We carried out an announced inspection of the service on 26 March 2018. Notts Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own homes and flats. It currently provides a service to older adults. Not everyone using Individual Homecare Services receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There was a registered manager in post 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.

At the time of the inspection, Notts Home Care Limited supported 56 people who received some element of support with their personal care. This is the service’s second inspection under its current registration. At the previous inspection, the service was rated as ‘Good’ overall. At this inspection, they maintained that rating.

People were safe. The risks to their safety had been assessed although some assessments would benefit from more personalised information. Staff knew how to ensure people were protected from avoidable harm. People received care from a consistent number of staff. People’s medicines were managed safely. Staff understood how to reduce the risk of the spread of infection. Learning from accidents and incidents took place to reduce the risk to people’s safety.

People’s care was provided in line with current legislation and best practice guidelines. Staff were well trained and supported. Staff supported people effectively with their meals where needed and acted on concerns about their nutritional health. Other agencies were consulted for guidance when people developed more complex health needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The registered manager was reviewing how the Mental Capacity Act (2005) was implemented to ensure people’s rights continued to be protected.

People felt staff were kind and caring, treated people with dignity and respect and listened to what they had to say. People’s independence was encouraged and they were able to contribute to decisions about their care. People’s diverse needs were respected.

Prior to starting with the service, people’s needs were assessed to determine whether the service could meet those needs. When changes were needed to people’s care, they were always involved with this process. People were treated equally, without discrimination and systems were in place to support people who had communication needs. People felt able to make a complaint and were confident it would be dealt with appropriately.

The service was well led by a registered manager who was liked by all. People told us they would recommend this service to others and it was evident people received high quality care and support. People and staff were encouraged to contribute to the development of the service. Effective auditing processes were in place to monitor the quality of the service. The registered manager carried out their role in line with their registration with the CQC.

We carried out an announced inspection of the service on 17 March 2016. Notts Home Care Limited 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 78 people.

On the day of our inspection there was a registered manager in place and they had been registered with the Care Quality Commission since November 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.

During our previous inspection on 29 August 2014 we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to a lack of supervision of staff performance. During this inspection we saw improvements had been made and the breach had been met.

Staff now received regular supervision of their work and they felt supported by the registered manager. Staff completed an induction prior to commencing their role and plans were in place for all new staff to complete the Care Certificate training process. Staff received regular training to enable them to support people effectively. All staff training was up to date.

People were supported by staff who made them feel safe when they were in their home. Regular assessments of the risks to people’s safety were conducted and regularly reviewed. Care plans were in place to address those risks. Appropriate checks of staff suitability to work at the service had been conducted prior to them commencing their role. People were supported by staff who understood the risks associated with medicines. The decision making process regarding the administration of covert medicines needed reviewing.

The registered manager was aware of the principles of the Mental Capacity Act (2005). People were able to make choices and staff respected their wishes.

People were encouraged to eat healthily. People were happy with the way staff supported them with their meals. People’s day to day health needs were met by the staff. External health and social care professionals spoke positively about the way staff supported people and reported any concerns they had about people’s health and safety.

People told us they thought the staff were kind and caring, treated them with dignity, respected their privacy and acted on their wishes.

People were provided with the information they needed that enabled them to contribute to decisions about their care. People were not currently provided with information about how they could access independent advocates to support them with decisions about their care.

People’s care records were written in a way that ensured their aims and wishes were reflected throughout. People’s records were regularly reviewed although it was not always recorded whether people had agreed to the decisions made. People’s care records contained guidance for staff to respond to people’s needs, although two care records required further information regarding two people who were living with diabetes.

People and their relatives where appropriate, were involved with planning the care and support provided. People were provided with the information they needed if they wished to make a complaint. No formal complaints had been made.

The registered manager led the service well and understood their responsibilities. They ensured the CQC were notified of incidents that had occurred.

People and staff spoke highly of the registered manager. There were a number of processes in place to gain the feedback of people and staff in order for the service to develop and improve. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the care

The service was providing support to 83 people at the time of our inspection. As part of our inspection we met and spoke with ten people who used the service the relatives of three people who used the service, two care co-ordinators and four care staff. We asked people about their experience of using the service. We also examined care plans and other records relating to the management of the service.

We last inspected this service on 27 February 2014. At that time we found that care staff were not always supported by supervision and appraisal. We also found the provider did not have an effective system in place to assess the quality of the service. A system for notifying the Care Quality Commission about notifiable incidents was not in place. At this inspection we found a system for notifying incidents was now in place and the provider was assessing the quality of the service with surveys of people who used the service and their relatives. We found that the provider had completed supervision and appraisal meetings with some but not all care staff. A summary of what we found is set out below.

Is the service safe?

One person who used the service told us, "I have a shower every day I can shower myself but I leave the door open and they shout are you okay". Another person told us, "They come three times a day and at night they put the light out and make sure I have everything I need".

We asked care staff about the systems in place to protect people who received care from abuse or neglect. Care staff told us they would have no hesitation in raising any concerns they had. They said they felt they could discuss anything with the care co-ordinators and managers. One member of care staff told us they had moved jobs because they had concerns about the service provided in their previous organisation. They told us care staff helped each other and were interested in providing safe care for people.

We saw people’s needs had been assessed. Risk assessments had also been completed which identified the nature of the risk and how care staff could protect people.

We saw the provider's policy on assessing people's mental capacity. The policy described how the service supported people who might not be able to make informed decisions on their own about the care they received. Care staff we spoke with were familiar with the policy and we saw examples in care records of decisions made in the people's best interests. This meant the provider had arrangements in place to meet the requirements of the Mental Capacity Act 2005.

Is the service effective?

People's needs were assessed and care plans were reviewed. Care staff reviewed the support provided and identified if any changes to care plans were needed. Care staff accessed advice from specialist professionals to help them provide appropriate care for example for people with conditions affecting their mobility.

One person who used the service told us, "I got a commode and staff from the office came to visit and check everything was okay". Another person told us care staff helped them with their medicines. The person told us they took several medicine and could not see the packs clearly. The person said, "The carers arrange the tablets and tell me which one is which and make sure I don't drop any because I wouldn't be able to see them".

A relative told us told us about someone who had a condition which had affected their speech. They said their relative had been anxious in the beginning but one of the care staff had found an effective way of communicating with them which had put the person at their ease.

Is the service caring?

The people we spoke with all told us they found staff caring. Several people told us they looked forward to their carer arriving. One person said, "I talk a lot and they listen to me as well as getting on with the job". Another person told us, "The girls are brilliant they are all really nice".

The care staff we spoke with told us caring for people was important to them. One told us they had become involved in providing care after working for 25 years working in a different sector. They told us they really enjoyed caring for people and wished they had become a carer sooner.

Is the service responsive?

One person who used the service told us, "I asked if there was anything I could get to put in the bottle I use at night to stop it smelling and they brought something which is pink and its done the trick". Another person who used the service told us their partner had gone on holiday and they had contacted the office to arrange extra visits. They said, "We didn't know if it was going to be possible at such short notice they were able to provide everything we asked for".

We saw the service had arranged for someone to attend a memory clinic because care staff were concerned the person was developing dementia. We also saw the service had reviewed a person’s care because they had fallen at home. The service had increased the number of visits and obtained additional equipment to support the person. The service was responsive to people’s changing needs.

Is the service well-led?

The manager had developed opinion surveys for people who used the service which they told us they intended to evaluate to identify ways of improving the service. A staff opinion survey had also been developed which asked staff for their views about the service and improvements.

Since our last inspection the provider had developed a system for checking people’s daily care and medication records. If the records identified the person’s needs had changed their care plan would be reviewed and adjusted.

We spoke with relatives of three people who used the service. One relative told us the thought the service was, “Excellent and we have not had any problems with it." They told us their relative usually had the same group of carers unless someone was on holiday. They said their relative had, "Been using the service for a few years now and knew most of the staff and we would ring the office if we had any concerns."

We found the provider had taken steps to improve care staff supervision but this had only recently been put in place. Care staff records showed that supervision meetings had been held with some but not all staff.

During this inspection we reviewed documentation at the service's office address. We reviewed six care plans and four staff files. We reviewed a number of company records relevant to the running of the service. We spoke with people who used the service, two care workers, two care coordinators and the manager.

We found that before care and support was given people were asked for their consent. A person who used the service told us, “They (staff) talk to me, they never tell me what to do.”

Care and support met people's needs and people felt safe when their care worker was in their home. A person who used the service told us, “I always feel safe, they are lovely ladies, they do a great job.”

People who used the service felt their care workers were knowledgeable and well trained. However, records viewed showed that staff performance was not regularly assessed by the provider.

The manager did not a have process in place to monitor the quality of the service provided. People's views were asked for, but we saw no records that indicated these views had been used for future improvements for the service.

The manager was not aware of the process for notifying the CQC of incidents such as when a person had obtained a serious injury.

We used a number of different methods to help us understand the experiences of people using the agency. These included talking with people who were using the service and an examination of their care planning documentation. We also held discussions with the registered manager and members of the care staff.

People told us they were satisfied with the quality of the service provided by the agency and felt that the management team and the care staff respected their opinions and decisions.

People told us that the care staff would always promote their privacy and dignity when providing personal care and felt that all staff were suitably trained to perform their duties in a competent manner.

People told us that they felt confident in reporting any issues of concern to any of the staff employed at the agency and felt that any concerns would be addressed by the management team.