About the service: Nottingham Assured Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It currently provides a service to older adults. At the time of the inspection, 12 people were receiving support with personal care.

People’s experience of using this service:

• The risks to people’s health and safety were assessed and used to reduce the risk to their safety. People told us they felt safe when staff supported them. Staff understood how to report any concerns that could lead to people experiencing avoidable harm.

• There were enough staff to meet people’s needs. Staff arrived on time for calls and stayed for the agreed length of time and sometimes longer if needed. People’s medicines were managed safely; however, more formalised checks of staff competency were needed to ensure people continued to receive their medicines safely.

• Staff understood how to reduce the risk of the spread of infection. The registered manager had the processes in place to learn from mistakes and to reduce the risk of people experiencing avoidable harm.

• At our last inspection we raised concerns that some staff training was not up to date. This had now been rectified and staff had completed training in all areas deemed mandatory by the provider. Staff received informal spot checks of their competency; the registered manager acknowledged that a formalised process was required so that staff performance could be appropriately monitored.

• People were provided with care and support which protected them from discrimination. People received the support they needed with their meals and they had access to other health and social care agencies where needed. People were supported to make decisions about their care, the provider ensured these were made in accordance with appropriate legislation.

• People liked the staff, they found them to be caring, kind and respectful. People were treated with dignity and had their privacy respected. People felt able to make decisions about their care needs and staff respected their wishes. People’s records were stored securely to protect their privacy.

• People received person centred care and support that considered their personal choices and preferences. People welcomed the consistency of staff who understood their needs. People had access to information in a format they could understand. Complaints were handled appropriately and line with the provider’s complaints policy. People did not currently receive end of life care.

• People, relatives and staff respected the registered manager. They welcomed the fact that she was available, carried out care visits herself and therefore understood people’s needs and the role carried out by staff. Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. People and relatives told us they would recommend this service to others.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (5 December 2017).

Why we inspected:

This was a planned inspection.

Follow up:

We will continue to monitor this service and will return within the next 30 months to ensure they have continued to provide a ‘Good’ quality of care for people.

We carried out an announced inspection of the service on 12 October 2017. Nottingham Assured Home Care Ltd is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing the regulatory activity of personal care to 20 people. At the service’s previous inspection in December 2014 the service was rated as Good. However, during this inspection we identified concerns that have resulted in the rating of this service being amended to Requires Improvement.

On the day of our inspection there was 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.

Staff had not always been recruited safely. The required number of references were not always in place before staff commenced work. Staff had received training in the safeguarding of adults but this was out of date for five of the six staff employed by the service. The risks to people’s safety were assessed and, although brief in detail, provided staff with guidance needed to reduce the risk to people’s health and safety. Sufficient staff were in place to support people safely. People required minimal support from staff with their medicines.

Staff training was not up to date. Five of the six staff required refresher training in key areas such as safeguarding of adults, moving and handling and medication. Supervisions were carried out approximately every six months. The registered manager agreed the frequency of these needed to increase to ensure staff competency was regularly reviewed.

People had the ability to make their own decisions; however the registered manager was aware of the principles of the Mental Capacity Act (2005) and how they should be adhered to support people in their best interest. People were supported to maintain good health in relation to their food and drink intake. People felt their day to day health needs were met by staff.

People found the care staff to be kind, and caring; they understood their needs and listened to and acted upon their views. People felt the care staff treated them with dignity and respect. People were involved with decisions made about their care and were encouraged to lead independent lives. People were not provided with information about how they could access independent advocates.

Personalised care planning documentation was in place and contained guidance for staff to enable them to support people in the way they wanted. Information recorded in people’s care records relating to their day to day routines was detailed. People felt staff would respond appropriately if they made a complaint.

Current quality assurance processes were not always effective in ensuring that staff were appropriately trained. People’s views on developing and improving the service were regularly requested and acted on. Processes were in place to ensure notifiable incidents were reported to the CQC. Staff understood how to report serious concerns via the provider’s whistleblowing policy.

The provider did not meet the minimum requirement of completing the Provider Information Return at least once annually. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we made the judgements in this report.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

We inspected the service on 29 and 30 December 2014. Nottingham Assured Home Care Limited provides care and support to people living in their own homes. This is a small service and at the time of our inspection 14 people were receiving care and support.

The service had a registered manager in place at the time of 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.

When we last inspected the service on 14 January 2014 we found there were improvements needed in relation to the safe recruitment of staff and the training staff were provided with. The provider sent us an action plan telling us they would make these improvements by February 2014. We found at this inspection that improvements had been made but there were further improvements needed.

We found there were further improvements needed in relation to how staff were recruited in that the manager was not ensuring suitable references were in place.

People felt safe in the service and the manager knew to share information with the local authority when needed. Staff knew how to respond to incidents and what incidents needed to be reported. This meant there were systems in place to protect people from the risk of abuse.

Medicines were managed safely and people were supported to take their medicines safely. Staffing levels were matched to the needs of people who used the service to ensure they received care and support when they needed it. However people could not always be assured staff had been recruited safely.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. The manager told us that all of the people using the service had the capacity to make their own decisions but there were systems in place to ensure the appropriate assessments would take place if the need arose.

People were supported to maintain their nutrition. Referrals were made to health care professionals for additional support or guidance if people’s health changed. They were treated with dignity and respect and had their choices acted on. People also knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously.

People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. The manager assessed how well the service was running to identify if any improvements were needed.