About the service:

NDH Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. The service was providing personal to 190 people at the time of the inspection.

People’s experience of using this service:

• Staff understood how to protect people from the risk of harm or abuse. People were supported in a way that reduced risks to their safety.

• People had not experienced missed calls and the majority of people had their care calls at the preferred times. People were very complimentary about the staff who supported them on a regular basis. Some people had experienced shorter call times and a number of different staff which made it difficult for them to form relationships. The provider was reviewing call duration and trying to establish consistency of staff teams to improve people’s experiences. People had effective support with their medicines and were happy with staff practice in relation to infection control.

• People were supported by staff who understood their needs and had support and training to meet their needs effectively. People's consent to care was sought and they were supported to access healthcare professionals when needed. People were happy with the support they had with their meals and risks related to people's dietary needs were known.

• People described staff as kind, patient and caring and felt staff protected their dignity and independence.

• People had been actively involved in deciding their care and personal routines. Care plans were personal to the individual and included people’s preferences, goals and care needs. There was a system to manage complaints and people were confident of a response. People’s end of life needs had been considered and planned for.

• People, staff and relatives were positive about the service, their views were sought and reflected positive experiences. The provider carried out regular audits and checks on the service and on the competency of staff to ensure people received a quality service.

Rating at last inspection: Good. Published 09December 2016.

Why we inspected: CQC had been advised of two incidents of alleged theft from people’s homes and a concern related to staff recruitment. This inspection was brought forward to enable us to look at how these were being managed by the provider. The incidents of theft had been investigated and not substantiated and the provider had taken appropriate action. The provider had followed safe recruitment procedures although in one instance references were not followed up. The provider told us they would improve their audits to ensure this did not happen again.

Follow up: We will continue to monitor the service through intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

We inspected this home care agency 02 and 03 November 2016. This was an announced inspection. We gave the provider 48 hours’ notice of our visit because the location provides a domiciliary care service [care at home]; we needed to make sure that we would be able to speak with people using the service, visit some people in their homes, speak with staff and view records in the agencies office.

We last inspected this service in January 2016 when we found the registered provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicines were not being safely managed. They were also in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because there weren't adequate systems in place to check on the quality and safety of the service. After our last inspection the provider sent us an action plan telling us how they would improve the service. These improvements had been effective, and we found the provider was now compliant with the regulations and consistently meeting people’s needs.

A registered manager was in post, and was present throughout 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.

We met and spoke with six of the 37 people using this service. Either in discussion or through our observations we were confident that people felt safe. We observed people looking relaxed and appearing to feel comfortable around staff within their own home, and people and their relatives told us people felt safe whilst receiving personal care. Staff understood their roles and responsibilities to protect people from the risk of potential harm. Staff were aware of the provider’s processes for reporting any concerns. There were enough staff to support people safely and recruitment checks were in place to help ensure staff that were employed were safe to work with people.

Staff had been trained to support people effectively. Training had been tailored to ensure staff had the skills they needed to meet the needs of the people they supported. The training also provided staff with the specific skills to provide care in people's own homes. Staff told us that they received regular supervision and felt supported. More senior staff were always on-call for them to seek advice and guidance.

People had access to a variety of food and drink which they enjoyed. Staff followed care plans to ensure people stayed healthy.

Staff had a basic knowledge of their responsibilities under the Mental Capacity Act 2005. We observed staff working consistently in line with people's care plans, promoting people's independence and choice and seeking consent before offering any care.

People were relaxed in the company of staff and people described many positive, compassionate interactions they had experienced from the staff who were supporting them. Staff ensured people’s privacy and dignity was maintained.

People knew how to raise complaints. Where complaints had been raised the registered manager had taken prompt and appropriate action. There was a range of systems and opportunities for people to provide feedback about all aspects of the service.

There was a registered manager in post who was aware of his responsibilities, and who had the skills and experience required to develop and lead this service.

This inspection took place on 14 and 21 January 2016. We gave the registered manager 48 hours notice of our visit, to ensure that office staff and records could be made available, to enable staff that provide care to people in their home could be made available to speak with us, and for us to make arrangements to speak with people using the service and their relatives.

This was the first time we had inspected NDH. The agency registered with us in August 2015, but we were informed the service had only been fully operational and delivering care for three months.

NDH provides care and support to 18 people living in their own homes. At the time of our inspection most of the people needing support did so because of needs relating to their older age, or mental ill health.

There was a registered manager in post who was present for the 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.

People were not always safe. People that required full support to manage their medicines had not all been supported by staff with the appropriate skills or knowledge. Records of medicine management were not always adequate to provide evidence people had their prescribed medicines at the correct time.

Staff were supported by a consistent team of staff who they liked. Systems to reduce the chance of missed calls were not entirely effective, and left people at risk of having their care needs unmet.

Staff were aware of the types of abuse people receiving care at home could experience. Staff had been provided with training to ensure they would recognise this and be able to report it.

Staff recruitment checks had been robust. New staff had received induction, training and support to ensure they were confident to meet people’s needs. Staff had been provided with a variety of basic awareness training courses which promoted safe working practices.

People were supported to maintain good health. Staff were aware of people’s specific needs and the support they required. Changes in people’s needs had been identified and action taken to ensure the person received the additional support they required and that their care plan was reviewed.

Staff were aware of how to promote people’s independence and choices. People’s rights to refuse care and treatment were not overridden.

People told us they were happy with the support they received to prepare food and drinks.

People were supported by staff that showed kindness and compassion, and worked to uphold people’s privacy and dignity.

The registered manager was keen to improve the service and take action in response to people’s feedback. There was a complaints procedure in place. Complaint investiagtions had not always been effective at fully resolving the concerns or making the changes required to reduce the likelihood of a re-occurance.

Our inspection identified that the agency was still in the process of developing and was not yet fully established. The inspection identified that while some people received good care that met their needs, this was not consistently the experience of every person using the service.

You can see what action we told the provider to take at the back of the full version of the report.