This inspection took place on 6 March 2018 and was announced. The provider was given 48 hours’ notice as they are a small service providing care to people in their own homes, we needed to be sure someone would be in.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults. At the time of our inspection they were providing care to one person.

Following the last inspection in November 2016 we asked the provider to complete an action plan to show what they would do and by when to improve their rating in ‘Responsive’ to at least good. The provider had taken the necessary action to improve the quality of needs assessments and care plans.

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.

When we completed our previous inspection in November 2016 we found concerns relating to the quality of assessments and care plans. At this time these topic areas were included under the key question of ‘Responsive.’ We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas are included under the key question of ‘Effective.’ Therefore, for this inspection we have inspected this key question and also all other key questions to make sure all areas are inspected to validate the ratings.

The service had clear systems in place to ensure the safety of people using the service. There were clear safeguarding systems and staff were knowledgeable about safeguarding adults from harm. Risks to people had been identified with clear plans in place to mitigate them. There were enough staff to ensure people’s needs were met and staff were recruited in a way that ensured they were suitable to work in a care setting. People were supported to take their medicines as prescribed.

People were receiving effective care. People’s needs were assessed and care plans reviewed and updated regularly. Care plans contained clear information about people’s preferences regarding their care and nutrition and records confirmed they were supported in line with them. Staff received the training and support they needed to perform their roles. Care files showed the service worked with other organisations and ensured people’s healthcare needs were met. The service worked within the principles of the Mental Capacity Act 2005.

Staff spoke about the people they supported with kindness and compassion. The service ensured people’s cultural and religious needs were supported. There were equality and diversity policies to ensure people were not treated differently because of their sexual orientation or gender identity. Staff understood and respected people’s right to privacy and treated them with dignity. People’s abilities and independence were promoted.

The service had a clear policy and procedure for responding to complaints. The registered manager sought regular feedback from people and relatives to ensure they were aware of issues or concerns. The service had policies in place to ensure they would provide appropriate end of life care if this was required.

The leadership of the service was clear and respected by staff and family members. Relatives found the registered manager approachable. There was an effective system of checks to ensure the quality and safety of the service. There was a clear values base to ensure a person-centred culture. There were clear plans for the future development of the service.

This inspection took place on the 17 November 2016 and was announced. The previous inspection of this service took place in February 2013. At that time we found two breaches of regulations. This was because staff had not undertaken training about safeguarding adults and risk assessments were not in place about people who used the service. During this inspection we found the provider had made improvements in these areas and was now meeting the relevant regulations.

The service is registered to provide support with personal care to people who live in their own homes. At the time of our inspection only a small number of people were using the service.

The service had a registered manager in place. 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 found one breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans were not sufficiently personalised around people’s individual needs. You can see what action we told the provider to take at the back of the full version of this report.

The service had appropriate safeguarding procedures in place and staff were knowledgeable about their responsibilities with regard to safeguarding adults. Risk assessments were in place which included information about how to mitigate any risks people faced. There were enough staff working at the service to enable the service to meet people’s assessed needs. Pre-employment checks were carried out on prospective staff. Medicines were administered in a safe manner.

Staff undertook an induction training programme on commencing work at the service and staff training was up to date. People were able to make choices for themselves where they had the capacity to do so and the service operated within the Mental Capacity Act 2005. Where people were supported with food preparation they were able to choose what they ate and drank. The service supported people to access healthcare professionals.

Relatives told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans had been signed by people or their relatives which showed they were developed with their involvement. People were supported to access the community in line with their choices and preferences. The service had a complaints procedure in place and people [or relatives where appropriate] knew how to make a complaint.

People [or their relatives where appropriate] and staff spoke positively of the management at the service. Various quality assurance and monitoring systems were in place, some of which included seeking the views of people that used the service.

During the inspection of Maryland Care Service Limited, we spoke to the provider but we were unable to speak to staff or people about the service. At the time of the inspection the service was not providing care to people.

People who use the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There was no evidence that staff members had undertaken appropriate safeguarding vulnerable adults training.

There were effective recruitment and selection processes in place.

The service had an appropriate procedure in place to regularly assess and monitor the quality of the service provided.

The provider told us that people were given a service user guide at the start of their service. This guide was provided in an accessible format and included details of how to make a complaint.

We reviewed the records of one person who used the service and found that they were inadequate. There was no written assessment of care or treatment and no risk assessments in place for this person.