We carried out an unannounced comprehensive inspection of this service on 10 November 2016 at which one breach of legal requirements was found. This was because there were not sufficient quality assurance systems in place at Adamson House.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 7 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Adamson House Business Centre’ on our website at www.cqc.org.uk.

Adamson House Business Centre also known as Naswell Care is a small domiciliary care agency that offers support to people living with attention deficit hyperactivity disorder (ADHD), learning and physical disability and autism who are being supported in their own homes. At the time of our inspection, there were 16 people using the service.

There was no registered manager 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 2008 and associated Regulations about how the service is run. The provider told us they had recruited a manager who would be commencing their post in July. The provider told us the new manager would be submitting their application for registration to CQC. The previous registered manager had left their post one month prior to the inspection. The directors of the service and the deputy manager were managing the service in the absence of a registered manager.

At our focused inspection on 7 June 2017 we found the provider had followed their action plan and legal requirements had been met. The provider had implemented quality assurance systems across the service to ensure the care and support provided to people was of good quality and met their needs.

The inspection took place on 10 November 2016. The last inspection took place in September 2014. There were no breaches of regulation at that time.

Adamson House Business Centre also known as Naswell Care is a small domiciliary care agency that offers support to people living with attention deficit hyperactivity disorder (ADHD), learning and physical disability and autism who are being supported in their own homes.

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 service was safe. Risk assessments were implemented and reflected the current level of risk to people. People were protected from the risk of abuse. Staff had received training in this area. There were sufficient numbers of staff to ensure people received the support they required. Where required, medicine administration, recording and storage was safe.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA). Where required, people were supported to meet their nutritional needs.

The service was caring. People and their relatives spoke positively about the staff. Staff demonstrated a good understanding of respect and dignity. It was evident people were receiving a service which was personalised to their individual needs.

The service was responsive. Care plans were person centred and contained sufficient detail to enable staff to provide safe and quality care to people. People and their families informed us they were involved in the planning of their care. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was not always well-led. Quality assurance checks and audits were not taking place. Staff, people and their relatives spoke positively about the registered manager. The service endeavoured to seek the opinion of those using the service, their families and staff through regular surveys.

The inspection was carried out by an inspector from the Adult Social Care (ASC) directorate. We spoke with the management team which consisted of the nominated individual, the deputy manager and the manager.

We were unable to talk with people who used the service as no-one was available to speak with on the day of our visit.

Our inspection of June 2014 and July 2014 found there were flaws in the recruitment and selection procedures which related to peoples safety being placed at risk. We found that the staff team had not received appropriate training, professional development, supervision and appraisal on a regular basis which had been in line with their training schedule which at the time of our inspection was not in existence. The purpose of this current inspection was to answer two of our five key questions; is the service safe and effective?

Is the service safe?

Our previous findings in June and July 2014 demonstrated that recruitment procedures were not safe and effective enough to ensure that people who used the service were being cared for by staff who were of good character and had the qualifications, skills and experience which are necessary for the work to be performed.

Since the last inspection the provider and the manager had implemented suitable recruitment practices to protect people they were supporting.

Is the service effective?

At the time of our previous inspection in June and July 2014 w we found that people were not benefiting from a staff team who were properly trained to deliver personal care and were not being properly supported with their personal development through regular supervision and appraisal in a consistent and timely manner which was in line with their training schedule. This is to ensure that employees are working effectively and delivering of personal care safely to meet people’s needs. Therefore, we found during our previous inspection that improvements had not been made to the training of staff and support practices and procedures which would enhance staff knowledge and skill.

During our follow up inspection visit one member of staff told us of the improvements that had been made which included regular training. We saw that there was a training matrix and people were supported with specialist training which was provided by the local authority. We saw that training in medicines was planned over the remaining months of 2014. There was planned further education at the local college and we saw evidence from the college tutor welcoming the staff team onto the NVQ level 2 in Health and Social care.

The inspection was carried out by one inspector over three days. We spoke with three people who used the service, one member of staff, the newly appointed manager and nominated individual. The purpose of the inspection was to answer our five questions; Is the service; caring, responsive, safe, effective, well led?

Is the service caring?

People were given appropriate information and support regarding their care and treatment. People had family involvement which was regularly encouraged and this had a positive impact for people who used the service.

We saw one member of staff demonstrated respect and compassion when providing care and treatment in a person’s own home. We observed the manager spoke respectfully to people in their home for example the manager would ask if we could review their care plans whilst in their home; people gave us their permission and we were able to discuss the contents.

Is the service responsive?

People's needs were assessed and personal care and support was planned and delivered in line with their individual care plan. The care plans we saw were detailed, personalised and contained sufficient information about the support people needed, such as personal hygiene, mobility and communication. We saw an example of this where people were given support with their personal care and encouraged to live independently.

Is the service safe?

People told us they felt safe and that their carer workers were “brilliant”. We observed that people’s privacy was respected by staff when providing people with personal care in their own homes. People were relaxed with the staff who assisted them with personal care. We spoke to one staff member who demonstrated an understanding of safeguarding people from the risk of abuse and neglect. We reviewed the provider’s policies and procedures in relation to safeguarding.

We saw that one member of staff had been providing care without a DBS check and another staff member without a completed risk assessment as a result of their previous personal history. This demonstrated that there were poor recruitment practices which could compromise people’s safety.

Is the service effective?

During a home visit as part of our inspection we observed that staff provided care according to people’s individualised need. Four of the people’s care plans which we saw at the nominated individual’s office; contained sufficient information about the support people needed as part of their care package and this included personal care.

Is the service well-led?

People told us they could exercise choice and their wishes were respected. We saw an example of this with regards to their personal choice to care. One person told us, “I choose when to have a bath”.

The provider had an effective system to regularly assess and monitor the quality of service that people received however people would benefit from more regular monitoring of the service standards of care. At the time of our inspection the provider did not have a registered manager in post.

At the time of our inspection the provider did not have a registered manager in post. During our visit we saw that a new manager had been in place for less than a week and told us they were in the process of applying to register with the Care Quality Commission. They continued to say that they were keen to make changes to ensure that people’s needs were met and the service was operating to it statement of purpose.