The inspection took place on 30 and 31 May 2017 and was announced. We gave the registered manager 48 hours notice of the inspection to ensure that key people were available to speak with.

The service provided personal care support and domiciliary care to people living in their homes in the South Gloucestershire area. At the time of our inspection a personal care service was provided to 81 people (11 of these people did not receive personal care support). The service employed 25 care staff and was actively recruiting additional care staff for the team.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People received a safe service. Staff received safeguarding adults training and knew what they had to do if they witnessed, suspected or were told about bad practice or abuse. Any concerns about a person’s welfare would be acted upon. Staff received moving and handling training and were then given instructions on how to move and transfer people from one place to another safely. Staff recruitment followed robust procedures which meant unsuitable staff could not be employed. Any risks to people’s health and welfare were assessed and then well managed in order to reduce or eliminate the risk and chance of harm. Those people who needed assistance to take their medicines were supported to do so safely.

Network Healthcare provided an effective service to the people they supported. Any new packages were fully assessed before a service was provided to ensure the service had the necessary resources. This included ensuring the care staff had the necessary skills and experiences to meet the person’s needs and any equipment required was in the person’s home. The staff team received the training they needed to do their jobs effectively and were supervised and spot checked regularly. Staff were able to refer to the care plans in people’s home with instructions about they were to be assisted. People were provided with support to have food and drink where this had been assessed as part of their care package. People were supported to access health care services if needed.

People received a caring service. Feedback received from people who used the service, relatives and health and social care professionals was good. The local authority had not received any complaints or information of concern and neither had CQC. People and their relatives told us the care staff were kind, caring, polite and treated them respectfully. Staff generally visited the same people each week however this changed during times of staff absences. The registered manager and senior staff ensured people were matched with the staff member who best suited the person’s character. People were encouraged to have a say about how they were looked after and the way the service was delivered.

People received a person centred service that met their specific care and support needs. People’s needs were assessed and then a package of care put together that met those needs. Their preferences and choices were respected. People were provided with copies of their care plans and the service responded by changing the plan and the service delivery arrangements of the person’s needs changed.

Network Healthcare Chipping Sodbury was a well led service with a registered manager leading the team who provided good leadership and management. The provider had a programme of checks and regular audits in place to ensure the quality and safety of the service was maintained. Where any improvements or shortfalls were identified, action plans were in place. People were asked for their views about the service received and they were listened.

We carried out a comprehensive inspection of Network Healthcare – Chipping Sodbury on 24, 25 February and 3 March 2015. Four breaches of the legal requirements were found at that time. These related to the management of medicines, the management of complaints, the systems in place to monitor the quality and safety of the service and having insufficient staff in order to meet every service user’s care and support needs. After the inspection, the provider sent us a report of the actions they would take to meet the legal requirements.

We undertook a focused inspection on 9 July 2015. This was to check the provider had followed their plan and to confirm they now met the legal requirement. This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection by selecting the ‘All reports’ link for Network Healthcare- Chipping Sodbury on our website at www.cqc.org.uk

Network Healthcare - Chipping Sodbury is a small domiciliary care agency that provides personal care and support to people living in their own homes. It is part of a national company that is registered with the Care Quality Commission called Network Healthcare Professionals Limited.

The majority of people using the service required long term support to enable them to continue to live at home and all lived within South Gloucestershire. At the time of this inspection 28 people were being provided with a service and 14 care staff were employed to deliver the care.

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.

On 9 July 2015 we found that the required improvements had been made in respects of the management of medicines. Care staff were not supporting people with their medicines unless this was identified on their care plans. Systems had been put in place to check that the medicine administration records were completed correctly. These checks ensured those people received their medicines as prescribed by the GP. Because these checks were made regularly, it was quickly highlighted where improvements were required with individual staff members work performance. Where necessary extra supervision or training was arranged.

On 9 July 2015 we found that improvements had been made with the management of complaints received. Since the registered manager had been in post (March 2015) four formal complaints had been logged. Records provided a clear account of the actions taken and the outcome of the complaint. Each of the complaints had been resolved. People could be assured that any concerns they had, would be listened to and acted upon.

On 9 July 2015 we found there were sufficient number of care staff to meet the care and support needs of the 28 people who were receiving a service. The service was actively recruiting new members of care staff. They had also started providing a new service for a number of people whose needs they were confident they could meet. The registered manager felt that the service had now stabilised and planned to expand the service after the summer holiday period.

On 9 July 2015 we found that the provider had implemented a programme of regular audits to assess, monitor and improve the service. Visits by the provider and the regional manager were regular and the registered manager kept them fully informed of how the service was running. The service had completed a survey with people using the service and the results had improved significantly. A staff survey was already underway.

When we visited in February 2015 the service had difficulties in ensuring that the time of arrival of care staff met people’s expectations. There was no breach in legal regulations however improvements were required. There was now greater adherence to the staff rotas and monitoring of the timing of calls. Where care staff knew a call was going to be delayed, office staff were asked to contact the person and explain. People confirmed this happened.

As a result of this inspection we have been able to change the rating of the service.

This inspection took place on 24, 25 February and 1 March 2015. This was an announced inspection. We gave the provider 24 hrs notice of our visit because the service is small and the office staff may not be available due to supporting staff or providing care. We needed to be sure that they would be in. This was the first inspection of the service since registration with the Care Quality Commission in November 2013.

Network Healthcare (Chipping Sodbury) is a domiciliary care agency that provides personal care and support to people living in their own homes. It is part of a National company that is registered with the Care Quality Commission called Network Healthcare Professionals Limited.

The majority of people using the service required long term support to enable them to continue to live at home. On the day of our inspection there were 23 people using the service with 11 staff employed to deliver this care.

The registered manager had resigned in December 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. There is a condition of registration that this location must have a registered manager. We were told recruitment for the post of registered manager was underway.

People had not always received a service that was delivered on time and in accordance with their care plan. The agency had increased the numbers of people they were supporting whilst experiencing a high turnover of staff. This meant that the agency was unable to provide consistent care and support during the months of November, December 2014 and early January 2015. The provider had devised an action plan and worked alongside local commissioners to minimise the risks to people. Twenty seven people had been served notice by Network Healthcare to find another care provider. Comments received from people confirmed there had been difficulties and they were not always satisfied with the care and support that was in place. However, people acknowledged this had improved in the last two months.

The majority of the people were receiving a service as planned. However, there was one package of care where there were not enough staff to provide the full seven day package of care.

People were at risk of unsafe medicine administration. This was because staff were not following the risk assessments and not recording medicines given. This meant people could not be assured they were receiving their medicines in a timely manner or as prescribed where they required support.

There was a lack of quality monitoring being completed to enable the provider to make a judgement on how effective and responsive the service was. This included making any improvements to people’s care and support packages. Complaints were not recorded centrally so could not be analysed for any themes or trends. Some complaints had not been investigated in a timely manner with feedback given to people on how their concerns had been responded to. Some people and their relatives were not satisfied their concerns had been listened to.

People commented positively about the care staff that were supporting them. They told us they were treated kindly, with respect and the staff were caring. People told us the staff had the skills and knowledge to support them effectively. People confirmed they had a plan of care that they had agreed. Care plans clearly described the support needs of people and these were kept under review.

People told us they felt safe. Staff knew what to do if they suspected that an allegation of abuse was taking place. Staff had been through a thorough recruitment process ensuring they were suitable to work with vulnerable adults and children. New staff shadowed more experienced staff until they were confident to work on their own. Some people told us that when new staff started they had to explain to them how they wanted to be supported.

Staff confirmed they received regular training and were supported in their roles. However, it was acknowledged that this was not always the case. They said there had been a lot of pressure put on them during November and December 2014 to ensure people received the care and support they required. Staff stated they now have regular people they support enabling them to build relationships with.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.