The inspection took place on 23 and 25 April 2018 and was announced.

Medacs Healthcare Old Trafford (Medacs) is a domiciliary care agency providing personal care to people in their own homes. It provides a service to adults and to children of all ages.

Medacs is also a provider for Trafford Council’s Stabilise and Make Safe (SAMS) project which is a short term service. As part of the SAMS project, Medacs provide a three night service whereby care staff, who are trained on completing risk assessments, undertake an assessment of a persons’ care needs. At the end of the three nights support and assessment they provide information to the council social work team about their assessment of the care the person requires.

On the date of our inspection the service was providing care and support to approximately 371 people in three local authority areas.

The service had a registered manager who was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During the last inspection of Medacs Healthcare Old Trafford in March 2017 we found there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; care plans not always meeting the needs of the people who used the service, the provider not doing all that was practicable to reduce the risks caused by missed visits to people who used the service and the provider not adequately assessing, monitoring and mitigating the risks to the health, safety and welfare of people because of the missed visits.

Following the last inspection of March 2017 we asked the provider to take action to make improvements. The provider sent us an action plan informing us that they had taken action to ensure the Regulations had been met. During this inspection we found the provider had complied with the previously breached Regulations.

Systems had been put into place to monitor and reduce the number of missed visits to people who used the service.

People's care records contained enough information to guide staff on the care and support required. The care records showed that risks to people's health and well-being had been identified and plans were in place to help reduce or eliminate the risk. Assessments were also undertaken around risks associated with general safety issues within people's homes.

We found that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse.

We found people were supported by sufficient numbers of suitably skilled and experienced staff who received a thorough induction, were adequately supervised and were safely recruited.

People we spoke with told us the staff were kind and reliable and had the right attitude, skills and experience to meet their needs.

We saw that staff were taught to deliver non-discriminatory practice and cultural awareness to ensure that people’s cultural and religious beliefs were respected.

Staff received the essential training and support necessary to enable them to do their job effectively and support people safely. Records showed that staff had also received training relevant to their role.

Records showed that reviews of people's care were undertaken regularly.

We found the medicine management system was safe. Records showed that staff received training and competency assessments before they were permitted to administer medicines.

We found that the service was working within the principles of the Mental Capacity Act (MCA) 2005 and that staff had a good understanding of the MCA.

People told us they knew how to make a complaint. Records we lo

This inspection took place over several days between 6 and 14 March 2017. We gave one working day’s notice before the first day of the inspection in order to enable the service to prepare lists of people using the service for us to visit and telephone.

The previous inspection of this service was in February 2015 when it had another name, Medacs Healthcare Manchester, although it had just moved to its new offices in Old Trafford. At that inspection we found the service to be ‘requires improvement’ in four areas and overall. We found no breaches of regulations.

Medacs Healthcare Old Trafford (Medacs) is a domiciliary care agency providing personal care and other services to people in their own homes and in one extra care facility. The service covers primarily the local authority areas of Manchester City, Trafford and Tameside. At the date of our inspection the service was providing care to approximately 550 clients in the three local authority areas.

There was a registered manager in post who had taken up her position in June 2014. 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.

People receiving the service told us they felt safe when the care workers visited. They were however unsettled by late visits and missed visits, by visits being cut short and by unfamiliar care workers arriving.

Missed visits had been a historical problem with this branch of Medacs. The list of missed visits showed over 100 missed visits in a year, but we came across further missed visits which were not on this list. Consequences of missed visits could be very serious, although they were a small proportion of overall visits made.

Action was being taken. The causes of missed visits were analysed and disciplinary action taken when needed. One potential cause was a care worker receiving more than one call on their rota at the same time. We were assured this would no longer happen once a new mobile phone system was introduced.

We considered that the level of missed visits was unacceptable and was a breach of the regulation relating to the safety and welfare of people using the service.

Recruitment procedures were robust. Staff were trained in safeguarding and knew how to report abuse and whistleblow if necessary.

Staff were also trained in administering medication. We considered that the care plan should specify what medicines people were receiving to reduce the possibility of errors.

People using the service thought their care workers were well trained, on the whole. All new staff did a three day induction followed up by the Care Certificate. There was ongoing refresher training for all staff, and specialist courses were available.

Staff received regular supervision and were often observed by their supervisor while delivering care. Not everyone had received an annual appraisal.

The service was aware of the requirements of the Mental Capacity Act 2005 (MCA). The policy on consent was clear, but the form used to record consent if a person lacked capacity to consent did not make clear that a family member alone cannot give consent in those circumstances.

Staff supported people to access healthcare services. Where it was required, staff prepared food for people using the service which was generally liked.

People gave us positive feedback about the care they received. They particularly valued their regular care workers. We found evidence that carers were sympathetic to people’s needs. People thought that care workers respected their dignity.

Care files and personal data were kept securely in the office. Staff were mindful of treating people equally.

Care plans were created using the support plan provided by the local authority. In some cases there was not enough