The inspection was announced and took place on 19 and 20 March 2018.

Next Step Domiciliary Care Limited is a domiciliary care agency registered to provide care for people in their own home and specialist housing. It provides a service to older adults and younger disabled adults. This service also provides care and support to people living in two 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of our inspection, the service offered support to 31 people, however only 24 people were in receipt of the regulated activity ‘personal care’. This consisted of 15 people living in the supporting living schemes and nine people receiving care at home.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

At our last inspection in March 2016, we found two breaches of the regulations in relation to recruitment and the service was not appropriately notifying CQC of incidents. We also made recommendations in relation to medication, safeguarding information, training, awareness of Mental Capacity Act 2005, records and the complaints procedure. The provider sent us an action plan of how they would address these shortfalls. At this inspection, we found that improvements had been made. However we made a further recommendation in relation to medication.

We saw that it was not always clear on the Medicine Administration Records in the supported living schemes what support people needed with their medication and where people needed assistance with topical creams, we found that body maps were not always in place to inform staff where this should be applied. Staff knew people well and were able to describe what support people needed, therefore we made a recommendation to review paperwork in line with current guidelines for medication.

Risk assessments were in place, however where we found high risks the risk assessments were not always detailed. Staff we spoke with were very clear on the risks and could explain what action they would take. The registered manager agreed to ensure that the risk assessments reflected the staff knowledge and were more detailed. The registered manager commenced a review of the risk assessments during the course of our inspection.

There were sufficient staff to complete the scheduled visits for each person and travel time was built into the staff rotas. They told us that generally staff arrived on time and they were contacted if there were going to be any delays. Visit times were recorded on an electronic system so the registered manager was alerted if there were any delays or if any of the tasks were not carried out within the visit.

Arrangements were in place to protect people from the risk of abuse. We spoke to staff about their understanding of safeguarding and they were able to describe what action to take if they suspected that someone was at risk of abuse or they saw signs of abuse. People using the service reported that they felt safe and their relatives told us that they were confident that their family members were safe and supported by the staff of Next Step Domiciliary Care.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

Next Step is a small family run company and care and support is provided by a small

This inspection took place on 8, 14, 18 and 22 March 2016. The provider was given 24 hours’ notice of our first visit because the location provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be in.

Next Step Domiciliary Care Limited is a domiciliary care agency registered to provide care for people in their own home. The provider serves Macclesfield, Stockport, Cheshire and the surrounding areas. The agency has a number of services to offer individuals from supported housing, home care services as well as personal assistant services, supported holidays and companionship.

Some of the people who use the service live in group houses where they hold independent tenancies with a private landlord. Their support is provided to them as a group but there are also personal assistants who provide more individualised care. Other people receive the service on an individual basis in their own home. In this report when we have to distinguish between the two groups we have referred to these people as receiving “care at home” whilst those people living in groups are referred to as receiving the “supported living” service. At the time of our inspection there were 13 people living in two group houses and 19 people receiving care at home.

Next Step Domiciliary Care Limited has had a registered manager since it first registered with the Care Quality Commission (CQC) in 2014. A registered manager is a person who has registered with the 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.

Next Step Domiciliary Care Limited provides a service to people living at home which is tailored around their needs and preferences. The service provided is reliable, flexible, consistent and dependable. Staff provide care with dignity and respect and work hard to establish friendly relationships with people who use the service. Staff are prepared to assist with a wide range of tasks including providing personal assistance to people so that they can take part in community and other activities outside their own home.

During our inspection we found that the provider needed to maintain better records of how people were involved in setting up and agreeing their care plans and keep better records of the training that staff had received as well as how they had been recruited.

We have recommended that the provider reviews the availability of safeguarding. We have also recommended that the provider reviews arrangements for medicines including the format of record sheets. Further recommendations include the provision of training in medicines at an appropriate level for the tasks being undertaken as well as in the Mental Capacity Act 2005.

We found that the provider's recruitment procedures did not meet the requirements of the relevant regulations. We also found that the provider had not notified us about certain events about when they are required by law to do so. You can see what action we told the provider to take at the back of the full version of the report.