were informed on how to express any issues or concerns they had so these could be investigated and acted upon.

People who used the service and care workers were able to express their views about the service which were acted upon. The management team provided leadership that gained the respect of care workers and motivated them as a team. There were systems in place to monitor the quality of the service and make improvements when needed.

Mears Care - King's Lynn is a large domiciliary care agency that provides personal care to about 450 people living in their own homes and in supported living in the King's Lynn and surrounding areas. There is a registered manager in post

Staff had been given training about how people should be treated with kindness and how to promote peoples dignity, respect and privacy. People who used the service told us that staff treated them with dignity and respect and when they had raised any concerns they had been dealt with effectively. . One person told us, "They are always kind and gentle and never rush me when giving me care. Another person told us, "They (the carers) show a lot of respect and are very polite".

Although staff had received training during their induction on the Mental Capacity Act 2005 not all of them had a good working knowledge of what this meant for the people they worked with. This meant that staff may not always be aware if people needed support with making decisions about things that affected them

All of the people that we talked with who used the service told us that they felt safe and that they would know what to do and who to contact if they thought they had been mistreated in any way. There were systems and processes in place to reduce the risk of people suffering any abuse.

In line with the provider’s procedures all incidents and accidents had been reported to the safety, health and environment team, investigated and if necessary action taken to reduce the risk of accident or incidents reoccurring.

Staff had the support, skills and competencies they required to meet people’s needs. Care staff told us that they could request extra training for example, they had previously requested training for working with people living with dementia and this had been arranged. New staff had been given the appropriate time to get to know the people they would be working with before they were expected to work on their own.

People had been involved in the planning of their care. Important information about people’s history and preferences, which helped the staff get to know people and how they would like to be cared for was recorded in their care files. However, the written information provided about how staff should support people and how risks should be minimised varied in the style and the amount of detail according to which member of staff had completed it. This could lead to people receiving inconsistent care and support because of lack of information or guidance. The shortfalls we found breached one of the health and social care regulations, and you can see what action we told the provider to take at the back of the full version of the report.

Staff had received training in the administration of medication and had been made aware of the agency’s policies and procedures. However we found that these were not always being followed to ensure that people received their medicines in a safe manner

There were effective systems in place to monitor and improve the quality of the service provided, which took into consideration the views of the people who used the service. The agency had sent out detailed person centred questionnaires for people who used the service. It not only looked at the service the agency was providing but all other aspects of the person’s life. The agency had been working through the responses and, even where they were not directly responsible for issues of concern that had been raised, they had tried to provide support to improve the quality of life for people. Staff felt that they could discuss any concerns with the manager and that there was an open culture within the agency (or service).

The manager was aware of the risk of social isolation to people and had arranged a "service user’s forum" so that people who used the service could come together and meet other people and socialise.

During our inspection on 27 June 2013 we reviewed 10 people’s care plans and records. We found that they did not always contain detailed information to aid and prompt staff to deliver safe care and support to people using the service with specific health care needs. In some of the care records we looked at we saw that it had been risk assessed that two staff members were required at each care call. However, in the daily notes reviewed, we could only evidence that one staff member had attended the care call. This meant that we could not be sure that two staff members had attended the care call as required.

Some of the people we spoke with told us that the provider did not always inform them if their care call was going to be delayed and that this was not their preference.

The provider wrote and told us that improvement actions would be undertaken by 01 November 2013.

During this inspection on 19 February 2014, we found that the provider had taken remedial action and had made the improvements required.

To gather feedback from people who used the service we spoke with 26 people and 11 relatives/carers of people using the service by telephone. We also sent out a questionnaire which was completed by 18 people who used the service and 11 relatives/carers. The majority of people told us that they had positive comments about the care and support they or their relative received. One person told us, “I am quite happy with my care, it is regular and very good, no problems at all.” Another told us that, “They (staff) help me keep my independence, I get on with them all.”

We reviewed 10 people’s care records and found that they did not always contain up to date and detailed information in them for staff to deliver safe care and support to people who used the service.

During our inspection on 26 July 2012 we found that the Medication Administration Records (MARS) we saw did not evidence accurate documentation to ensure that people were protected against the misuse of medication. During this inspection on 25 June 2013, we found that the provider had made the required improvements to the recording of medication administration.

The provider had an effective staff recruitment process in place to make sure that people received support and safe care from suitable, skilled, and knowledgeable staff.

Quality assurance procedures were in place for monitoring the quality of the service delivered to ensure that people consistently received safe care and support.

Concerns were raised by relatives of people who use the service and they told us that people were not appropriately protected, as some staff did not have their CRB (Criminal Records) checked before they started working with people. They also told us that people who were confused were not appropriately and fully supervised to eat or take their medication safely. Relatives also claimed that records kept in people’s homes were not sufficient to ensure their safety.

We spoke with a person in their own home and they told us that their carers were good and that they trusted them. They stated, “They are good, but I am not”, referring to their health. They could not remember who was giving them the medication or when. They knew their carers by name and told us that carers were there, with them, when they needed them.

We collected the views and experiences of people who use the service from the agency’s own quality review, compliments letters and complaints. This analysis showed that the majority of people were happy with the service. Several comments praised individual care workers.

Family members of people who use the service commented in more detail about the service, about particular procedures and the comments we saw were positive and cooperative.

We also checked several complaints that had investigated and responded to. These records contained communication details between the service and people who had made a complaint, which showed that people who use the service and their relatives, care workers and the management of the agency work together to resolve any potential problems.

People said that staff members were polite, kind and respectful. They confirmed that their privacy and dignity was respected.

People received the care and support they required to improve their health and well-being. Care records were written and provided adequate guidance to staff members, who knew people's needs well.

People said that they felt safe and that they were happy using the service provided by Mears Care - King's Lynn. They confirmed they would be able to raise concerns with staff members and stated that they felt sure action would be taken. Staff members had an appropriate understanding of their role in reporting abuse and how to support people if this happened.

People received their medicines in a safe way, although medicine administration records were not always appropriately maintained to ensure medicines could safely be given.

Staff members received supervision and training from the provider or from external sources to ensure they had the skills and support to properly carry out their roles and care for people.

There were systems in place to regularly check and monitor the way the service was run.