Nayland Care Agency Limited is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to adults. At the time of this announced inspection of 23 July 2018 there were 196 people who used the personal care service. We inspected the service on a Monday and announced our inspection on Friday 20 July 2018 to make sure that someone was available.

At our last inspection of 1 August 2017, the service was rated requires improvement overall. The key questions for effective and caring were rated good and the key questions safe, responsive and well-led were rated requires improvement. At this inspection we found improvements had been made and is now rated good overall.

There was no registered manager in post, the previous registered manager had left the service in March 2018. 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.

Improvements had been made in how the service was led. This included improvements in their governance systems to assess and monitor the service provided to people. The service had a quality assurance system and shortfalls were identified and addressed. As a result, the quality of the service continued to improve.

Improvements had been made in how the service provided people with safe care. Risks to people were managed, including risks from abuse and in their daily lives. The service learned from incidents to improve the service. There were enough care workers to cover people’s planned care visits. A new system was in place to support the service to monitor and address missed and late visits. Recruitment of care workers was done safely. Where people required support with their medicines, this was done safely. However, an issue had arisen when a person was not receiving their medicines as required, this was immediately addressed. The risks of cross infection were minimised.

Improvements had been made in how the service provided people with responsive care. People received care and support which was assessed, planned and delivered to meet their individual needs. There were systems in place to support and care for people at the end of their lives, where required. A complaints procedure was in place and complaints were investigated and responded to and used to drive improvement.

The service continued to provide people with an effective service. People were supported by care workers who were trained and supported to meet their needs. People were supported to have maximum choice and control of their lives and care workers cared for them in the least restrictive way possible; the policies and systems in the service supported this practice. Systems were in place to support people with their dietary needs, if required. People were supported to have access to health professionals where needed. The service worked with other organisations involved in people’s care to provide a consistent service.

The service continued to provide a caring service. People had positive relationships with their care workers. People’s dignity, privacy and independence were respected and promoted. People’s views were listened to and valued.

Further information is in the detailed findings below.

Nayland Care Agency Limited provides personal care and support to people living in their own homes. On the day of our inspection on 1 August 2017 there were 160 people using the personal care service. This was an announced inspection. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to know that someone would be available.

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.

At our last inspection of 30 November and 8 December 2016 this service was rated requires improvement overall. Effective, Caring, Responsive and Well-led were rated requires improvement and Safe was rated as inadequate. We had identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, safe care and treatment, good governance and staffing.

You can read the report from our last comprehensive and focused inspection, by selecting the 'all reports' link for Nayland Care Agency Limited on our website at www.cqc.org.uk.

The service sent us an action plan they were working on with the local authority to improve the service. During this inspection on 1 August 2017 we found improvements had been made. Some were ongoing and not yet fully implemented and embedded in practice.

Improvements had been made in how the service monitored and assessed the service provided. This included spot checks on care workers and asking for people’s views about the service they were provided with. The service had purchased a computerised system which assisted them in the planning of visits and monitoring including, missed and late visits. This was not fully implemented and embedded in practice, for example people were still experiencing late visits and not having their preferences met relating to the way the rota was managed. The provider told us about the plans for the future to further improve and assured us that this system would improve people’s experiences of the service.

We had received concerns about the recruitment processes in place. This included checks made with the disclosure and barring service (DBS). We found that the service had taken immediate action to address this. However, we found that further improvements were needed in the way that the service kept records about any disclosures.

Improvements had been made in how the service provided safe care to the people who used the service. The services’ medicines policy had been reviewed and updated. Systems were now in place to guide staff on the support that people required with their medicines. Systems had been improved in how staff had recorded when people had been assisted to take their medicines. Risk assessments were now in place which guided care workers on how the risks to people, relating to their specific conditions, falls and risks associated with people’s homes. People told us that they felt that the care workers treated them with respect.

There were systems in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Care workers understood their roles and responsibilities in keeping people safe.

Improvements had been made in how the service recorded care worker induction and shadow shifts. Improvements had been made in the training and support provided to care workers.

People’s care records had improved and clear guidance was provided to care workers in how people’s individual needs and preferences were met. This related to the person centred care they required and preferred, including relating to their dietary requirements and independence. People told

Nayland Care Agency Limited provides personal care and support to people living in their own homes. On the first day of our inspection on 30 November 2016 there were approximately 250 people using the personal care service, on the second day of our inspection there were more people due to the service taking over other care packages from the local authority. This was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to know that someone would be available.

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 provider’s quality assurance systems were not robust enough to identify shortfalls in the service and to take actions to address them.

The ways that care visits were scheduled and care workers deployed was not always effective, in ensuring that all planned care visits were completed and in a timely manner.

Improvements were needed to ensure that the risks associated with people’s conditions were identified and care workers were given guidance to minimise them.

Not all care workers had received up to date training and competency observations to ensure that medicines were managed safely at all times. Improvements were needed in how audits of medicines records were completed.

Training records were not up to date. Care work’s personnel records and comments from care workers identified that not all care workers were provided with training to meet people’s needs effectively. Care workers were not provided with regular one to one supervision meetings and spot checks of their work to ensure that they were working in an effective way.

Improvements were needed to identify people’s preferences regarding the times of their care visits and the gender of care workers who care for them. Improvements were needed in care planning to identify how people’s specific conditions affected their daily living and the care provided to them. Some people who had transferred from other care services had not yet been assessed and care plans were still in place which had been provided by the other services.

People told us that they had good relationships with the care workers who supported them and that they were treated with respect.

Where people required assistance with their dietary needs there were systems in place to provide this support safely. Where required, people were provided support to access health care professionals.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed.

We have identified breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the full report for the actions we have asked the provider to take to improve the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Care records contained detailed risk assessments which had been carried out for each element of care planned. Actions to reduce any risk identified were documented. Risk assessments balanced risk with the rights of people to maintain their independence. People told us that staff took care of them and made sure they were safe.

The provider had appropriate systems in place with regard to the administration and recording of medicines. The provider responded appropriately to any complaints or concerns about medication administration. Staff received medication awareness training and training in recording relating to medication.

Is the service effective?

Care records were well written and reflected the needs and wishes of the people who received a service. People told us they were fully involved in developing their care plan. Daily records demonstrated that care staff delivered care in line with the care plan. Care plans contained sufficient information for staff to carry out the care required.

The minutes from staff meetings demonstrated that staff received updates, information and guidance aimed at improving care. There was evidence that incidents, complaints and feedback were discussed. Any appropriate lessons were learned and necessary actions were monitored through supervision.

Is the service caring?

We talked with 19 people and the relatives of people who used the service. All the people we spoke with said the service was good or very good. People we spoke with described the service as: "Very caring ", "Their care to my [relative] is 100% and beyond ", "it works for me so I feel that everything works smoothly – so they must be doing a good job."

Is the service responsive?

All the people we spoke with said that they had been asked for their views about the service they received. Issues raised in surveys and reviews were discussed at staff meetings and supervision. People told us they were confident that any issue raised or complaint made would be thoroughly investigated and acted upon.

Policies and procedures were up to date and reflected national legislation and guidance.

Is the service well-led?

Staff told us they felt well supported by their supervisors and the registered manager. They told us that they were treated fairly and that issues they raised were dealt with appropriately.

Staff had good access to a wide range of training relevant to their role. All staff received a comprehensive induction programme prior to working alone.

There were systems and processes in place to monitor the quality of the service. These included analysis of incidents and complaints, satisfaction surveys and supervision visits to observe care staff delivering care.

During our focused inspection to look into the concerns that we had received anonymously through our National Customer Contact Centre, we did not come in contact with people who used the service. We spent time at the location's office, looked at records and spoke with four of the staff.

We found where new staff, as part of their induction, had received training to assist people with their mobility needs in a safe manner, not all the staff had received refresher training to keep their skills and knowledge updated. The provider told us that they were aware that there had been slippage in their training programme, and they had taken action to address it. We saw that since January 2013 regular training sessions had been carried out / planned. This would ensure that all staff that required the training would have received it by April 2013.

We saw that where a person’s needs changed and they required mobility aids or an increased care package; systems were in place to alert the relevant health and social care professionals to ensure that these changing needs were met.

We spoke with nine people who used the service and four people’s relatives. They told us that they were happy with the service that they were provided with and that the support they received met their needs. One person told us, “A good agency really doing a good job.” Another said, “We are pretty happy with the service.”

People told us that the care workers were polite and treated them with respect. One person told us, “Staff are very nice.” Another person told us, “Jolly good indeed, no problems at all, very pleasant people.”

We looked at the care records of four people who used the service and found that the people experienced care, treatment and support that met their needs and protected their rights.

We found that there were enough care workers employed to meet people’s needs. One relative told us that the person who used the service had, “Really developed a good relationship with (their) main carer, there is a good bond there.”

The provider monitored the service to ensure that people were provided with safe care and support which included announced and unannounced checks on the quality of care and support people were receiving during their care visits. One person told us, “(Senior member of staff) comes out every now and then, they visited recently.”

People told us if they had any concerns that they would speak to their care worker or contact the office.