Mears Help to Live at Home Wiltshire is a large domiciliary care agency. It provides personal care to people living in their own homes in the community. It also provides care and support to people living in two ‘supported living’ settings, so they can live independently as possible. At the time of this inspection, Mears Help to Live at Home Wiltshire was supporting approximately 900 people over a large geographical area in Wiltshire.

The inspection was announced. We gave the service 48 hours’ notice of the inspection visit because we needed to be sure that the registered manager would be available. This was the agency’s first inspection, since its registration in June 2017.

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 registered manager was available throughout the inspection.

This service was registered in June 2017. This was because the Amesbury and Melksham branches of Mears Help to Live at Home Wiltshire both merged to become one service, with a new registered address in Devizes. The registered manager transferred from the Amesbury and Melksham branches.

The agency was the main provider for the local authority’s Help to Live at Home contract. To ensure sufficient staffing, the agency subcontracted some care to other services. In addition, staff sickness meant staffing levels were not always sufficient. The registered manager told us they were in a process of recruiting more staff.

People were not always happy with the timing and consistency of their visits. There were comments that staff were sometimes late arriving and they did not always stay for the allocated amount of time. The electronic monitoring schedule confirmed some inconsistencies in people’s visits were occurring. We recommended that the provider monitors the timing of support to ensure it meets people’s needs and expectations. A “cell track” system was used to monitor people’s visits and minimise the risk of missed calls. This was not always effective as a number of missed visits had occurred through system errors and double up visits had not always occurred for one person.

People’s medicines were not always safely managed. Instructions for medicine administration were not clear and staff had not always signed the records to show the person had taken their medicines. However provider’s audits had identified such shortfalls and improvements were being made. We recommended further monitoring to ensure staff supported people with their medicines safely, in line with current guidance.

Staff received a range of training. However, this did not include training related to people’s individual needs and complex medical conditions in all cases. We recommended this training is delivered based on current best practice. People were positive about the competency of staff who supported them regularly but told us when new staff covered the calls they were not always familiar with their needs.

Risks associated with areas such as nutritional needs and mobility had been identified and action taken to promote safety.

People had a clear support plan, which they were involved in developing. The information was clear and showed the support people needed to meet the required outcomes. Staff documented a summary of their visit within a communication log. However, much of the information within the log, was task orientated and did not demonstrate areas such as how the person presented. People were asked for feedback about the service they received during reviews of their care. More formally, surveys were sent on a yearly basis to enable people, their relatives and staff to give their views about the service provided.

People were encouraged